What is the Perfect Tablet Computer for Healthcare?

Many would argue (as I have) that the Apple iPad is THE perfect tablet computer for healthcare professionals. And for many of the mundane tasks of looking up or inputting information into an electronic medical records, that may be true. (Watch a video using the iPad to access MediTech as well as PACS here.)

However, there is a vast area of healthcare that the iPad just does not work at all.

That area is connecting to surgical equipment. Especially in the ENT world, there is a lot of microscopic and endoscopic work that is done. The software that records imagery from such devices are ALL based on the windows platform. Yes... we can record on to a CD, DVD, USB Memory Drive, etc and transfer the file to the iPad for viewing, but there's a lot of steps involved with that:

1) Record the video/image
2) Transfer to media of choice (CD, DVD, USB memory stick, etc)
3) Transfer file to PC/Mac
4) Move it iTunes/iPhoto
5) Synch with iPad

Geez louise!!!

I am currently aching for a highly portable tablet computer to connect to my JedMed Digicam in order to video-record fiberoptic endoscopy, ear work under the microscope, etc. The software the Digicam works with is only Windows compatible (and from my conversations with JedMed, there's no plans to make it work on any other platform in the foreseeable future).

As such, at this time, the Windows (and not iPad) world is the current way to go to address this deficiency. Not Google Android, iPad, Blackberry, etc.

In my mind, the best tablet for video work in the healthcare setting must have the following properties:

1) Windows 7 operating system for compatibility with surgical hardware
2) USB port
3) 10" Tablet for portability
4) Cheap (comparable to iPad)
5) Fast boot (SSD drive)

And WOW... I was amazed at the plethora of tablets introduced at the 2011 CES Convention Jan 6-9, 2011 in Las Vegas.

There were over 80 tablets that were introduced from big name companies to nobodies. Surely, there will a be a few which fits the bill?

Sadly, there were only a few that may fit my needs.

These include:

1) Samsung Note PC Series 7
2) Motion CL900 Windows Tablet

The Dell Inspiron Duo may possibly work, but the swinging screen just looks way too fragile.

What do others think? I'm pinning my hope on the Samsung model as the Motion tablet price is a bit much. The Samsung tablet is suppose to go on sale in March 2011 with a price tag around $699.

Watch a video the demonstrates the Samsung Note PC:

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New Video Produced on Using MediTech EMR on the iPad!

Our office has been instrumental in bringing the Apple iPad to Fauquier Hospital allowing physicians to access MediTech.

In order for physicians to see how MediTech can be accessed and used on the iPad, our office has created a YouTube video tutorial. Not only is MediTech shown, but also PACS. This video has been added to our YouTube channel.

Please note that this video is in REAL-TIME. It has not been speeded up. The system we are using is Citrix Version XanApp 5 and MediTech Client/Server v5.6.4 PP13.

Watch the video on YouTube here or below.

Related iPad and MediTech Blog Articles:
6/12/10 iPad Use In the Medical Clinic and/or Hospital For the Surgeon Doctor
6/19/10 The Perfect Computer for Healthcare and Electronic Medical Records
9/8/10 Dr. Chang Featured in Magazine Article on Using iPad with MediTech EMR
9/20/10 UPDATE: iPad and MediTech Electronic Medical / Health Records
10/12/10 UPDATE #2: iPad and MediTech Electronic Medical / Health Records

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Fauquier Hospital MediTech Now Accessible on the Mac (As Well As iPad, Windows PC, iPhone, etc)!

Can I just express how totally excited and grateful I am to Fauquier Hospital Information Technology Department for upgrading their Citrix server?!! I can now access the hospital's MediTech EMR from anywhere using not only Windows PC, but also the iPad and Mac platforms as well!!! Even the iPhone, though the screen is a bit small...

GREAT job and appreciate how responsive the department as a whole has been!

Thank you! Especially given I'm a Mac person.

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UPDATE #2: iPad and MediTech Electronic Medical / Health Records

This blog article is a continuation of prior blogs (6/12/10 and 9/20/10) I wrote on the use of the iPad with Meditech.

Since June 12, 2010 when I first wrote about my experiences of using the iPad with my hospital's Meditech EMR system, a LOT has happened...

First, the hospital has upgraded its Citrix infrastructure to allow iPad (as well as Mac) connectivity to the hospital's MediTech EMR using the Citrix Receiver app (free in iTunes). I reported this back in 9/20/10.

