Technology: Hardware’s Hard Challenges

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 evaluate 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 evaluating 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 a hardware platform reflects the fact that medical groups are becoming increasingly computerized, automating not only administrative functions but also clinical tasks. Careful contemplation of IT choices is crucial because the success - or failure - of hardware tools within medical practices 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 challenges, including giving physicians multiple text and data input options; providing patients an easy means to enter data directly into a practice’s system; enabling physicians and other clinicians to interact easily with patients while accessing and entering information into computers; and persuading physicians to try alternative hardware forms after a computerization launch fails.

Accommodating data entry

For example, settling on specific computer hardware to support a major IT system at East Lansing Orthopedics in Michigan turned into much more than basic compare-and-contrast shopping when unexpected difficulties arose.

Before setting out on their initiative, 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 information technology program.

At the core of their 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 system. Then things got dicey. To make sure these 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,” he explains. “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 says.

To accommodate these diverse data-entry preferences, the practice chose tablet PCs from Motion Computing in Austin, Texas. The 3-pound, slate-shaped tablet PC - about the size of a clipboard - features 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 affirms. “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 have to accommodate the tech preferences of their patients as well.

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 computer hardware choices. Their success depends upon implementing IT that makes their patients happy as well.

Why? 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 than 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 clinicians and administrators as well as their 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 patients access to desktop PCs, they typically go with the mobile option, Freedman says.

Freedman recommends 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, Freedman suggests a combination of desktop, laptop, and tablet options, depending upon the users’ mobility needs at each practice.

But Freedman says the most important consideration for practices is to ensure that they buy their 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. “That’s why I feel more comfortable recommending that doctors buy from a known company.”

EMRs and the doctor/patient relationship

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

Although typical usability and cost questions were also issues when Gutierrez sought to purchase hardware to 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.

So 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, however, 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 PDAs to access its new EMR, but the physicians in the group quickly realized that the small gadgets didn’t have what it took to make the best use of their investment.

In the late 1990s, the pediatric group’s physicians, convinced of the patient care and business benefits of EMRs, purchased a system for their practice. They used wireless PDAs to access their EMR, but they soon realized those PDAs were unable to hold large files and had limited function and input capabilities.

Rather than dropping the EMR altogether, however, the practice’s physicians tried another hardware platform: tablet PCs. With tablet PCs deployed over a wireless network, the group now taps easily into its EMR software applications. Most important, the physicians are happy with their switch to tablets.

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

The practice expects the new EMR to yield additional bottom-line benefits. With its new system in place, the group 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 per year 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.

This article originally appeared in the September 2006 issue of Physicians Practice.