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Mobile EHR for the iPad slowly coming to market

As iPad adoption among doctors continues to climb, vendors focus their efforts on mobile EHR systems. November’s iOS update, which supports multitasking, should speed things up.

In theory, porting an electronic health records (EHR) system to the iPad might seem like the ultimate mobile health care dream to some physicians. Hospital IT managers know the devices are so popular that the allure of adding iPads to a mobile EHR rollout can raise physician and nurse enthusiasm for the process, easing the transition to meaningful use compliance.

In practice, it's harder than it looks. "Doctors are buying an iPad, and they have no clue what they're going to do with [it]," said Mark Hollis, client relations director at MacPractice Inc. "They're beginning to think, 'I can use an [electronic medical record]' … but they don't understand that they need a complete solution," which means integrating a server, desktop computer, smartphone and iPad.

On top of that, few vendors have procured native iPad EHR applications, partly because it’s new technology and partly because the current iOS does not support multitasking.

With so few native applications, early adopters must use "terminal" setups such as VNC by MacPractice or Citrix Systems Inc.’s Citrix Receiver for iPad. These function like desktop-sharing applications, except one half of the equation is an iPad as opposed to a traditional PC.

Those are workable substitutes while waiting for actual iPad EHR apps, said Dr. Robert Gallo, an OB-Gyn in New Jersey who uses VNC to port his MacPactice EHR to his iPad at his office.

"VNC is a means to an end, but it's not exactly the most elegant way of getting there, and I don't know how long it's going to take [MacPractice] to develop something on their own,” Gallo said. “I think if you want to be innovative and you'd like to use the technology, you make your own workaround. It's working well for now, I'm happy with it."

While Pulse Systems Inc. and Inc. are among the handful of vendors with a mobile EHR for the iPad, many others have applications in development. While MacPractice has made no official product announcements, Hollis pointed out that Apple's upcoming iOS system update, due in November, will support multitasking, which will help vendors create much more robust iPad EHR apps than the present iOS supports.

Epic Systems Inc., meanwhile, has an iPad EHR system in development it calls Canto, which builds on its popular Haiku iPhone app. Gallo -- who uses Epic software via VNC on his iPad part-time at a hospital -- said it will be a big leap forward for the iPad because it promises to give the large Epic user base access to lab results and other key patient data on the mobile tablets.

What about mobile EHR data entry?

Physicians love the iPad -- it’s lighter and less expensive than a laptop, while its form factor recalls the traditional clipboard chart from the paper-and-pen era.

There are other advantages, too, said Gary Ferguson, president and CEO of ClearPractice LLC, an EHR vendor with an iPad app in development, "The battery life is unreal, so the physicians aren't looking for plugs and recharging and docking stations. The UIs are dramatic and appealing, the resolution is great … and I think the iPad brings the physician back to the device, making them actually want to practice medicine because it's fun and cool."

But its chief downfall in the patient-care workflow is data entry into a mobile EHR, which is more complicated with the touchscreen "software keyboard." Some physicians can use a dock-and-keyboard setup for complex data entry into free-text fields. Others may try their hand at speech recognition software, since the multitasking of the next iOS will make such integration possible, though Gallo said that for his practice, speech recognition software would disrupt the flow of a patient visit.

The key to effective mobile EHR implementation for iPads, Gallo said, is to turn as many processes as possible into electronic forms with checkboxes and other iPad-friendly, one-touch features. This saves keystrokes during a patient visit and helps maintain continuity of eye contact with patients. While Gallo can perform simple one-sentence EHR data entry with the iPad's touchscreen keyboard, he saves detailed patient histories for his laptop or an iPad external keyboard.

Epocrates Inc., which is developing a mobile Software as a Service (SaaS) EHR, plans to get it on to the iPad from the start. Development lead Dr. Tom Giannulli said in an email to that the company will release its iPad app at the same time as the iPhone version. (Though iPhone applications will run on the iPad, Hollis said that using rather rudimentary iPhone apps does not tap into the potential of the iPad.)

Giannulli said he sees the desktop version of the Epocrates EHR as the main portal for data entry, though some will be done in the mobile EHR interface, too.

"Each [version] will accommodate the different needs and practice scenarios physicians face," he wrote. "Specifically, the iPad is perfect for capturing data at the point of care, between provider and patient, and moving from exam room to exam room. The iPhone will be ideal for retrieving information remotely, and the desktop will be fully functional for in-room data entry."

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

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