Since than, the hospital has done a remarkable job optimizing and speeding up the connectivity to the point where using MediTech on the iPad is JUST AS FAST as using it on a hospital networked desktop. Of course, the iPad needs WiFi access to achieve these speeds.

Furthermore, I can now access PACS directly via Citrix Receiver app on my iPad rather than going through MediTech which is just great!

My only complaint now (which may not be possible to address with current Citrix software) is the initial prolonged time it takes to get to the MediTech logon screen. After that, speed is quite zippy.

From my conversations with individuals in the know, the next step would be to create a "MediTech" app on the iPad, rather than going thru Citrix Receiver app.

Obviously, one way of doing this is if MediTech creates a native application for the iPad which does not appear to be likely anytime in the near future.

A more likely solution that may be achievable in the next few months is to create a "virtual" MediTech iPad app using Citrix as the engine "under-the-hood". This is an active area of development and I am optimistic that such a virtual MediTech iPad app will soon be available.

Related iPad and MediTech Blog Articles:
6/12/10 iPad Use In the Medical Clinic and/or Hospital For the Surgeon Doctor
6/19/10 The Perfect Computer for Healthcare and Electronic Medical Records
9/8/10 Dr. Chang Featured in Magazine Article on Using iPad with MediTech EMR
9/20/10 UPDATE: iPad and MediTech Electronic Medical / Health Records
10/25/10 New Video Produced on Using MediTech on the iPad!

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UPDATE: iPad and MediTech Electronic Medical / Health Records

Ever since I wrote my initial impressions of using the iPad with Meditech EMR on June 12, 2010, that blog article has received almost a thousand hits since that time, averaging about 20 hits per day. I've even been featured in Meditech news.

Also in the interval period, I have received numerous inquiries from health systems all over North America using MediTech regarding more specifics on how the iPad is used/incorporated into MediTech EMR.  Due to this interest, I've decided to write an update regarding what is going on since that initial blog article...

SO... I no longer need to use LogMeIn in order to access MediTech. Since then, Fauquier Hospital has upgraded their Citrix infrastructure so I now use a Citrix Receiver app (free in iTunes) to access MediTech.

Things are of course much faster, but still not quite as fast as I would like it to be. Currently, the hospital and I are working to resolve some of the speed issues seen. McKesson PACS (radiology imaging software) also is on the drawing board for direct Citrix access rather than going through MediTech which would also be welcome.

I recently heard from a confidential and utterly reliable source that MediTech has been asked to create a native app for the iPad (thus avoiding Citrix altogether), but the company at this time has politely declined to develop such an app that would hugely improve the user experience and most likely speed.

I would encourage all MediTech users to contact MediTech directly and demand/request that such a native iPad app be developed which would be immensely beneficial and strongly desired. Otherwise, alternative 3rd party software like Citrix will have to be used along with its inherent handicaps.

Click here to view MediTech's contact information.

Related iPad and MediTech Blog Articles:
6/12/10 iPad Use In the Medical Clinic and/or Hospital For the Surgeon Doctor
6/19/10 The Perfect Computer for Healthcare and Electronic Medical Records
9/8/10 Dr. Chang Featured in Magazine Article on Using iPad with MediTech EMR
10/12/10 UPDATE #2: iPad and MediTech Electronic Medical / Health Records
10/25/10 New Video Produced on Using MediTech on the iPad!

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Dr. Chang Featured in Magazine Article on Using iPad with MediTech EMR

On Sept 8, 2010, a story was published in MediTech Magazine regarding how Dr. Chang has piloted the use of the Apple iPad with MediTech electronic medical records used in Fauquier Hospital.

Click here to read the story (pdf document).

Related iPad and MediTech Blog Articles:
6/12/10 iPad Use In the Medical Clinic and/or Hospital For the Surgeon Doctor
6/19/10 The Perfect Computer for Healthcare and Electronic Medical Records
9/20/10 UPDATE: iPad and MediTech Electronic Medical / Health Records
10/12/10 UPDATE #2: iPad and MediTech Electronic Medical / Health Records
10/25/10 New Video Produced on Using MediTech on the iPad!

