Home Forums Laptops vs. Notebooks, vs. Tablets HELP!!

We are a 4 provider office and plan on starting to use AC starting with one provider and then will implement the others as we "work the bugs out". We are trying to figure out how the providers are planning to document the chart note. We are interested in using a convertible tablet with a stylus while in the exam rooms and then convert to a keyboard/docking station in their office to finish. Does anyone have any advice to offer or input on what they use or recommend?

For our M.A.'s want something small and portable to enter vitals...Any ideas on something that will be compatible with AC?

RMcFadden
Lacey, WA

There is a discussion here.

Your ultimate aim should be for the docs to finish the chart in the room before they leave. So I would vote for setting up a system now that would allow for this. Laptops are getting cheaper. I favor one in each exam room and forget about hauling it around with you. If you have a vitals station, set one up there for all the MAs to use. Otherwise, the MAs chart on the room laptops as they room the patient.

Like Leslie, I have a laptop in each room and complete the encounter before leaving. Print the clinical summary and give it to the patient. Printers are centrally located at check out desk.

If you are going to have something in each room, why not get a desktop. You can have a solid desktop for dirt cheap. With 4 providers definitesly having them stationary would work the best.

I did not have the room for a desktop in each exam room otherwise nothing wrong with that either.

Leslie:

Makes sense, was just throwing out another idea for them to consider.

On that note, I have been wireless in my office the whole time for my laptop (shared office, cant' have a hard wire here in the back), but in the new office def going to be hardwired everywhere!

Actually, we have hardwired our laptops which speeds things up significantly.

I'm with Leslie, Do everything you can to encourage the doc to finish the note in the room. I put inexpensive dell desktops in the rooms, WIN 7, with 4GB ram for about 400.00 per work station.
Wired is the way to go. Ever considered the electrical wire network which works through your outlets? They are faster than wireless.

My issue with laptops left anywhere in the office is that they may "grow legs." And then esccape. yeah, I know folks will say that can't happen in their office. For a varitiety of reasons. Nevertheless, I've worked in and around many offices of various businesses and this happens if they are not secured down. But then they are't portable.

Desktops are pretty cheap now too. Like an el cheapo Dell Vostro. As the unit that will sit FDH (Fat, Dumb and Happy) in the exam room, it or something cheaper will do. Probably wont cost more than a laptop. And yes, hardwire the things. Toshiba makes decent cheaper laptops. $550 or so total. There is another brand that is reputed to be good, but i cant remember their name. Starts with an "A" I believe.

Electrical wire network that works through your outlet?? Thats a new one one me. Is there a brand name you can give so Ican google it?

It is called powerline over ethernet - if you google that you will find it.

oh. I've seen that. had one. That is wireless. well, you plug the thing into your outlet and it makes a hotspot right there. Is there a connector for an ethernet cable on it?

Thank you all for your recommendations.

Unfortunately, our exam rooms are not hardwired and we have a 2 story building with 9 exam rooms upstairs and another 4 downstairs. Not sure of what the cost would be to have this done. We can't really afford that many computers which is why we liked the laptop or tablet mobile idea since we wouldn't have to purchase as many computers. Our other reasoning for not have dedicated computers was to keep the patient-provider relationship focused on the patient not the computer. A tablet seems more like a chart style then a laptop/PC typing on a keyboard seems less personal. But I will look into the powerline over ethernet. I haven't heard of that before. Oh this is great stuff thank you.

Tiger Direct has an All-In-One 20 inch HP with a AMD dual core (1.6 MHz E-350, an Atom equivalent) with Win 7 Pro for $299. Don't know if this processor is powerful enough. Anyone using anything equivalent (Oh, 2G and 320 hard drive, would plan to upgrade to 4 G since it is set at 32 bit)

I think all of us would prefer to be able to keep our attention focused on the patient and not the computer but, your docs and patients may as well get used to the fact that it is not going to happen. As MU and other government demanded programs continue to force physicians to practice medicine by protocol, there is no way you can avoid the intrusion of the computer. Personally, I believe they will not be happy with a stylus and tablet but if there are any users out there using this successfully, please chime in.

I previously used the Motion C5 tablets, and now mostly the ASUS Slate EP-121. I have been very happy for the most part. But I think that tablets work better if you use a lot of templates. Text entry is definitely slower.

They also have same computer with 4 gb RAM for 349. I just bought two and was going to get them set up this weekend and try them out. I certainly have used devices with much less processing power in the past without problems.

Are you guys finishing new patients in the room? I think I would need another staff person to do all of the computer entry from PMHx, Meds, Allergies, Vitals, etc to be able to complete new patients in the room. It's very time consuming and when you see 7-10 new patients per clinic, that's a slow down.

I have a laptop/tablet and really don't use it much. Carrying it between rooms is just a habit I can't get used to so putting one in each room is more reasonable.

