New iPad EHR system goes native, eliminates need for desktops, servers

ClearPractice debuts Nimble: a native iPad EHR system offering meaningful use compliance as a SaaS, that will help the iPad establish itself as the leading tablet for health care.

ClearPractice LLC today unveiled Nimble, an iPad-based electronic health record (EHR) system that runs natively on the Apple Inc. tablet -- meaning that physicians theoretically could get by without their laptops, servers or desktop computers.

ClearPractice hosts Nimble on its own servers using a Software as a Service (SaaS) or cloud computing model, and offers access to it via traditional computers, iPhones or iPads through applications optimized for each device. Joel Andersen, incoming president of ClearPractice, said he envisions customers -- most of whom subscribe to the company's EHR and integrated practice management modules -- keeping desktop machines to fulfill such back-office functions as billing and booking appointments via ClearPractice's Web interface.

Nimble beta tester Kenneth Luckay, an independent family practitioner and osteopath in Troutville, Va., said his own experiences with the Nimble EHR system and the iPad in general are in line with that.

He could see eventually forsaking his traditional computers in favor of an all-iPad practice, although he still has a computer in every room in his office, Dr. Luckay said. He uses the iPad predominantly over Wi-Fi connections, not 3G, because AT&T Inc.'s coverage is spotty in his area.

ClearPractice hopes to distinguish Nimble from other iPad EHR systems because of its mobile access and the fact that it's iPad-native, not just an instance of a desktop app requiring a back-end server setup at the physician's office, Andersen said. That, plus the company's connections to Apple's developer relations team, which offered input on Nimble's look and feel during development.

"They [helped] us find ways to simplify, to make it easier to use," Andersen said. "We were coming from our classic EMR [electronic medical record] experience, and the first iteration was a lot like it. It's great, but not really appropriate for an iPad device," he said. "They're not EMR experts, but they certainly are user experience experts. So, they would catch things we probably wouldn't have caught. By the third visit, we really felt like we nailed it."

What makes the iPad EHR different

Data entry is easy enough on the iPad to do the functions Dr. Luckay needs. Using the iPad EHR also improves the patient experience: Patients felt uncomfortable when he turned away to enter data into the desktop computer, he said. The positive reception the iPad has received has spurred him to learn more about additional iPad functions, such as its touchpad keyboard, and about Nimble and its workflow.

"The advantage of the iPad and Nimble is that you can sit right with [patients] and share [information] easily," Dr. Luckay said. "I can show them things, like anatomical patterns and pictures right there, interact with them, showing them what's going on in their bodies, whether it's stomach problems or esophagus problems or joint problems. I'd been able to do a little of that before with my desktop EMR. It worked, but . . . it was clumsy, very time-consuming, and it didn't flow very well."

The iPad-SaaS EHR configuration will serve physicians well, especially those with mobile practices -- for example, doctors who make rounds at nursing homes, Dr. Luckay said. It also keeps physicians on the EHR system while they're away from the office, checking messages and clearing tasks off their to-do lists that otherwise would pile up. "It's much sweeter that way," he said.

Mobile EHR as the future of health care?

The importance of tablet support is probably the first question on the minds of many physicians as they sign up for their first EHR system in order to reap Health Information Technology for Economic and Clinical Health, or HITECH, Act incentives.

Those [doctors] who are coming out in their 20s and 30s are going to embrace this much quicker. . . . But there's still quite a schism in the medical community [among] practitioners as far as accepting computers.

Dr. Kenneth Luckay, family physician

After testing the iPad in his own practice workflow, Dr. Luckay is convinced they will work so well in health care that they eventually will be an important part of the health care workflow.

"I think it will happen, especially with the younger doctors," Dr. Luckay said. "I'm 54, but still somewhat interested in keeping up with the way the technology goes. Those who are coming out in their 20s and 30s are going to embrace this much quicker. Many of my colleagues my age are refusing to have anything to do with a computer, basically, so they're not going to go with tablets of any form -- willingly -- although maybe it'll get a little easier as they get comfortable with it. But there's still quite a schism in the medical community [among] practitioners as far as accepting computers."

Then there's the question of meaningful use. Tablets are lighter, software-wise and have less CPU power and less-complex operating systems than their desktop counterparts do. Is there enough computing firepower present to meet compliance needs? Dr. Luckay thinks so, but he points out that, because the federal government is still finalizing regulations and standards, it's not a done deal.

Let us know what you think about the story; email Don Fluckinger, Features Writer.

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