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The Perfect Computer for Healthcare and Electronic Medical Records

So I've been using computers in the healthcare setting for over a decade now. First at Yale than Duke. I've been thru the Veteran's Affairs Medical Center using Vista (New Haven, CT; Durham, NC; Asheville, NC; and Portland, OR). I've been at 5 different community hospitals on both the West and East Coasts. I've used all the different flavors of electronic medical records (EMR) in all these different locations/settings. I'm now using (not by choice) NextGen, Meditech, Rcopia, and PACS currently in the office, hospital operating suites, and inpatient settings.

Throughout this time period, I've used desktop computers, handhelds, laptops, netbooks, and tablet computers. I've even tried to cobble together a semi-functional iPad able to access all the different EMRs I need on a daily basis (read blog about this here).

What I discovered is that the perfect system (in my mind) is ALMOST there... just not quite yet. Maybe in the next few years, it will exist because all the pieces now exist! The bad news is that it does not exist RIGHT now.

So, here's my dream machine and the reasons. I hope some computer company is paying attention!

To understand how this all fits together, one needs to envision how my office works right now. There's a desktop computer in each exam room. Patients are taken back by a nurse and information inputted into the desktop computer. Than the computer is locked and the nurse leaves. The physician than soon follows, unlocks the computer, and then proceeds with further history, exam, and plans treatment which all gets documented in the computer. If tests are ordered (ie, hearing test, blood draw), the doctor leaves and sees another patient while the tests gets done before coming back. As such, the computer stays in the room with the patient. One can envision that there is a lot of back and forth into and out of an exam room movement of nurse, doctor, and patient. The computer gets locked every single time. Furthermore, I need EMR access when seeing patients in the hospital as well as during surgery.

First the Hardware:
• A tablet touchscreen (with no physical keyboard) 12 inches diagonal. That size hits the sweet spot. Any larger and the size itself becomes unwieldy to constantly move around as well as heavy by the end of a day. Any smaller and the screen real estate becomes so small to become inefficient. 12 inches diagonal also allows the possibility of an actual full-size virtual keyboard on the screen with adequate screen left-over to see what's going on.

My experiences with the iPad virtual keyboard was mixed (given it is somewhat smaller than full-size). I CAN do it and I did do it... I just didn't like it to the point I relied on a wireless bluetooth keyboard.

• Bluetooth technology and WiFi are a MUST because...

• With this tablet computer, one can dock it without wires or connector pins (similar in concept to Motion Computing JR3400 with its FlexDock). The docking station allows for use of regular USB keyboards and mouse along with direct ethernet wired connectivity. My dream machine docking station and tablet would communicate with each other using bluetooth or some other alternative short-range wireless technology which makes direct physical connection unnecessary. This is important, because I would have the docking station in each exam room. When I leave the exam room, I would have the option of taking the tablet (and therefore the screen) with me. The constant connecting and disconnecting of current docks is quite the pain given it requires an actual physical connecting port as well as precise placement. With the constant connecting and disconnecting, it opens the possibility for breaking as well.

What would be even cooler would be if the tablet charges when in its docking station using inductive charging similar to how a Philips Sonicare Toothbrush recharges.

Why do I even want a docking station? Several-fold. Ergonomics... I like the screen at my eye level. Also, I can still see the patient while typing away. If I depended on the virtual keyboard like on the iPad, I'm looking down which is not patient-friendly as well as a pain in the neck (from looking down). Also, though I guess I can learn to type fast on a virtual keyboard, I think I would still prefer the physical full-sized keyboard if given a choice. Furthermore, though wireless WiFi for all internet connectivity is nice in principal, it does introduce potential security problems as well as speed issues (wired ethernet in my experience is still the most reliable and fastest way of communication along with being secure).

However, WiFi connectivity is still important as pretty much every medical setting has WiFi and so one does have continuous high speed wireless access. Also, it would allow me to read a little bit of what's going on with a patient before walking into an exam room (I would load up the patient's chart using the touchscreen before walking into the exam room and docking the tablet). I just do not want to always DEPEND on WiFi.

A WiFi tablet touchscreen like the iPad is also great as one can BRING your office with you where-ever you go like the hospital and operating room without bringing a keyboard, mouse, etc. It's all self-contained. It's intuitive. It's all neatly packed into a simple, elegant tablet touchscreen that's highly portable and usable.

