Computer Consult

Toward a handheld EMR

Wireless computers that fit in your pocket could finally help push electronic medical records into the mainstream.

By Robert Lowes

Before thoracic surgeon Richard Anderson enters an exam room to see a patient, he whips out his handheld computer to review dictated notes, lab results, and medications. "I don't have to ask the nurse for the chart anymore, or worry about where it is," he says.

The introduction of handhelds to Anderson's seven-physician Peoria (IL) Surgical Group last year illustrates how these increasingly popular devices could jump-start the mopey growth of the electronic medical record.

The stereotype of physician as computerphobe, often cited to explain why only 5 percent have converted to the EMR, is clearly not supported by Anderson's example or by the facts.

One doctor in four now uses a personal digital assistant such as a Palm Pilot, according to a Harris Interactive survey. Of those, 70 percent incorporate PDAs into their practice, mostly for clinical and drug reference material, according to medical informatics experts. Doctors will, evidently, embrace technology that fits into the pocket of a white coat.

When the Peoria surgeons considered going paperless, they nixed working on stationary desktop computers in exam rooms. They simply didn't want their backs turned to patients while they typed.

Instead, they chose two portable devices—the iPAQ handheld, made by Compaq, and the Fujitsu 3400 pen tablet computer, a step up from the PDA and about as big as a file folder. Peoria doctors can use either device. Both allow them to call up or enter data with a stylus—an important feature, since many doctors hate keyboards.

The iPAQs and Fujitsus wirelessly access the practice's EMR program, OmniChart from Medical Manager Health Systems, which runs on the office's server. With OmniChart, doctors can write prescriptions as well as review patient records. The practice anticipates adding a sister program soon that will allow physicians to document patient visits—replacing dictation—and capture charges.

For all their handiness, PDAs alone won't make the EMR commonplace, though. "They're not a panacea," says C. Peter Waegemann, executive director of the Newton, MA-based Medical Records Institute. "We've heard the same hype about voice recognition."

The PDA is handicapped by its tiny screen, which can't display the wealth of data that appears on a typical EMR desktop. "A handheld is probably too small for taking a history," says Anthony Vendetti, who tracks e-health for the New York investment firm Gruntal & Company. "I see more of a future for tablet computers."

Tablets may not be the final answer, either. They can't slip into a coat pocket or match a handheld's durability, says Mark Bard, director of health practices at Cyber Dialogue, a New York-based research firm. Tablet prices—as high as $3,900—also deter adoption, but fortunately, they're falling.

The future may hold better hardware choices: Vendors may develop an inexpensive device sized between a PDA and a tablet. And PDAs may come with larger, fold-out screens.

What most mobile devices will have in common is a radio-frequency connection to a server, whether it's inside the doctor's office or offsite. Such wireless networking overcomes the PDA's inherent limitation in storing data.

Many hurdles have conspired to keep the mobile EMR from taking medicine by storm—the expense of wireless networks, the limited bandwidth available to cellular networks, and the quest for the right portable computer. Nevertheless, the forecast for steady growth is good. A third of doctors who don't use a handheld to record patient notes expect to be doing so by 2006.

Mark Bard predicts that PDAs will supplement rather than replace desktops and other computers in a doctor's office. "We'll learn which functions make sense on what machines," he says. "But when it comes to patient care at the point of the service, you need a mobile device."

The author, who is based in St. Louis, is a Senior Editor of Medical Economics.

 

Robert Lowes. Computer Consult: Toward a handheld EMR. Medical Economics 2002;1:26.