
IPad in Business: St. Louis Urgent Cares - pg
http://www.apple.com/ipad/business/profiles/st-louis-urgent-cares/
======
inuhj
tldr: Drchrono does the exact same thing as any other EHR...but on an iPad.

"Physicians can each create their own exam templates and enter data quickly by
tapping checkboxes or selecting from menus, rather than having to write or
type. For physicians who don’t type well, the touchscreen makes information-
gathering a lot simpler than trying to use a keypad, says staff physician Dr.
Carol Ann Smith, who also takes advantage of the speech-to-text feature in
drchrono EHR to dictate notes."

As someone who spent the last hour charting(takes me about 2 minutes a patient
with templates) I think this part of the article glosses over the real
difficulty of using a tablet for EHR--namely that when patients are sick you
have to manually enter a lot of data that wouldn't be in your template.

For example:

Subjective Findings: Patient presented to clinic for a 4 day history of cough
and 2 day history of vomiting. He has vomited 3 times and there is phlegm in
the vomitus. He also complains of a rash on his forehead that has spread down
to his trunk that is maculopapular and itchy. The patient denies any fever,
chills, dizziness, or headache.

A template can't do that for me...and it's a pain to enter that on a tablet.
It effectively nullifies the use of tablets as effective EHR.

In my opinion the ideal solution is a macbook air(or similar ultralight) based
EHR.

~~~
ugh
“A template can't do that for me...and it's a pain to enter that on a tablet.
It effectively nullifies the use of tablets as effective EHR.”

Entering so little text on a tablet is definitely not a pain for me and,
though quite a bit slower than typing on a hardware keyboard, it’s also quite
a bit faster than handwriting for me.

I don’t get why so many people seem to think that tablet keyboards are
unusable, I never had any problems typing a few paragraphs of text on them.
This seems like some kind of weird meme demonizing all software keyboards as
inferior to everything.

~~~
inuhj
It's not a "weird meme". It's my personal experience. You may be able to enter
data quickly on a tablet but many of the physicians I work with still
type(painfully slowly) with 2 fingers. Maybe drchrono will be appealing to
younger physicians who are comfortable with tablets...but the average
physician is old.

If I demo'd drchrono and it was slower than my current system you're not going
to sell me by telling me that "I'll get used to it." They're definitely not
going to sell any major hospital on drchrono unless they also offer a computer
based interface. The "old dog" physicians will never figure out how to type on
it.

~~~
azulum
"but the average physician is old."

this is a curious statement to me for three reasons:

1) the ipad has been hailed as a device for first time computer users—the very
old and the very young or even the physically/mentally challenged.

2) if they type painfully slowly with two fingers on a tablet, how do they
type on a laptop?

3) the layers of abstraction are much greater on a laptop than a tablet.

true, data _input_ may be a little more tedious, but it will still be
infinitely less tedious than dealing with paper files, with the added bonus of
being instantaneously transferable should the patient be traveling. and if
they are already using a laptop, then what is the dilemma?

anyway, the "old dog" argument strikes me as a lazy cop-out—but if true,
doesn't bode well for the mental acuity of said old dogs. i've always assumed
that doctors are innately curious, always trying new things tempered by the
old things that work†. if these old dogs can't step out of their comfort zone
to try something new, it doesn't give me much hope for their patients.

† i understand the toxicity of the new, when science claims to have found no
difference between breast milk and formula, for instance, but gathering
information does not necessarily equal an endorsement. and for the record,
touch screens are very old technology, we just haven't been able to implement
them in a mostly non-frustrating way until now.

------
dmix
Having real people using the app in a video demo is 10x more effective than a
cute animation explaining your features.

------
gacba
I love that they're doing this. It does, however, bring up one disadvantage
that the paper record does not.

Suppose you're sitting in the room with your loved one and you want to see
what the doctor wrote about their condition and treatment suggestions. You can
pick up the records and look through them, and ask questions about what you
don't understand. With the iPad, you're kind of left out in the cold and at
the mercy of whoever is there. That's a weakness of the system I'd like to see
them address.

BTW, I'm not saying that you'd be able to understand all the medical shorthand
on the charts, which is definitely a language unto itself, but you'd at least
be able to have a starting point for a conversation. "Hey, what's this..?"

~~~
inuhj
I've never had a patient ask for their medical records...and frankly they
wouldn't understand them if they saw it. It's filled with doctor's
handwriting, abbreviations like OM(otitis media), PRN(take med as needed),
etc. It's mostly a reflection of what the patient has told the doctor and
doesn't contain much information that is useful to the patient. It would be
better to ask the doctor your questions directly.

