Home Forums Discussions General Discussion Which Tablet PC should I use with AC? + other Q's

Hello All and thank you for this forum,

I am new to EMR systems. I took pride in thinking I would be the last physician to buy an EMR but I need one because I practice at multiple locations and have >200 labs incoming daily.

My patients have complained about other doctors that type on a keyboard in front of the patient. As I like to take notes while the patient is talking, and have experience making specific templates, I was wondering if a tablet PC might work. I also dictate in front of the patient and am interested in writing detailed summaries, as an alternative, for referring doctors if the handwriting software would be up to par.

Questions:
1. Which brand/model?
2. How good is handwriting recognition technology
3. How accessible is lab data input? ie how long does it take AC.com to be up and running to accept data from the lab you work with?
4. Can AC be used in a split screen mode. I like to look at letters from co-managing MDs while I update the PMH, for example.
5. How do members use the email function of AC? I was told by AC that it isn't HIPAA compliant. Do you direct patients to another secure email program? How is that text saved into AC?
6. What program is best for remote access? I have a server and four computers in the office. I plan to access from home or while travelling.
7. Any MacHeads have problems with using MacBook Pro/Air and AC?

Thank you all in advance,

Chuck

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.

Welcome to the User Board!

Questions:

1. Which brand/model?
This question is just impossible to answer. I use a refurbished Toshiba Stylistic 5210 ($700 on eBay), but your needs and price range may differ sharply from mine. Here's a couple of resources:
The Medical Quack
TabletPC2.com

2. How good is handwriting recognition technology
Depends on the tablet. Mine is generally good, but I would agree with Martin's caveats above.

3. How accessible is lab data input? ie how long does it take AC.com to be up and running to accept data from the lab you work with?
My hookup to LabCorp took 4 - 6 weeks, but I wasn't trying to hurry anybody up. If you're trying to hook up to a lab that Amazing Charts hasn't interfaced with before, you may be in for a long wait.

4. Can AC be used in a split screen mode? I like to look at letters from co-managing MDs while I update the PMH, for example.
It is not a native function, but I had good luck doing something like this with two separate computers and freeware/cheapware Multi Monitor software from MaxiVista.

5. How do members use the email function of AC? I was told by AC that it isn't HIPAA compliant. Do you direct patients to another secure email program? How is that text saved into AC?
Sorry; I don't use this feature.

6. What program is best for remote access? I have a server and four computers in the office. I plan to access from home or while travelling.
I have been very satisfied with LogMeIn Pro , which is powerful and inexpensive. There is a freeware version also.

I don't use a Mac and can't help with that last one. Good luck, and if you learn anything good, come back and share it with the rest of us!

Thank you both DocMartin and bcmd,

1. I'll test drive the Fujitsu T4220 as you suggested. Lots of positive reviews online.
2. bcmd, how do you write into a field? Does it expand for you to insert handwritten text? How does one right click with the pen?
3. I'll check with each of the labs here and see if they already interface with AC. I know PacLab doesn't and several AC clients are waiting for it to come live.
4. Good suggestion on work around.
5. Anyone else email their patients through the AC interface?
6. I'll check out LogMeIn Pro as you suggest.
7. I think I'm won over by the tablet PC idea. I'll leave the Mac for home.

Chuck

bcmd, how do you write into a field? Does it expand for you to insert handwritten text? How does one right click with the pen?

With my software you just tap the appropriate field once with your pen and the cursor appears there. Then, there is a special field at the bottom of the screen where handwriting recognition takes place. More recent technology may improve on this system.

You can just hold down the pen down on the screen for a moment, and the tablet responds as if you have right-clicked.

Ive been using a tablet since starting using AC last July. Here is my experience.

Questions:
1. Which brand/model? Lenovo (IBM) Thinkpad x60
2. How good is handwriting recognition technology Excellent. Does a better job than my staff ever did.
3. How accessible is lab data input? ie how long does it take AC.com to be up and running to accept data from the lab you work with? Seemless. We work with Labcorp primarily and do downloads of labs twice a day. They come up in the imported items tab and come up faster than I could flip to them in a paper chart.
4. Can AC be used in a split screen mode. I like to look at letters from co-managing MDs while I update the PMH, for example. No experience with this. But if it works with regular AC you should be able to do it on your tablet.
5. How do members use the email function of AC? I was told by AC that it isn't HIPAA compliant. Do you direct patients to another secure email program? How is that text saved into AC? E-mail is only intra-clinic between me and my staff. It is not used with patients.
6. What program is best for remote access? I have a server and four computers in the office. I plan to access from home or while travelling. I use GoToMyPC for home access to my server computer (doesn't involve my tablet) and when I am away I use my tablet, but also through gotomypc over the internet. I found trying to sync databases just too much of a hassle.

Hope this Helps

Hello All,

Just a follow up note. I bought the Fujitsu T4220. I am very pleasantly surprised at the accuracy of handwriting recognition, even at a fast speed of writing. I was prepared to have to relearn how to write but the demo suggested minor technique changes that have been very easy to implement on my part.

I highly recommend the T4220.

Chuck

Wow! Is there any other color than red? I need Visine!

Chuck, when you talk about email, are you referring to the message feature within AC as Dan is referring to or are you talking about the few icons in AC that you can click on to bring up an Outlook or Outlook Express email? Or possibly Eudora, etc. Although, it seems that Eudora and Pegasus, etc. have fallen by the wayside somewhat.

Chuck,

And, as to the remote access, I would recommend doing a search. That topic has been talked about ad nauseum, i.e. RWW, RDP, LogMeIn, GTMPC, VPN, VNC, yell out the window, etc. There seems to be a good contest between:

What is the best way to handle faxes 2,098 posts

What is the best way to access your office remotely? 3,121 posts

Dear Mr. Sensitive Eyes:

I hope I have not permanently damaged your retinas. Please pick a more soothing shade from the following selections:

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Well anything's possible.

