Tablets vs. Convertibles vs. Laptops and EMR

The one fundamental to every EMR is some sort of computer. Yes, I’m using this in the broadest since possible since there are many EMR today that are now even compatible with something like the iPhone. However, even the little iPhone is essentially a mini computer. However, computer makers have long believed that the tablet computers were great for healthcare.

As I look back over my 4 years writing this blog, it’s really interesting to see the evolution of the tablet technology. We first bought our tablet computers over 4 years ago as we implemented our EMR. Correction, we bought our first convertible tablet computers over 4 years ago. They served us quite well. The crazy thing is that almost none of our providers used any of the tablet functionality. I can count on my hands the number of times it was really beneficial to have the tablet functionality.

Since we actually ordered the convertible tablets (converts from a laptop to a tablet), all of our users pretty much just used it like a regular laptop. These convertible tablets came up for replacement as they went out of warranty and it was pretty much a no brainer decision to just purchase laptops instead of convertible tablets.

I’m not saying that the tablets aren’t without their merits. However, none of my users really adopted much of the functionality. In fact, I think I used it more than all of the clinicians combined. Although, there was one feature of the convertible tablets that was used quite often. The swivel screen. Yes, the least technical part of the convertible tablet technology is what they found so useful. They loved being able to swivel the screen to show another provider something in the EMR.

As I researched the various tablets available today as opposed to 4 years ago, I found that no computer manufacturer offered any convertible tablet larger than the 12″ screen. The ones we purchased for use with our EMR were 14″ and we didn’t want to go down. In fact, since we did away with the tablets and just went with laptops, we moved up to the 15″ monitors and all of the providers love the extra space to more easily navigate the EMR.

Of course, the computer manufacturers say that the reason they only do a 12″ size is because no one wants to carry the 14″ ones around. It’s true that 14″ is quite a lot for many providers to carry around. That’s why we just put computers in each exam room. No more carrying computers around and a nice size monitor for your EMR wherever you go.

This said, in one of my EMR consulting gigs I’ve done here locally, the doctor carries his 14″ laptop around no problem. He replaced his laptop recently and decided to continue with the same.

I was lucky enough to just get one of the second generation Dell convertible tablets. It has not only touch screen technology, but multi touch technology. It’s a lot of fun to demo and show off. However, I just don’t see much practical application for it. At least not until I implement an EMR that has touchscreen in mind when they develop the EMR.

What are your thoughts on Tablets, Convertibles and Laptops? Have you found a compelling reason to use the tablet technology in your office?

About the author

John Lynn

John Lynn

John Lynn is the Founder of the HealthcareScene.com, a network of leading Healthcare IT resources. The flagship blog, Healthcare IT Today, contains over 13,000 articles with over half of the articles written by John. These EMR and Healthcare IT related articles have been viewed over 20 million times.

John manages Healthcare IT Central, the leading career Health IT job board. He also organizes the first of its kind conference and community focused on healthcare marketing, Healthcare and IT Marketing Conference, and a healthcare IT conference, EXPO.health, focused on practical healthcare IT innovation. John is an advisor to multiple healthcare IT companies. John is highly involved in social media, and in addition to his blogs can be found on Twitter: @techguy.

17 Comments

  • We typically recommend Sun Microsystem’s Sun Ray product line to our clients for in-office computing (See Sun’s store for some basic information.) This system is ideal for a healthcare environment: Two-factor authentication (smartcard and username/password) is built in; the machines are inexpensive, highly reliable (no moving parts), and very power efficient; they’re infinitely more secure than typical laptops (there’s no local data storage, and the systems themselves are inoperable without a smart card); there are no batteries to recharge, and no computer to lug around or drop. The best part is what Sun calls “hotdesking”, in which your desktop session follows your smart card to whichever terminal you happen to be using. We’ve had great success with this system in our client’s offices and our own. If you’re in a position where you’re considering purchasing new laptops for EMR access in your office, the Sun Ray system is definitely worth consideration as an alternative.