If you read the chart and asked me "hey what's this?" for every question I
would be tired of you within 2 minutes and tell you not to worry. If it was
important I would tell you.

------
simonsarris
It looks like the same app is available for android, though it doesn't have
all the features yet:

[https://market.android.com/details?id=com.drchrono&rdid=...](https://market.android.com/details?id=com.drchrono&rdid=com.drchrono)

If the versions are the same in the future (so the same app is available for
android tablets), why would doctors/hospitals choose the iPad over an Android
device? Would there be any compelling reason for doctors/hospitals to want one
over the other?

~~~
sudont
It's harder to provision an Android device to HIPAA requirements. iPads are
also cheaper.

~~~
josteink
My Asus Eee Pad Transformer with maxed specifications (32Gb storage, 3G & wifi
and keyboard dock with SD-card reader, USB-slots and about 8 hours extra
battery-time) costs me the same as an 16GB 3G iPad 2. That's a 16GB storage
and keyboard dock in delta, and not in Apple's favour.

It may be a more favourable comparison if you go for the plain iPad, but Apple
doesn't sell them any more, at least not where I live.

Anyway: Putting out "iPads are cheaper" as blanket statement like that is
either uninformed, dishonest or plain trolling.

~~~
sudont
Fewer ports are better with HIPAA. You don't want somebody sneaking out data
on a card. You don't want doctors with all their personal crap on the tablet,
so what does it matter if there's 2x the storage on a Transformer? Do you put
2-3x times the ram in a dedicated app server _just because_?

In this case, everything a consumer wants is antithetical to what the hospital
wants. I think you're the one trolling, talking about consumer needs in a
locked down situation.

Also, _seriously?_

'My old account evidently got flagged "troll" for speaking against the Apple-
worship cult found on HN.'

~~~
absconditus
HIPAA does not enforce anything related to the number of ports or any other
such nonsense. Most hospitals use standard laptops and desktops with more
ports than a tablet will ever have.

------
littlegiantcap
Laptops are going to be cheaper, last longer, and going to be harder to break
IMHO. IPad's are fun and I definitely use mine, but I'm not sure if they are
the best bet for this application. Outside of looking cool and making patients
think their doctor is really technologically advanced I'm not sure what they
bring to the a table that a much cheaper netbook couldn't.

------
jannes
Aren't you asked to turn electronic devices off when you enter a hospital? I
don't understand why there's an exception for the iPad. And at least from what
you can see in the video their iPads are not in airplane mode, but are
actually connected to WiFi and the AT&T network.

~~~
Duff
When cell phones were new, there was some hand-waving regarding the risks of
planes crashing, respirators stopping, etc. As is often the case, these risks
were not very credible.

The signs stay up because while the RF signals won't kill anyone, listening to
people jabbering on the phone is very annoying. For example, my wife's
pregnant, and we spent some quality time in her OB/Gyn's waiting room the
other day. Hearing another patient screaming into phone with a graphic
recounting of the bursting of some sort of cyst for 30 minutes made the
experience of sitting in a 90 degree waiting room for a half hour that much
more noxious.

------
CrystalKoo
Wouldn't the iPad be a good way to spread germs?

------
baptiste
It's all about internal purpose. Any experience with iPad in public access
that all the customers of the point of sales can use?

~~~
dmix
Lowe's is deploying 42,000 iPhone apps for use on the retail floor.

[http://www.appleinsider.com/articles/11/09/08/lowes_deployin...](http://www.appleinsider.com/articles/11/09/08/lowes_deploying_42k_iphone_based_pos_systems_in_retail_overhaul.html)

------
logjam
We've tried iPads in our practice for EHR, including a trial of Dr Chrono. It
is unusable because:

\- it takes too long to enter notes on a tablet. A "template" system is way
too inflexible.

\- the dictation feature didn't work.

\- nobody has ever been able to even begin to convince us that our patients'
data was secure.

Laptops work MUCH better. We do use tablets for patient education purposes,
for which they are much better suited.

~~~
rdl
I worked on PACS and incidentally integrating with EHRs in the past -- I'd be
very interested in talking with you about exactly what security concerns you
have with this kind of solution and figuring out how a system could satisfy
them.

I think the dictation issues are non core; either apple fixes it in iOS 5 or
drchrono could integrate with a third party transcription provider.

The template and macro thing is definitely at the core to a good ehr

