"Early on, we saw physicians purchasing PDAs, which gained fairly widespread acceptance because of their communications capabilities," says Doug Rahn, director of client services and operations for Stoltenberg Consulting Inc., a healthcare information technology consulting firm based in Pittsburgh, Pennsylvania. "But these proved cumbersome to use and lacked the functionality needed for many critical clinical applications." As a result, many physicians have been gradually moving to tablet computers. Not only do they give physicians the capability to view radiology images in enough detail to actually make a diagnosis, but they possess the full keyboards necessary when doing any sort of work that involves significant amounts of data input, such as entering notes on a patient's chart. "As tablets go mainstream, more physicians are turning to them," says Rahn.
But there are exceptions. Physicians working in "acute" healthcare situations such as hospitals or clinics generally don't want to be anchored by a 5- or 6-pound device. Still, they want to be reachable. Such professionals have been gradually giving up their cell phones, pagers, and PDAs in favor of smartphones, or multifunction devices that perform all these duties, says Gregg Malkary, managing director, Spyglass Consulting Group, a Menlo Park, California-based technology market research firm specializing in healthcare. "Some doctors are still walking around with six devices hooked to their belt, but many are turning to these converged devices that offer phone, pager, and access to clinical information services in one piece of hardware," says Malkary.
In more controlled environments, however, like physicians' offices and smaller healthcare organizations, Malkary agrees that tablets are proving much more popular than PDAs or smartphones. "If you've only got 16 steps between exam rooms, a tablet or laptop makes a lot more sense," says Malkary. "You can have your PC with you wherever you are, and there are docking stations that make it easier for you to quickly set them up and work with patients."
Here's a quick checklist of the sorts of questions a physician needs to ask to determine what device is the best fit for him/her:
What kind of hardware will your software support? "Your first consideration should be whether your software actually supports the use of a PDA or a tablet," says Rahn. Many physicians' back-office and POC systems have separate modules that support certain PDAs; but before actually purchasing a device, you need to verify this. And if you routinely need to access a hospital's network, you need to check to see what devices the hospital information systems will support.
How much IT support is available to you? "In extremely large hospitals we see more doctors acquiring PDAs and smartphones. Not only are they easier to carry around, such organizations generally employ large enough IT staffs to deal with the somewhat thorny technical issues that arise," says Mike Tatum, IT director at AccuStat EMR, in Myrtle Beach, South Carolina, a healthcare technology consulting firm.
How important are high-resolution graphics to your applications? To view X-rays and other clinical results as well as trending data, PDAs and smartphones simply don't cut it, says Malkary. "You need a larger system to access the more robust clinical applications," he says. Agrees Rahn, "There's not much you can do there with the PDA's or smartphone's small screen." But, however, with the 10-inch screens of most tablet PCs and a good graphics card, "you can not only look at chest X-rays and electrocardiograms, but you can make diagnoses."
How much data do you need to enter? Some clinical applications are designed to require very little keyboarding so that PDA and smartphone users can simply point and click. Others require more typing. The more typing you have to do, the less a PDA or smartphone will suit your long-term needs, as you'll need a highly functional keyboard.
How eager are you to deploy speech and/or handwriting recognition technologies? Many physicians are looking forward to the time when they can dictate notes or handwrite on a tablet and have it recognized and accurately translated into electronic text. Certain of these technologies-for example, the Dragon speech recognition system specifically designed for medical professionals-are already available for some PDAs and tablets, but relatively few physicians are using them on a daily basis. "These are still emerging technologies," says Malkary. But Tatum believes they will be the wave of the future. "A lot of physicians are beginning to ask for these capabilities in their devices," he says.
And many physicians have decided that they shouldn't have to choose one over the other. Many have the best of all worlds: a tablet or laptop for doing the more heavy-duty data entry and graphics viewing, and either PDAs or smartphones for more convenient communications and "quick-hit" online research. "Although much of the hype surrounding smartphones was that they could be used to access clinical information, that fantasy didn't play out," Malkary says. To do that, and still remain mobile, "one really needs a tablet or laptop system," he says.
