Technology allows you to make rounds, save time
By Jay D. Mabrey, MD
Robert Jones, IV, MD, arrives on the orthopaedic ward for rounds on the two total hip replacements he performed the day before.
He doesnt look for his patients charts or a computer terminal. Instead, he takes out his Tablet PCits the latest in mobile computing technologyand heads for his first patient.
Since Dr. Jones thumbprint is built onto the biometric sensor on the Tablet PC, it immediately informs the medical records server at the hospital he is the rightful user. The Tablet also tells him that he is using University Hospital Tablet #798 and he logged on wirelessly at 6:34 a.m. on Nov. 14, 2003. A list of Dr. Jones patients also appears on the Tablets flat panel display along with each patients latest lab values and vital signs. Carrying the Tablet to the bedside of his first total hip replacement patient, he taps the screen with a stylus, reviews the patients lab results and physically checks the patients vital signs. He then pulls up an order entry form on his Tablet to prescribe a lower dose of coumadin for this patient.
New electronic tool
As more hospitals move into the realm of the electronic medical record (EMR), orthopaedists will inevitably encounter the latest tool in mobile computing: the Tablet PC. Powered by Microsofts® recently released Windows XP Tablet operating system (www.microsoft.com/windowsxp/tabletpc), this product promises to enable physicians and nurses to access real-time patient information at the bedside and in the clinicwithout the need for computers, cables or keyboards.
More than just a super PDA (personal digital assistant), a Tablet PC promises to deliver full desktop computing capabilities along with handwriting recognition in a package weighing no more than three pounds vs. carrying stacks of in-patient charts.
$1,700 can buy you an 800 MHz tablet with 256MB RAM, a 20GB hard drive, 56K modem, 10/100 Ethernet, built-in wireless receiver and a 10.4" LCD display.
Health care application
Two factors account for the appeal of a Tablet PC in the healthcare setting: 1) it utilizes the new 802.11b wireless communications standard and can roam about a large area without cables; and 2) the "Tablet" format allows users to input data directly on the touch-sensitive screeneliminating the need to sit down at a keyboard. In fact, you can write directly on the screen with a special stylus and the Tablet PC will convert your handwriting into text that can be entered into any of the Windows XP applications such as Word or Excel. The added advantage that Tablet PCs have over the ubiquitous PDA is that its 10-inch screen can present a full page of patient data, whereas the PDA user must scroll about to see all of the information.
Many hospitals, such as St. Vincents in Birmingham, Ala., (www.stv.org/advertising/wireless.asp) have already installed wireless networks on their wards and in the ors so nurses can access patient data via laptop computers that roll around on small carts. While these carts are more convenient than desk-bound terminals, they still require the user to sit directly in front of the computer to enter data via a keyboard, utilizing a mouse. The Tablet PC, on the other hand, works just like its paper cousin: it is cradled in one arm while the user picks and chooses items from drop-down menus using a special stylus.
One of the functions of Windows XP Tablet that sets it apart from its desk-bound predecessornamely handwriting recognitionis the one function that most surgeons (and the nurses reading that handwriting) want to avoid. This "digital ink" technology was designed to allow users to mark-up documents in a collaborative fashion prior to producing the final output. This is not possible, nor desirable, in an electronic medical record.
Even if XP Tablet had perfect handwriting recognitionwhich it does notit is still more efficient to use menus and checkboxes to enter data in a standard fashion into the electronic chart. This enforces a standard data format that can readily be searched for both research and billing purposes. XP Tablets tap and click mode allows the user to select menus that pop- up to the right or left of the pen tipdepending upon their hand preference.
The future of the Tablet PC is in vertical markets such as health carenot in the mass market. Its appeal is in its mobile access to a more powerful server and this requires a dedicated infrastructure of antennae built into the users site. We wont see widespread adoption of the Tablet until users can count on mobile access in public spaces such as the initiative taken by Starbucks Coffee (www.star bucks.com/retail/wireless.asp). Until then, it is in every orthopaedic surgeons interest to encourage his/her hospitals information technology managers to movetoward the Tablet solution.
Jay D. Mabrey, MD, is an associate professor of orthopaedics at the University of Texas Health Science Center at San Antonio, and chair, Electronic Media Education Committee. He can be reached at (210) 567-6297 at firstname.lastname@example.org.