I am not using my tablets as tablets right now, but I have not given up on the concept.
I was initially very attracted to the idea of carrying a tablet (I actually have slates) into the room, for several reasons:
It is so analogous to what I have done all these years, i.e. carrying a paper chart into the room, and writing on it with a pen.
I don't really trust my patients (especially children) alone with a computer in the exam room, especially a laptop; I have never ceased to be amazed at the depths of poor judgment parents exhibit at times. Truly, I don't really feel that I could turn my back on them for a moment. With a tablet or slate, you carry your valuable PC and sensitive PMI out with you.
I don't have room in my exam rooms for a standalone PC, or even a thin client. It would mean a major remodel. At one point, I had planned on rolling the laptop into the exam room
a la Coghill. Most of the stands I saw looked rickety. I had nightmare visions of my brand-new Dell crashing to the floor. I actually found a great laptop stand, designed for hospitals, that was very stable, sturdy and compact. However, I found it to be too crowded when I rolled it into my exam room. Also, it created quite a show, clattering across the threshold.
I ran into some problems while trying to execute my tablet plan, however.
Some of the problems were directly related to Amazing Charts: The screen is smaller than a standard screen. Amazing Charts' display is already a little small. The combination can make it a little harder to navigate.
There is a glitch with the vitals fields. When you change your laptop from landscape to portrait views, the vitals fields "squish", and can't be restored.
Some of the problems were related to my personal conversion from paper charts to electronic records. I find that I am still needing my paper charts to a large extent, for reference to past notes, labs, etc. it was a little clumsy, trying to riffle through my old paper chart and deal with the tablet.
When I started, my wireless network was bone-achingly slow, due to the most incompetent network installation in recorded history. You have got to have a fast network, or your tablet will be a real source of frustration. If you're not using it wirelessly, what's the point of a tablet?
My tablets didn't have the memory or sound card capabilities to give me the voice recognition capabilities.
Now that I'm changing from paper charts to Amazing Charts, I have to basically create a complete history and physical for every patient the first time they are entered into the system. The first day of Amazing Charts, *every* patient I saw had to have a *complete* history and physical. About half of these patients were complicated, internal medicine type patients. I found that there was no way I could input that much data into Amazing Charts in a reasonable amount of time, except via dictation, using Dragon NaturallySpeaking.
I am not saying that tablets aren't available with voice recognition capabilities, only that I didn't have them. As a matter of fact, I have seen demos of tablet/slate PCs which seemed to have excellent voice recognition and internal microphones, and did a creditable job of voice recognition.
Peripherals increase tablet functionalityThere are also wireless and Bluetooth dongles now, which just plug into your USB port and interact with a wireless dictation headset, which give excellent voice recognition accuracy, and would in fact be compatible with my slates.
Since my initial discouraging experience, I have added some other peripherals which have improved the functionality of my slates. I got some great "bump cases" for my Fujitsu's, which makes them much easier to handle. I got a couple of little light weight folding stands which they rest on. They have wireless keyboards and mice which rest in the vicinity of the folding racks. You can take the tablet into the room, jot down your notes, bring the tablet or slate to the dictation area, rest the tablet on its stand, and it immediately starts working like a regular computer, via the wireless keyboard and wireless mouse. You can type and mouse around all you like, and then snatch it up and dash to the next room.
I am now considering adding the wireless microphone dongle, so that I would also be able to slip on a wireless headset at this point and just start dictating into the tablet. That might be the missing piece for me.
Amazing Charts with Tablet PCs - suggested improvements.If Jon could make just a couple of minor adjustments to the program, Amazing Charts would be an ideal EMR for a tablet, maybe the best on the market.
Fix the vitals glitch.
Change the vitals input screen, to make it ideal for a touchscreen, as I described in another thread.
Make a few changes to the layout of the patient record for people viewing it in portrait mode, a "tablet" mode, if you will.
Allow a "Print Preview" before moving to the "Sign" screen, to allow a larger-print view of the whole note, to allow users to see any items which might be hidden in scrolling screens. This would actually be a good feature for non-tablet users, especially those of us with less-than-perfect eyesight.
In conclusion, I think tablets can be a viable (even ideal) method for recording and displaying patient information, but implementation is definitely not as simple as it appears.
