Are Cool Handhelds and Tablets the Right Choice for Your Patients?

Many of my colleagues use tablet PCs and handheld computers. I won’t deny that these gadgets are cool, but I have to wonder if it really makes sense to use them in everyday practice.

Handhelds are relatively limited in their functionality—they have small screens, aren’t compatible with most peripherals, and run a limited number of programs. Most doctors I know use their handheld as a cell phone and/or e-mail device (eg, Blackberry, iPhone), to run clinical reference and decision-support programs (eg, Epocrates), or to write electronic prescriptions.

Although some PDA screens go up to four inches diagonally, most sport a 2.5-inch screen, which is far too small to easily view and manipulate most medical information. Tablet PCs are a middle step between handhelds and traditional laptop and desktop computers. Currently, most tablets run Microsoft Windows XP Tablet PC Edition as their operating system. In the most common configuration, a tablet PC looks like a normal laptop computer but usually has a swivel screen that can rotate 180 degrees and lay flat over the keyboard. In place of a simple touch screen, which could register false entries from a stray finger or sleeve, most tablet PCs require a stylus for entering data; selecting, dragging/dropping, and opening files; drawing diagrams; and writing notes. Windows XP Tablet PC is fairly good at translating handwriting to text, in theory allowing users to “scribble” notes that are automatically translated into typed text within an application (such as an EHR). Although Tablet PC handwriting recognition software “learns” as it goes and becomes more accurate over time, in practice, even a low mistake rate in translating your handwriting to typed text means multiple taps and clicks to fi x erroneous text—requiring even more time to create a record. Despite this serious issue, it is estimated that 25% of EHR users rely on this method to enter data into their records.

Although tablets are cool, the handwriting recognition issue and the need for multiple taps to document a simple note make these systems rather cumbersome. As we all know, most patient histories and thoughtful assessments are not that amenable to the checkbox approach to documenting (see “10 Secrets EHR Vendors Don’t Want You to Know”). Entering the patient’s story into an EHR often requires a more robust entry system, such as typing or speech; otherwise you end up with a note that looks like you just completed taking a Yes/No inventory. In my experience, it is hard to beat the speed and accuracy of a keyboard for adding notes to a chart and moving from field to field in a form. For non-typists, current speech recognition programs, such as Dragon Naturally Speaking, are significantly more accurate than they have been in the past, providing an efficient solution to documenting the dozens of notes physicians strive to complete each day.

The other major problem with using tablets in your practice is their reliance on a wireless network. Although they can be plugged into a hard-wired port in each exam room, doing so negates the tablet’s portability benefi ts due to the significant wait time required while the tablet negotiates and connects to the hard-wired connection. Not plugging in at each station, however, leaves you at the mercy of your wireless network. Even worse, in terms of privacy and HIPAA concerns, ensuring consistent and strong encryption over the wireless network results in further delays.

These relatively short delays (slower data exchange, increased time to fix incorrectly translated handwriting, multiple clicks and screen navigation to get around a note, etc) add up, and before long, you’ll realize that using the “cool” equipment may make each patient encounter longer, resulting in decreased patient volume and revenue.

Despite all the cool features and portability benefi ts of handhelds and tablets, I still believe that putting an inexpensive desktop computer in each exam room remains the optimal choice.

Dr. Bertman is Physician Editor-in-Chief of MDNG: Primary Care/ Cardiology Edition. He is also a Clinical Assistant Professor of Family Medicine at Brown University and president of AmazingCharts.com, a leading developer of Electronic Health Record (EHR) software. He also is the founder and president of AfraidToAsk.com, a consumer website focusing on personal medical topics. He is in private practice in Hope Valley, RI