But Nelson notes that voice-enabled smart phones, which she says will eventually replace traditional PDAs, are still working out a few kinks. Weak voice reception and slow or shaky Internet connections can sometimes make them difficult to use. “Doctors are loving smart phones, but you have to figure out what your dominant need is,” she explains. “Is it the phone or the PDA? Because the device you select will have one feature compromised at the benefit of the other.”

Nelson says physicians who want a hand-held device primarily for its keyboard functionalities, such as sending quick e-mails, accessing the Internet, and text-messaging colleagues, may prefer a smart phone over a PDA. But doctors who spend a good deal of time taking calls or who don’t want to carry around the bulk of a built-in keyboard may do better to keep their PDAs and their cell phones separate.

Although some smart phones can cost up to $1,000, Samsung’s SCH-i730 retails for around $699, while the Palm Treo 700w and the BlackBerry 7130c both start at roughly $300.



Pursuing the paperless dream

Larger practices with EMRs already in place may choose to spend the extra couple hundred dollars required to make more of their transactions paperless. Bruce Kleaveland, president of Kleaveland Consulting, a Seattle-based healthcare IT consulting firm, says digital signature pads and scanners cost little but pay off big. “When practices get an electronic health record, they’re usually so involved in trying to implement the technology and get everyone trained that they don’t necessarily explore the other little gadgets that can help minimize paperwork and improve work flow,” he says. “That’s what it’s all about.”

With a signature pad, patients can easily sign consent forms and other medical documents electronically, creating a legally binding digital signature that is automatically uploaded to their charts. For administrative staff, there’s no need to process additional paperwork or to scan manual signatures.

For about $100, Wacom Technology sells the Graphire4 4X5 Pen Tablet, which allows patients to sign on an electronic pad connected to a computer via a USB port. Higher-priced products allow doctors and patients to write directly on a tablet PC. For example, Wacom makes the Cintiq interactive pen display with an LCD monitor, which sells for nearly $2,500. Topaz Systems sells its SignatureGem and SigLite signature pads for anywhere from $87 to $665, depending on the product’s technological sophistication. Higher prices usually buy you direct screen-writing capabilities.

Scanners can further help reduce patient registration time by copying insurance identification cards and turning them into PDF, TIFF, or JPEG files that can be digitally attached to a patient’s electronic medical record. You can pick up a Visioneer Strobe XP 300 portable scanner for as little as $275, while Card Scanning Solutions offers its MedicScan for $350 to $500, depending upon the product’s features.

“These tools were not specifically created for the healthcare arena, but what we’re finding is that as the healthcare industry begins the process of moving from paper-based to paperless, there’s a whole host of accessories and gadgets that suddenly become relevant,” says Kleaveland.

Put your typing where your mouth is

Digital voice recorders that enable physicians to verbally record notes, treatment options, and patient information throughout the day undoubtedly give them a high-tech edge in productivity. These devices store dictation as downloadable WAV or MP3 files, which can be e-mailed via a secure server to a transcriptionist or to an on-call physician, who can be informed of any patient health status change that requires action.

“This technology is a lot less expensive and more portable than [traditional] digital dictation systems,” says Bruce Eckert, executive consultant for Beacon Partners, a practice management consulting firm in Weymouth, Mass. “It’s eliminating the need for written notes.”

Many PDAs (and even some Apple iPod models) are already equipped with digital voice-recording capabilities, but consumers looking for stand-alone versions can try Olympus, which sells a handful of digital recorders ranging in price from $30 to $500, or Sony’s full range of such products, including its mid-priced ICD-SX46 recorder, which retails for $150.

Voice-recognition software such as Dragon Naturally Speaking will most likely eliminate the need for transcriptionists — eventually. The software can translate a physician’s verbal recordings into typed text. Eckert says such software seems to work best in practices with 10 or fewer physicians. “You need to adapt the software to your own [voice and word choice] idiosyncrasies so it recognizes terminology,” he explains. “Large practices … would have to create a standard medical dialogue, which doesn’t always work out so well.” The technology remains a work in progress — the automatically transcribed text still requires significant proofing to ensure accuracy. And although the standard software retails for less than $200, if you want a version that’s geared toward the medical world, expect to pony up nearly $1,000 for it.