EMR Interface: Making Hardware Fit Your Needs

December 15, 2007

Evaluate your peripheral options carefully when purchasing an EMR. If your physicians are uncomfortable with the PDA or tablet PC you choose, they’ll go back to paper.


Physicians - being physicians - are generally noted for their due diligence in carrying out their everyday responsibilities, which often involves making life-or-death decisions, frequently with limited information.

Such diligence is an important asset when physicians leave the exam room to choose the hardware that’s necessary to help their practices operate efficiently. Unlike in emergency clinical situations, however, physicians can take their time gathering as much information as possible when determining which tools will best fulfill their specific business and clinical needs.

Subsequently, many physicians carefully compare and contrast IT products, using checklists that incorporate considerations such as cost, processing power, memory, mobility, and software vendors’ recommendations.

This deliberate effort in selecting hardware platforms reflects the fact that medical groups are becoming increasingly computerized, automating not only administrative functions, but also clinical tasks. Carefully contemplating one’s IT choices is crucial because the success - or failure - of hardware platforms within a medical practice frequently hinges on whether or not clinicians will actually use them.

Many practices have already come to terms with hardware shopping basics and can easily determine which options are best for them based on cost, processing power, and the like. But physicians and their office managers still get caught off guard when they face unexpected scenarios, which can include having to choose among multiple text and data input options; providing patients an easy means to enter data directly into a practice’s electronic system; learning how to interact with patients while simultaneously accessing and entering information with computers; and facing the reality of having to choose alternative hardware tools after the first ones prove untenable.

Accommodating data entry

Unexpected difficulties turned selecting which computer hardware to support a major IT system into much more than a basic compare-and-contrast shopping expedition at Michigan-based East Lansing Orthopedics.

Before setting out to digitize their office, physicians at the six-doctor group developed their IT vision for the practice. “Basically, all of our technology decisions are driven by a particular vision of what we want to do,” says Brian McCardel, the physician who took charge of the group’s IT program.

At the core of this vision is the physicians’ desire to access an integrated practice management system and EMR. “It seemed that the best way to automate both the administrative and clinical functions of our practice was to find a solution from one vendor,” McCardel says. “That way, we wouldn’t always be relying on interfaces.”

After selecting integrated practice management and EMR software from iMedica in Santa Clara, Calif., the orthopedic doctors had to agree on the type of hardware that would allow them to best utilize their new software. Things quickly got dicey. To make sure his physicians would fully utilize the clinical program they had chosen, McCardel realized the practice would have to meet the clinical data input preferences of each physician.

“We had to look at hardware that would accommodate multiple ways of doing data entry,” explains McCardel. “Each of the physicians had their own ideas about how they wanted to get information into the electronic records. Some of the doctors wanted a keyboard to type in data. Others wanted to write information directly into the record. Some just wanted to be able to dictate the information into the system, and others wanted to hand-write text into the system using a stylus.”

Accommodating all these wishes seemed a bit pie-in-the-sky, but McCardel knew that the practice’s technology initiative depended on physician buy-in to succeed. “The more options we could provide, the more likely it would be that the physicians would actually adopt the technology,” he reasoned.

To accommodate everyone, the practice chose tablet PCs from Motion Computing in Austin, Texas. The 3-pound, slate-shaped tablet PCs - about the size of a clipboard - feature a bright 12.1-inch screen that allows doctors to view a full-page document without scrolling. The PC’s design makes it easy for doctors to carry it under one arm, enabling them to move about just as they did with paper charts. As the practice continues to roll out its tablet PCs, its physicians are coming to appreciate the benefits of a computerized practice, says McCardel.

“There are many benefits that we will realize from the system,” he says. “But already, there really is nothing like being able to carry your computer with you wherever you go and access information about any of the patients who see a doctor in our practice. It’s a great convenience, especially when you are on call and answering questions about a variety of patients, some of whom are not yours.”

Accounting for patient preferences


Meeting the diverse IT needs of an opinionated group of doctors is difficult enough, but some practices must also accommodate individual patient technology preferences.