I can see finishing f/u in the room easily. New patients? Hmm. Haven't figured that one out without slowing clinic to a halt and hiring another M.A. for data entry.

My experience is quite different than most of the responses above. I almost never complete the note in the room. I see mostly geriatric patients who come in with multiple problems. I can usually type some of the history, update meds, e prescribe prescriptions, and write plan (which I print to meet MU). Just to do this much however I feel like I am pushing the limits of face time with the computer vs. eye contact with my patients. I have no idea how those of you completing the entire note pull that off.

I walk back to my office and finish my note using a combination of Dragon dictation and templates.

Not complaining - this works OK for me. Just curious how the rest of you can do this.

Travis,

I may see several new patients daily and several more "Complete" exams. The patient completes a paper 4 page questionnaire before they are roomed (ideally they complete it before they even get to the office). The MA then rooms them, fills in the PMH, FHx, SHx, Meds, etc using the form the patient prepared, templates that I have made for this purpose, and questioning the patient on things that are not clear in their paperwork. By the time I get to the room I have a pretty good head start and can focus on the more important things.

I usually find that the history obtained from paper questionnaires the patients fill out are very differnt from what my nurse gets when she rooms the patient, and different again from what the patient tells me when I finally get to asking questions.

Sorting all this out, and making a coherent story is far more than I can do in the space of the office call time alloted -- I often have to think about it and compare old records or sometimes do some research before I can really feel good about writing the note.

And I can't sit there and do it in the room with the patient there -- they just keep on talking and bringing up more and more things.

And they won't leave the room until I do.

I don't understand how anyone can complete a record in the room, unless it is a laceration or an uncomplicated sore throat -- which I hardly ever see.

I am following this discussion with interest as now that I am storing all of the patient documents under imported items, it is clear that I will need some computer in the exam room. My major question is whether a convertable tablet is worth the extra price, compared to a laptop, given that mostly for AC you need to either dictate (with Dragon) or type into the window. There is not much in the way of clicking and drop down menus. Might anyone have uploaded any youtube videos showing how one might interact with AC using a tablet PC?

Leslie,
I would have to hire another person to do that in a timely fashion during clinic. My M.A. does do all of the computer entry from the patient's intake sheet but she does it in between patients or after morning clinic or even afternoon clinic. She also works the front desk, rooms the patients, schedules f/u, answers the phone, and retrieves rads.

I'll just save the overhead, and do the charts at the end of clinic or during slow times.

billfox: I've used a convertible tablet which works ok. I think a tablet is good for looking at the imported items, old records, etc but quite poor for data entry in AC

Travis,
Sounds like you need to hire another person!

Billfox--

I have been using a Motion Computing tablet and a Lenovo X200 tablet (got both off ebay pretty cheap.)

they work ok -- but I keep looking for something better.

I have been using a combination of handwriting recognition-- which is pretty slow and frustrating, compared to just writing on paper-- and templates to enter easy stuff into the AC boxes in the patient room, and I take more complex notes (handwritten) in OneNote which I save as a PDF file at the end of the visit. I pull that file up later as a crib sheet when I dictate (with Dragon) into the final note.

So I keep OneNote and AC both open in the tablet and switch back and forth. Works OK, takes a little practice, and if you get distracted you can get off track.

There isn't much in the way of "dropdown menus", but it is easy to create your own templates, and they are easily customizable on-the-fly so that notes don't always read like they came out of cyberspace.

Regards PC in the room vs laptop: I prefer the laptop and I carry it out of the room for what I perceive as two advantages:
1- The only legs the laptop gets are mine.
2- The only snot nosed little kid touching the keyboard is me. That includes procedures, if I have an I&D or other procedure, the computer is back in my office on the charger and doesn't re-enter the room until the odor of bleach is fading away.

Regarding laptops...has anyone following this discussion been using a 14 inch screen? I'm thinking about a Dell Latitude. The 14 inch screen weighs about 1 puond less than the 15.6 inch. I'm wiling to give up screen size to haul around less weight, but just wondering if it has been problematic to use AC and Updox in this relatively small space.

I use hardwired laptops in my examining rooms and they stay there. They are 17 inch fujitsu N6460. Plenty of screen and to big and too heavy for anyone to try to steel it. They worked very well in last 4 years.

We use hardwired 15.4" laptops in each exam room. They are secured with a lock cable bought on ebay for $1. Plugs into a security port the laptops came with, and then we drilled a hole in the wooden desk it sits on. I think it's mostly for show, but so far no problems.

So we have hardwired laptops in each room plus desktops in offices. We've thought about switching to something providers can carry instead of having so many machines, but this has worked well 4 years.

Why not just get desktops. They're much better in terms of price/performance especially if you're buying one for each room.