Welcome Chuck, thats quite a list of questions. Good ones, but tough. I'm only competent to offer an opinion on one question, the handwriting software. We have used three computers that offer that. Tablets by "Motion Computing" and we will not replace those. They were fine to a point but didn't meet our needs. We bought a tiny Fujitsu Lifebook for travel, my associate just left to go ski in Colorado and it is in her luggage. I am currently using a Fujitsu Lifebook, model T 4220. It was quite expensive, but worth every penny so far. It converts to a tablet, but best of all it allows the pen to be used while the keyboard is being used, such as sign offs. The pen is the fastest way to move the mouse, then the left hand hits the button and sign offs go real quick. I also have the second battery installed that lets me work over 4 hours before needing a re-charge. Very good.
All of those had the same handwriting recognition. It is very remarkable. It will learn your scribble, but you must learn a few rules (like how to get it to distinguish a "+" from a "t". But it is easy to do. Then you start to see patients. You have new, and terrible bedside manner as you hunch over the computer trying to get the right screen up and running, and trying to get the handwriting into text. One problem is that you must occasionally stop and enter the text. It is just a single click, but it is distracting. Another problem is with certain medical words. The software is context sensitive. As you write, and meaning becomes more clear, the software changes it's interpretation of what you have written. Most often this is absolutely correct. Very amazing. Then you write, "menopause" and the software copies "men in Paris". Then you edit, and it changes other parts of the sentence to make sense with "men in pairs", then "men with pain" etc etc. Soon the whole sentence is a wreck. The work around is to scribble away like mad, then just before "menopause" you tap 'enter' (saving the good part of the sentence) then tap 'keyboard' and tap out 'm e n o p a u s e' and then tap 'enter' and tap the handwriting feature and continue on. The problem is, when you look up, your disgusted patient will have left the room, (poetic license here).
I have abandoned the handwriting tool. I push the computer away and look the patient in the eye and say, "tell me what is going on". Then I listen. When it is time I say, "Wait a moment, that was really important and I need to get it down in your record". Then I type, if it is long I apologize for my appearing to ignore them while I "play this video game". This seems to break up the time into the interview, where they still feel they have my undivided attention, and the data input, which they tolerate.
There are of course lots of times that I can type without looking at the keyboard and I can put in some simple notes while they talk. But my 'electronic bedside manner' demands a time when I break from the computer to signify that they have my undivided attention. In the long run this saves time. It seems to work for me.
Sorry this is so long. A final thought. We did this and it was invaluable in helping us make the transition. We downloaded the system for free and loaded 3-4 fake patients in the system. (I would say "dummy" patients, but in my practice that might not be too clear..") Then we took a fake patient through the system several times a week, passing the chart around to handle phone messages, refills, appointments and charting visits. This was especially helpful for the dummy Doctors to begin to get up to speed. When we finally started to go live we were so committed to Amazing Charts that we did not do any real 'trial' period. We just went live as fast as we could. It might be useful however if you did go live just for the charting in one or two patients to resolve the tablet vs keyboard issues. We printed the whole visit out and kept them in the paper chart for the first few weeks. Hope this helps.