• Proximity security whereby the computer tablet "knows" you are right there. When you are no longer around the computer, it automatically locks. When you come back, it recognizes you and it automatically unlocks, all occurring invisibly to me without requiring me to actually do anything. I HATE the fact that I have 4 different userids with 4 different passwords to access the various EMR programs. Though I try to, I do not always remember to lock the computer 100% of the time. It should be all automatic. Does the technology exist? It sure does... It's called Single Sign-On for one userid and password that unlocks it all. And Xyloc by Ensure Technologies to allow for proximity recognition using RF technology. All I ask is that this technology be built-in to the hardware!

In a clinic where I'm constantly moving around where the tablet may not always be with me, due to HIPAA and HITECH, the computer needs to be secured. Though I try, I can not always remember 100% of the time to lock the computer. And same goes for my medical assistants. The security should be automatic, invisible, and secure.

The problem with biometric verification like fingerprint scanning or even ID card swipes is that I have to REMEMBER to do it. And the mere fact of doing it is aggravating because I would have to do it SO many times in a given day.

• Sturdy construction. The tablet is going to move around... a lot... It needs to stay working after being dropped from at least a height of 3 feet.

Which Brings Me to the Software:
What can I say? I LOVE the intuitive and simple interface of the iPad. Now, there's a few things I would tweak about it to make it MORE relevant in the healthcare setting.

• Multi-Tasking is a must. As I literally use Meditech (hospital EMR), NextGen (clinic EMR), Rcopia (electronic prescribing software), and PACS (radiology viewing software) all day long swapping back and forth even with a single patient encounter, I need to be able to easily jump between all these programs without shutting down the others. From what I understand, this functionality on the iPad will soon be reality with the release of the iOS4 operating system later June 2010.

• I constantly move back and forth among Meditech, NextGen, Rcopia, and PACS all day long. As such, having a few physical programmable buttons on one side of the screen on the edge would be wonderful which I could just press and it would take me immediately to my program of choice. Keyboard shortcut works, but imagine what touch-strokes would be required when I'm using it in pure tablet touchscreen mode...

• Apps already exist to connect via Citrix, Remote Desktop Connection, or screen mirroring... so I would just use those programs. If I was prone to unrealistic wishful thinking, I would ask for a single EMR program that incorporates Meditech, Nextgen, Rcopia, and PACS, but I do not forsee anything like that happening for decades (if ever). So, I'm going to stick with what is possible.

• A "tablet pen" is 100% optional and not necessary for use... Tablet touchscreen would be used predominantly using a finger(s) just like on the iPad. Personally, I do not foresee myself ever using a tablet pen. It's just one more thing that can get lost.

That's pretty much it! Is that so much to ask for???

Related iPad and MediTech Blog Articles:
6/12/10 iPad Use In the Medical Clinic and/or Hospital For the Surgeon Doctor
9/8/10 Dr. Chang Featured in Magazine Article on Using iPad with MediTech EMR
9/20/10 UPDATE: iPad and MediTech Electronic Medical / Health Records
10/12/10 UPDATE #2: iPad and MediTech Electronic Medical / Health Records
10/25/10 New Video Produced on Using MediTech on the iPad!

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iPad Use In the Medical Clinic and/or Hospital For the Surgeon Doctor

To read what I consider the perfect computer for healthcare, click here.


UPDATE 10/25/10: Watch video of using MediTech on the iPad

To give a little background, I am a ENT (otolaryngology-head and neck surgeon). I see patients in all sorts of environments including the hospital, operating room, and outpatient clinic. In the hospital, I use MediTech and PACS while in the clinic I use NextGen. Admittedly, I was not entirely convinced the iPad would ever be useful in this varied medical setting which utilized different EMR platforms when it first came out earlier this year.

However, several developments have occurred that has since changed my mind due to the ingenuity of app developers and other progressive technology that allows the iPad to connect with hospital and outpatient clinic electronic medical records (EMR) regardless of operating system and security settings.

The information provided here is based on using an Apple iPad 16GB model with WiFi only ($499).

Software

Foremost of these evolutions is the iPad/iPhone apps now available that allows for EMR access. To give some background, I use MediTech and PACS in the hospital and NextGen in the outpatient clinic. In order for me to access all electronic health records, two iPad apps are necessary:

1) LogMeIn: Wonderful app that allows the iPad to remotely control a Windows (or Mac) desktop computer anywhere in the world. The iPad app itself is $29.99. The LogMeIn desktop software (free) also needs to be downloaded to any desktop you want to access/control with the iPad. In essence, the iPad takes control of the desktop which you can see on the iPad screen. As such, any software including EMR programs like MediTech, NextGen, or indeed any other application (via Citrix) on the desktop, can be opened and visualized on the iPad. Click here to download this program.