  • Bill,
    These types of “thin clients” are really gaining some steam from both Sun and VMWare. The only problem is that there’s a huge up front cost for the background hardware you need to make this happen. Plus, in most small practices, they don’t need that many machines. So, since they don’t need that many machines they don’t have enough scale to really enjoy much cost savings. Nor the technical expertise to manage that type of implementation. Especially if you compare this type of outlay with say one laptop computer.

  • John,

    Good points, but the Sun solution isn’t as expensive on the back end as you might think. Sun’s software is almost all open source now, which means you save a tremendous amount on licensing. Smaller practices don’t need a particularly juicy server for this kind of implementation, either — As a rough estimate, I’d say around $2500 per physician is a good guess. (Our quotes are around that figure, anyway.)

    As far as technical expertise goes, that’s of course what companies like mine bring to the table, but even so, Sun Rays are (in our experience) blissfully easy to use and support once the system is installed. If you go to the local computer store and purchase and install your own hardware, you’re acting a bit like the patient who tries home remedies before going to the doctor — It might work, but you might make things worse, or more expensive to fix, by the time all’s said and done.

    As far as ‘one laptop’ goes, if you only need one computer in the practice, you either only have one employee (the physician herself), or your not taking advantage of all of the functionality that a good EMR brings to the table.

  • Bill,
    $2500 per physician, with a minimum of how many physicians generally? Would you run this off of one server at a cost of $2500? I guess then you’d still have to buy all the thin clients at what cost?

    Of course, my point is that without scale I think you run into cost issues. Luckily the costs of the servers and the software has come way down and so it seems like this type of setup would be great for a medium size office. However, doctors should just be aware of the limitations of thin clients. Basically, the reasons why everyone is looking at this setup in the IT world, but few people have implemented it system wide. In the next few years I think this will probably turn the corner too.

    I’m also interested in what you think about relying on Sun. Weren’t they just acquired or something? I can’t remember the details, but one of my colleagues was a little nervous about the future support for Sun products.

    I agree with you whole heartedly about partnering with a quality IT firm. Especially if you’re going to implement something as technically intense as thin clients. In fact, I had a good discussion about some of these issues at an EHR Stimulus Money presentation I did for an IT firm in Austin.

    As far as ‘one laptop’, the point is that the doctor would only have to have one laptop instead of one computer at his desk and one computer in each exam room. Granted we have to take into account nurses, etc, so I’d say using laptops probably cuts the number of computers needed in half. Assuming you don’t mind carrying a laptop around with you.

  • John,

    Great questions! Here’s my two cents:

    “$2500 per physician, with a minimum of how many physicians generally? Would you run this off of one server at a cost of $2500? I guess then you’d still have to buy all the thin clients at what cost?”

    The price I’m suggesting here is for a minimum (one) physician practice. After three or four doctors, the price/doctor ratio should start to taper down below this price point, as these systems scale well. Yes, we’d run this off one server — We’ve done it this way for years at our clients, as it makes it affordable. The cost of the thin clients will depend on the model, you can see Sun’s list prices in their online store (see my first post for the link); our quotes usually come in below list. Note that these devices typically last five to ten years; we have units in use our office that were manufactured in (e.g.) 2002 that we use every day.

    “I’m also interested in what you think about relying on Sun. Weren’t they just acquired or something? I can’t remember the details, but one of my colleagues was a little nervous about the future support for Sun products.”

