Trendspotter: iPad Makes Strides Toward Being Usable for EHRs

Ever since the iPad debuted last spring, physicians have been asking if and when they’ll be able to use this alluring new technology with EHRs. Well, it appears that that capability has arrived - at least on the inpatient side - and is in the process of being improved further. Conceptually, there’s no reason why the same approach could not be used in ambulatory-care practices as well.

What has stirred the recent excitement is the increasing usability of iPads with Citrix and Microsoft Terminal Services. These “thin-client” networking products enable practices’ computer servers to feed programs and data to “dumb” terminals or portable devices. While the iPad is designed to send and receive data via wireless or cellular networks, a thin-client interface allows it to work in a client-server network. Because most EHRs are still accessed via such networks, the addition of Citrix and Terminal Services makes it practical to use the iPad for typical EHRs.

A quick scan of the blogosphere shows that physicians are using iPads with two of the most common inpatient EHRs, Epic and Meditech, as well as NextGen in outpatient clinics. (Presumably, Epic is available in ambulatory care, as well.)

One ENT at Fauquier ENT Consultants in Warrenton, Va., wrote last June that he’d tried third-party apps called WinAdmin and Jump to open NextGen in a virtual desktop on his iPad through Terminal Services. It was a bit clunky to use, however, and another application called LogMeIn that opened Meditech on his iPad was painfully slow. Recently, he posted that Fauquier Hospital had upgraded its Citrix network, allowing him to use Meditech on his iPad nearly as well as he could have if he’d used a remote terminal directly with the application.

Internist Vineet Arora, a faculty member at the University of Chicago Pritzer School of Medicine, recently began using her iPad to access her Epic EHR via Citrix. “However,” she writes on KevinMD, “the Epic interface is often clumsy if you don’t have tiny fingers, making me wonder what my male counterparts would do! We’re currently working on getting a stylus to try to improve use of Epic.”

Advantages of the iPad are the myriad applications available for it, including those already created for the iPhone and iPod Touch. Arora uses her iPad for medical calculations, immediate computer access for billing or consulting Epocrates, and, of course, e-mail.

When I first wrote about the iPad back in February, physicians were intrigued by its similarities to the iPhone, its wide-ranging features, its relatively large screen, and its svelte weight (1.5 pounds). Drawbacks for EHR use included the lack of a stylus-based interface and the fact that most EHR vendors were not supporting iPads. Many vendors still aren’t, but it seems that physicians are pushing ahead anyway as more and more of them acquire iPads.

One obstacle to using the iPad in a client-server network - unless it’s a thin-client network - is that patient information remains in the iPad memory after visits or rounds are completed, posing a security problem. But Apple says that theiPad uses 256 bit encryption to protect information on the device. In addition, the iPad can be configured to wipe out data after several failed login attempts; administrators can also eliminate data remotely if a device is lost or stolen.

When the current interface issues are overcome, some physicians look forward to using iPads in place of computer tablets, which cost four times as much as the iPad’s $499 entry cost. This could encourage more doctors to get EHRs because the initial cost of setting up a computer network will be lower.

Because of its reasonable cost and rich functionality, some observers say, the iPad has the potential to transform healthcare delivery. But Apple and EHR vendors need to provide some additional features that will make iPads truly usable in patient care.