The National Spine Network is a nonprofit organization based in Marietta, Ga., that unites 28 independent centers of excellence for spine care. It includes a number of small orthopedic and neurosurgery practices, which, with each of the other organizations that make up the network, face a set of unique challenges when it comes to selecting computer hardware. Their success depends upon implementing an IT program that makes their patients happy.

Why? Because each medical group in the network uses SpineChart, a clinical program that requires patients to enter information directly into the system. “This clinical software is different from clinical software that is used in many other practices,” says Harry Freedman, the network’s executive director. “Not only does it require that clinical staff input data, but it also requires that patients do so as well. And that is something that many other clinical programs don’t do.”

As a result, Freedman finds himself making hardware recommendations that must meet the needs of three parties: clinicians, administrators, and patients.

Patients within the network use touch-screen technology to input their personal data. Practices can provide either stationary desktop computers in their waiting rooms or give mobile devices to their patients to collect their data. Because most network practices lack the space in their waiting rooms to offer all patients access to desktop PCs, they typically go with the mobile option, Freedman says.

Freedman recommends that the network’s practices provide patients with tablet PCs. He says he prefers tablets to laptops because a laptop’s keyboard can easily distract patients. For the network’s clinical and administrative staff, he suggests a combination of desktop, laptop, and tablet options, depending upon the users’ mobility needs at each practice.

The most important consideration for such practices? Make sure you buy your equipment from a trusted vendor.

“Dependability is important because physicians and staff members have to rely on the equipment for so many vital functions,” says Freedman.

EMRs and patient relations

Patient needs were a prime consideration for Elaine Gutierrez when she decided to implement an EMR at her private practice in Torrance, Calif.

Although usability and cost were important issues when Gutierrez sought to purchase the hardware that would make the most of her EMR, she had a few other concerns as well. Most important to her was to ensure her computer use would not interfere with patient interactions.

“I wanted to be able to make eye contact with my patients while I was taking their histories,” says Gutierrez. “If you have a desktop computer in the corner of the exam room, it is really hard to do that. And it is really hard to make eye contact when you bring a laptop in and just place it on the countertop.”

Gutierrez also worried that her pediatric patients might view new desktops in the office as toys while they waited to see her. “I thought the kids might bang on them and ruin them,” she says.

Gutierrez settled on a Dell laptop. She can wheel her compact computer into exam rooms on a rolling cart, enabling her to adopt a position in which she can easily interact with her patients. And Gutierrez is gaining another unexpected benefit from the set-up she chose. Her back and neck don’t bother her nearly as much as they once did.

“When I had been working with paper records, I would lean over and write on the counter. I started having problems with my neck and shoulder from the writing,” she explains. “Now I can adjust the laptop to the perfect height - and I don’t feel any strain.”

If at first you don’t succeed …

Like many other physicians who have evaluated different hardware platforms, Gutierrez realizes that choosing the right tool was crucial to her successful foray into the world of EMRs. But many other practices aren’t so lucky with their first choice.

For example, ’Specially for Children, a pediatric subspecialty group based in Austin, Texas, initially used wireless PDAs to access the new EMR it purchased in the late 1990s, but the physicians in the group quickly realized that the small gadgets didn’t have what it took to make the most of their investment; the PDAs were unable to hold large files, and they had limited function and input capabilities.

Rather than dropping the EMR altogether, however, the practice’s physicians decided to try tablet PCs. Deployed over a wireless network, the group now taps easily and happily into its EMR software applications using its new interface tools.

“The tablet makes it possible for me to do more in real time,” says Jeff Zwiener, a pediatric gastroenterologist within the group. “Our charts are more accurate and almost impossible to lose, since they’re electronic.”

The practice expects its EMR to yield additional bottom-line benefits. With its new system in place, it is eliminating $130,000 to $180,000 in paper chart costs per year. And because doctors and staff members now work more efficiently, the practice will be able to see an additional 2,500 patients annually without having to add staff members.

Talk about a win-win situation.

John McCormack has been a healthcare journalist for 15 years. He has served as associate editor for Materials Management in Health Care and as managing editor for Health Data Management. He can be reached via editor@physicianspractice.com.