The pictures below show MediTech as well as PACS being opened on the iPad using LogMeIn. The keyboard you see is a bluetooth keyboard wirelessly connected to the iPad (more on this below).

Of course, this method produces a slow response time as one is jumping through different networks to obtain medical records access (iPad --> LogMeIn --> Desktop --> Citrix --> Medical Records).

A more elegant solution would be direct Citrix/VPN access to the medical records (iPad --> Citrix/VPN --> Medical Records). Unfortunately, the hospital/clinic would need to upgrade their software in order to make this happen (which has not yet happened at my hospital). For those curious, the iPad software is called Citrix Receiver and is a FREE app download! Click here.

2) WinAdmin or Jump: Of course, if one is able to access medical records using terminal services (rather than citrix, VPN, etc), there's a perfect app for that called WinAdmin or Jump. Just punch in the same info you do to open terminal services on Windows and viola... the remote desktop appears on your iPad! Both  apps are iPad optimized and costs $8.99 for WinAdmin or $19.99 for Jump. Click here to download WinAdmin or here to download Jump. You can see a screenshot (to the right) where NextGen Master IM was opened up on the iPad using WinAdmin app.

The difference between Jump and WinAdmin are several-fold. Jump has better mouse usage controls (there's a mouse!), better virtual keyboard (including Tab, Esc, Function keys), and allows for external keyboard text entry. WinAdmin does not (so far). But I guess you get what you pay for! Having used both, I personally prefer Jump (originally purchased WinAdmin because it was cheaper).

SO, I basically use Jump to access NextGen which is accessible via terminal services and I use LogMeIn to access MediTech (as well as PACS viewer). As soon as direct Citrix access is available (should the hospital upgrade their Citrix software), I would change to Citrix Receiver instead of LogMeIn in a heartbeat.

Hardware

The keyboard is essential as I do a great deal of free-typing which is not easy (to type very fast) when using the iPad's virtual keyboard. As such, a bluetooth wireless keyboard is important for me to allow fast touch-typing. There are plenty of wireless keyboards out there... the one I use is the Apple Wireless Keyboard. However, this keyboard isn't perfect as the keyboard is bigger than the iPad and as such, needs to be carried around separately. I never even bothered getting the iPad Keyboard Dock as one MUST orient the keyboard vertically (in order to dock the iPad) which is not preferable when I used the iPad for accessing electronic medical records. For just that reason, I always keep the iPad screen locked in horizontal orientation.

As such, for me, the next piece of the iPad implementation for medical use is hardware. Here, I am most eagerly awaiting for the ClamCase which is supposed to be available for sale in Fall 2010. The "ClamCase" offers the perfect package in my mind:

• A nice case for the iPad for transportation

• A wireless bluetooth keyboard for freetyping

• Full use of the iPad as a standalone device in case I don't want to use the keyboard

• Keyboard fits within the case where you want it (so it can be opened up like a laptop)

What the ClamCase does that no other device offers is a wireless bluetooth keyboard BUILT-IN to the iPad case in a single beautiful package!

Here's a YouTube video showing the full features of the ClamCase:



Hopefully, it will live up to its hype and I will be basking in heaven using the iPad to do pretty much everything whether in the hospital, operating room, or clinic. Once multi-tasking becomes available with the next OS Upgrade (iOS4) later this month, that will be most awesome as than I can have NextGen, MediTech, and Safari up with Rcopia (the electronic prescribing program I use) all up and running simultaneously and I will be able to just switch among the programs without losing anything.

For now, I'm trying it out on a limited basis before ditching the old system (desktop computer in each exam room) and using iPad exclusively.

Will keep those interested updated on my experiences over time...

In meantime, read what I consider the perfect computer for healthcare here.

Related iPad and MediTech Blog Articles:
6/19/10 The Perfect Computer for Healthcare and Electronic Medical Records
9/8/10 Dr. Chang Featured in Magazine Article on Using iPad with MediTech EMR
9/20/10 UPDATE: iPad and MediTech Electronic Medical / Health Records
10/12/10 UPDATE #2: iPad and MediTech Electronic Medical / Health Records
10/25/10 New Video Produced on Using MediTech on the iPad!

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