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In choosing EHR for iPad, consider native, virtualized, hybrid options

As physicians continue to use the iPad, an EHR system for the device isn't far behind. Here two experts discuss the pros and cons of native, virtualized and hybrid EHR apps.

With physicians and other health care professionals eager to use their iPads on the job, tablet support is becoming an important consideration for health care IT organizations as they evaluate electronic health record (EHR) systems. Whether upgrading a legacy EHR system or implementing an EHR system for the first time, the merits of a native vs. a virtualized EHR for the iPad is a question that's sure to come up.

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When considering a native or virtualized EHR system, IT needs to consider how the application will be used by the end user as well as how it will be managed within IT. Shahid N. Shah, CEO of Netspective Communications LLC and blogger at The Healthcare IT Guy, recommended that health care organizations consider EHR for iPad as a "read-focused companion" to the larger application.

"No one is going to throw away desktops for an iPad," Shah said. "If you're doing [mobile EHR as] a read-focused companion, virtualization is quick, secure and easy to deploy. It’s a great place to start."

A virtualized EHR application is typically no different from an organization's existing EHR in terms of the user interface. Instead of sitting on each workstation, the application itself and all data reside on a server. The user interface is delivered to the end user device -- in this case, the iPad -- and the application is no different from the one users are accustomed to using on a desktop.

As a result, it doesn't leverage the built-in functionality of the iPad. Users must zoom in, zoom out and scroll to navigate a single screen within the application. 

"The trade off for the user is that yes, they're giving up the native application experience, but they're gaining mobility for their corporate applications," said Shawn Torkelson, managing director for clinical and health IT consultancy Stage7 Systems. "A doctor can fire up his iPad from Starbucks and -- boom -- he's in his EMR. Will it be a little bit cludgy? Sure. But you're getting mobility."

On the other hand, the IT organization benefits from ease of deployment, management and security. "If you’re a consumer, native applications are fantastic. If you're a corporate user, then you want that security blanket," he said. "Especially if you're the CIO or director, you want to be able to control the environment as much as possible."

This becomes critical not only as the number of users accessing the EHR for the iPad grows, but also as their requests to access other applications grows. Users are likely to ask for access to the patient registration system, a file system application and office productivity apps, Torkelson said.

It is much easier to accommodate these requests when the applications are centrally managed and streamed down to the end user, he added. Because all the data for virtualized apps is stored on the server, as opposed to the end users' devices, IT can more easily secure data and provision users as well.

Hybrid EHR for iPad looks like native app, runs on server

While end users often start using the iPad as a consumption device, Shah said, "Over time, they need more -- connections to Windows apps, for example -- or the ability to read and write."

When you write a Web page, you never write it for IE or for Chrome. You write it so that it works for both. Do not write systems that only work on iOS today.

Shahid N. Shah, CEO, Netspective

This is where health IT organizations may want to take a step further with the hybrid application model, in which applications are built for thin clients.

"As soon as you move beyond read capabilities to full functionality, then the best design is the hybrid model. It still looks like an iPad app, but all the data, functionality and security is still managed on the server."

In doing so, Shah recommended that developers not specifically write an EHR for iPad use, or an EHR specifically for Android devices.

"Write to a thin client so [you] don't have to react to each device," he said. "When you write a Web page, you never write it for IE or for Chrome. You write it so that it works for both. Do not write systems that only work on iOS today. While iOS is cool, in five years it might not be, and what are you going to do?"

Crystal Bedell is a technology writer and editor. Her articles, tips and guides help IT professionals evaluate technology, secure and modernize their IT infrastructure, solve business problems, and prepare for IT certification. She can be reached at or contact @SearchHealthIT on Twitter.

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