You didn't pick a color, Bert, my good man.

I think #1 and #4 are my favorite.

By the way, here's the translation:

See I did pick a color. I chose the phrase that goes:

Ut enim ad minima

If I checked correctly, that was the only one which correlated with purple. I guess I could have said purple, lol.

Oooohhh.... I should have picked up on that. That was #4, which was my other favorite besides #1.

So, I guess I'll use # 1!

Hello and thank you for the mention on the Tablet PC. I have a lot of information over at the blog about the Sahara Tablet and their other products. In addition, feel free to email me at ducknetservies@gmail.com, or if you forget you can find the email address at the site.

I use Dragon 9.5 on the unit as well as Windows Vista dictation and both work well for those who are interested in voice recognition and in a quiet area the dual array microphones allow you to not have to use a headset.

There is a new 10 hour battery coming out soon, so it will allow for 13-14 hours of tablet time. It fits snug right on the back of the unit and is just a bit over a 1/2 inch wide, so not bad at all and it can double as a docking station and has 2 usb ports on it as well and you get an additional power unit cord as well. Some of you might recognize me from EMR Update where I contribute from a geek or programmers point of view, but I no longer actively write.

The blog has a full tablet section, so it's easy to go there for all the tablet pc information. It is not a heavy forum for discussion, but more so for information and there are daily medical news posts as well as resources on the right hand side, like the links to the $4.00 script pages for the retailers.

I see some local southern California folks here too, and Tablet Kiosk is located in Torrance, CA, so they are local for the So Cal folks too.

You probably won't see me here very often, but I saw some links on the blog from folks here and just wanted to say thanks and make everyone else aware of the information I have on the site and you can feel free to comment on any posts if you like at the blog.

Barbara Duck

The Medical Quack

http://ducknetweb.blogspot.com

Welcome, Barbara!

I hope you won't mind if AC members pester you about tablet PC questions from time to time.

We just had a lady post a question about handwriting recognition on a tablet, and I would appreciate your input:

http://amazingcharts.com/ub/ubbthreads.php?ubb=showflat&Number=7675#Post7672

Barb,
Welcome. I was just mentioning to Vinny in a PM last night wondering who this "Quack" person was, and that is sounded a little strange for a doc to be calling themselves a Quack. Now it all makes sense... Sorry and welcome aboard. As an old hockey fan, I guess your family name is one step behind "Mr Ducksworth" from the original "Mighty Ducks". "You guys quacked that the principal???"

Anyhow, thanks for the tips and the offer of assistance as it is always apperciated here. Matter of fact we have two older Gateway tablets the M-275 and the M-280 and we were never able to really make their tablet functions worhtwhile and would love your suggestions as to how to make the most, the best of them. They are both running XP Tablet, SP2 (I'll probably be taking SP3 real soon, just waiting for a few others to go first...) and I really love my old 275. Matter of fact I need a new cable for the the cable set-up that connects the main body to the LCD and runs thru the hinge, so sourcing would be nice too....

Nice to meet ya,
Paul

If those are some of the older Gateways, they used a different technology other than Wacom, which is used in all of the other tablets. I think they were trying to save a few dollars. They do work, but not as well as others. I ran across those when I was doing some retail training for Intel with processor platform education and they were not my favorites and some were what I called the "monster" tablets...big and too bulky to carry around.

With the last name of "Duck", yes I get a lot of jokes and thus I am not very thin skinned (grin). I tell just about as many as I hear so the name Medical Quack seemed to fit for the blog.

I address things from the programming side of things and no longer write, but a few years ago I wrote an EMR, which for it's time was good, but with recent changes, you can't have a life and do the same, it takes a team of at least 2 or more by today's standards.

My best advice with using tablets it to take some time to get to know how to use one and play around with Windows Journal a bit, which comes with every tablet and that way when you start to use a tablet with medical records, it will make a little more sense as humans we are not quite instant plug and play yet (grin).

I wrote an article too about the plight of the EMR vendor a while back and it floated around the web quite a bit, basically telling the story on the other side of the hard work that EMR vendors put in to creating software, thus going back to the teamwork concept of both sides working together and the next level of genomics coming down the tubes and where do we go with the next level there. Again feel free to email me at any time and I'll do my best to answer any tablet questions as well. I am a Microsoft Partner and can offer a lot of assistance too with MS Office too. Anyway, here's a link to the post for anyone who might want to take a look.

http://ducknetweb.blogspot.com/2008/03/in-defense-of-electronic-medical.html

Hi Barbara!

Welcome to my "vacation home" from emrupdate. The guys and gals here are wonderful and I know that you can help them lots.

Can you start a thread to elaborate on your emrupdate statement:

"Good news for you Al, Active Inking will port to an Access Data Base, I did some of the beta testing with Steve a couple years ago. It's funny I have talked and demonstrated his software for some time and now it's finally catching on! Good stuff!"

I think that all of us want to have inking with our MS Access EMRs!

Thanks a million, I will look into it.
RMT

Hello All, I know I don't get over here too often, but wanted to let you know the 10 hour batteries for the i440D Tabletkiosk Sahara tablet are finally in. They cost $369.00 and have a power cord and can be used as a mini docking station as well. It has a removable clip to stand it up if needed, otherwise its portable.

I also made up this "speed read" page whereby it has widgets of my blog, information on the i440D tablet and widgets from some other sources, general healthcare blogs, most of them I know and exchange links, etc. and the NEJM updates.

Here's the link if this is helpful. It has about the last 20 updates from each site and could be useful for a quick check or for the tablet PC information.

http://ducknet.net/default.aspx http://ducknet.net/default.aspx