    Sun is being purchased by Oracle. The deal has been approved by Sun shareholders, and is awaiting approval from the justice department (I expect they’ll ultimately approve it.) As you can imagine, I read the tech news closely every day, and it’s not entirely clear yet what Oracle’s intentions are regarding the Sun Ray technology in particular. The obvious options are keep it (reasonably likely), kill it (highly unlikely — way too valuable), or sell it (I hope so; I’ll be lining up investors as soon as I get the word it’s available.) I’m hoping Sun will open source the Sun Ray Server software, much like they’ve done with the rest of their offerings, but we’re researching alternative vendors just in case. So far, the leading contenders are Citrix (which offers “smooth roaming”, similar to hotdesking, but I don’t know the licensing details yet, or whether it supports smartcards); teradici (we’re looking at their partner offer), and panologic (I believe this company was started by some of the engineers who designed the Sun Ray system. Their offering isn’t as convenient, as it requires VmWare be installed separately.)

    Historically, we’ve favored Sun servers as well; they’re amazingly reliable. We’re waiting to see what Oracle plans to do with Sun’s hardware line, however regardless of what they do, I expect they’ll honor Sun’s existing (pre-merger) support contracts through the end of their terms. If Oracle kills hardware production entirely, we’ll probably switch to HP or IBM.

  • Bill,
    Please let us know how the Oracle acquisition turns out for the Sun Ray system. Now that I think about it, some of my colleagues at my day job were testing a couple of these out. I assume it must have been the Sun Ray system.

    I’d certainly welcome a guest blog post if you’re interested comparing a thin client implementation with a standard desktop/laptop environment. I’d just be interested in it covering realistically both the benefits and limitations of such an implementation.

  • John,

    I’d be honored to write a post comparing the costs and benefits of both kinds of systems in a balanced fashion. Please let me know how to submit it.

    On a separate note related to the original topic, Always Innovating’s Touchbook is another product your readers might like to know about. I’ve got one on order, and I’ll try to remember to post a review when it comes in.

  • Bill,
    I’ve sent you an email about the guest post.

    That’s a killer product. Pretty innovative I’d say. It’s really interesting all the movement going on in the Netbook space. I can’t even keep up it’s moving so fast.

  • Anyone crazy enough to spend an $1k-$2k Wacom Cintq (combination LCD/graphics tablet) for clinical use? They’re meant for computer artists, but I thought it would be interesting to have a big screen lying almost horizontal while taking notes and accessing data at the same time. I usually keep a paper chart on my lap, but that’s just my style. Citiqs are usually attached to desktop computers.

  • Nova doc,
    I’ve always wanted to try out a Wacom tablet as a simple replacement for a tablet PC. Seems like a good option in some situations. The LCD addition is interesting. Just a little pricey it seems.

  • Very much looking forward to the article on Thin Clients vs. Tablets. Thanks!

    I’d also be curious about Thin Clients vs. Fat Clients in exam rooms too. The portability of an instance with Citrix offers a huge benefit in my opinion, but maybe it isn’t really necessary as long as the fat clients are turned on already.

  • Nick,
    I kind of let this one fall off the map I think. Maybe I should go back to the pros and cons of thin clients vs. tablets etc.

  • I envision using convertible laptops or tablets for presenting materials in classrooms or small groups. Possibly allowing the teacher to walk amongst the students, tablet in hand, manipulating the presentation and allowing students to interact with it as well. In the medical field I suppose the tablet would reduce the need for paper. Patient files would require less space and might be easier and quicker to access. Also, tablets would allow you to share information and highlight, manipulate, or focus on areas of a graphic such as an xray or ultrasound.

  • First of all several ppl that are compenting must not be in the medical field! All medical practices are being forced away from paper charts and into EHRs! So whether your style is paper or not does not matter any more. Our office had one of the first tablets put out on the market for medical use. They did not like them because you had to dock it to be able to type. We then ventured into putting desk tops into all exam rooms. This also did not seem to do the trick as you can not place them anywhere in the room to have the doctor facing the patient and not the wall. We are now exploring the Fujitsu Tablet which has an attached keyboard that folds to the back and can be used as a tablet. No docking required to type! the tablets look very nice and sleek but the functionality of them is not very realistic when in reality, at some point before the chart is signed off on, the physician will have to type.

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