Friday, January 2, 2009
Tablets vs. workstations
I continue to get requests for recommendations on using tablets vs. workstations vs. laptops etc. for our providers that are new to EHR. I was hoping someone could give me an idea of which direction you have gone and any positive or negative aspects of this decision. If you have chosen tablets, which brand did you choose and are you happy with it?
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8 comments:
Michael -
To further add to your question, if I may, I'm wondering if some organizations allow provider preference to dictate which devices to use, even though for the IT staff it means supporting various types of hardware. I know that some providers like to document in the exam room, others wait until after the visit and still others may prefer to do the bulk of their notes at the end of the day. Does this workstyle preference factor into the decision and how do you accomodate these personal preferences?
Michael, We've used all three over the past 2 years and what we've found is thin-client workstations are the best in terms of management and performance.
For Providers, only those providers that are savvy enough to work with wireless should be considered. We used Motion Tablets which worked pretty well but they have some liabilities, the most obvious of which is screen size. Today we have about 3 providers who continue to use them.
Generally, our workflow is such that the providers mainly use the computers in the room to share info with the patient but not really for charting. They tend to use their workstations for that.
All have been issued laptops for use from home or on the road. we receive minimal complaints about remote access.
I'd be happy to chat with you more about this. Just let me know.
Cheers, Charles
Shasta Community HC
Thanks Charles and SA. I appreciate your responses. I too wonder about when the actual charting is done as that also factors into our decision. As you mentioned your providers don't really use the workstations for charting in the exam room, so my question would also be when, where & how are they normally doing this? Do they use paper and then transfer if over at a later time? If so, do you find this adds to the workload as you in essence are still doing some double entry?
Some chart entirely in the room, but they are the minority. The terminals in the room are used primarily by nursing staff and if the provider does anything in the room, it's the HPI and sometimes the physical. They tend to use the chart to show growth charts, lab graphs, recent results etc in an effort to better explain care. But the assessment and plan are usually done outside of the exam room at a clinical workstation set up in the hallway or in the provider office. For ordering, if the provider and nurse are both in the room, the nurse can handle the ordering of labs, diagnostics, etc while the provider explains care to the patient. Very few of our providers are able to do both at the same time.
The providers that are most comfortable navigating the system do more in the room for obvious reasons. Generally the providers do their notes immediately after leaving the exam room so writing things down is unnecessary. The big concern is that they don't want to appear like they are paying more attention to the computer than to the patient; a concern that has been mentioned more than once by our patient population during satisfaction surveys.
It's still a moving target though, and many of our providers are becoming more and more confident as the days march on.
Michael-
I have heard from both sides of the fence on the issue of tablets versus workstations.
The previous comments have well documented the matrix that must be considered in assessing this technology: patient perception, provider perception and IT perception.
I have some personal experience with tablets in the emergency room setting. If the templates are well created, I can have adequate eye contact with patients while taking the HPI. Being able to order in the patient's presence provides an impetus to review the course of treatment and why you are doing specific tests. I would then have to go back to my desk and fill in any HPI details and my physical exam findings. I didn't use the tablet extensively because the wireless connectivity was sporadic, and I couldn't tolerate the lack of reliability.
One of our site visits when we were looking for an AEMR vendor was to a pediatric practice using eCW. They loved their tablets and their patients seemed to not mind them. A bonus for tablet use in the pediatric setting is that a computer doesn't remain in the exam room and exposed to the "elements": kids like to use the keyboards as drums and the monitor as a canvas for fingerpainting or other hands on creative modalities.
Financially, tablets are more expensive, unless you can find the ROI in removing both an personal office PC and exam room PC. They also present more of a security risk and require additional software to "self-destruct" the data if get into the wrong hands.
Finally, our IT department found some shortcomings in the tablet version of Microsoft XP which were addressed in the tablet version of Vista, but there are no plans to support Vista by them at this time.
We did give our peditricians the option to use the tablets, but after they tried them out, they opted instead for a wall unit mount for a workstation which stows everything away from inquiring hands.
Mike
Thank you to everyone for your excellent comments. This was very helpful.
Seems to be more ergonomic issues with laptops.
With respect to Ergonomics, we brought in a erognomics specialist who works with our Worker's Comp carrier (most carriers have them on contract, often at little or no cost to their clients). He went to each provider's work station; in the exam rooms, the charting areas (outside of the exam rooms) and their offices. We did this because we began to hear from primarily the clinicians that they were having neck, back, arm pain. This was an early warning sign. From these visits we learned a few things: (1) Laptops are the worst for ergonomic reasons as you tend to hunch over and the head, neck and arm angles are horrible (something to mention to you kids as well). The wall arms in our exam rooms were seen as generally good but the newer wall arms that allow the keyboard and the screen to move apart independantly rather than as one unit were seen as the best as clincians height and body shape are major factors in good ergomontics. (2) Desktops at the charting station and offices should be aligned to the clinician's height and if using a chair, that should be factored in. The screen should be high enough to maintain good posture - again a ergonomic specialists can help with this. (3) Laptops are tough as there are no great ways to make it better except for keyboard angles (with hands and wrists)and trying to keep good posture (not using it on a bed or floor).
In general, as a lesson for a practice going down the EMR road, it is a good idea to bring in one of these people. Most of the fixes were not expensive and can not only save on future WC costs but also help to save a career of a clinician or staff member.
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