In the comments of my previous post about Tablets vs. Convertibles vs. Laptop and EMR, we started an interesting discussion about “thin clients” in addition to laptops and desktops in the healthcare environment. From that discussion I invited Bill to do a guest post about the various advantages and challenges of laptops and thin clients with an EMR. Bill did such a detailed job I decided it was worthy of 2 posts. The following is Bill Horvath II’s description of the pros and cons of laptops with an EMR.
Because doctors who have an EMR system need access to patient histories at the point of care, they need a computer in the exam room. Traditional desktop computers have been used for this purpose in the past, however, more cost-effective laptops and thin clients are becoming much more common in clinical settings. This post examines some of the pros and cons of laptops.
An office which chooses this approach will typically have one laptop per physician, and possibly one for each of the other staff members who move between exam rooms, such as nurses. In this scenario, traditional desktop PCs are usually used at the stations occupied by non-mobile staff, such as the receptionist.
- Mobility – The doctor can take a laptop wherever he or she goes, including out of the office. Remote access to charts is usually accomplished via a VPN.
- Local Data Storage – The doctor can easily store files on the hard drive of the laptop, meaning those files are accessible wherever the laptop is, and regardless of whether it’s connected to a network or the Internet.
- Many OS Options – Laptops are available for virtually all of the major operating systems (Windows, Apple, Linux, Unix, Solaris, BSD, Chrome).
- Broad Peripheral Support – Laptops usually have built-in drivers for dealing with a wide variety of peripheral attachments, such as USB mass storage devices, cameras, printers, and scanners.
- Flexible Performance – With a few minor exceptions, the performance of a laptop computer is determined solely by the capabilities of the computer itself, and how it’s used by the person sitting in front of it.
- Require Recharging – When configured for mobile use, laptops run off battery power, which means they must be plugged in periodically to recharge, or the doctor must switch to a freshly charged battery when the available charge runs low. Most laptops will provide two to four hours of continuous use on one battery charge. Laptop battery capacity also typically declines approximately 20% per year, which adversely affects performance over time.
- Expensive – Good quality, business-class laptops start at around $1000, and can range into $3000+ for more advanced units. Necessary accessories (docking station, supplemental monitor, extra batteries, carrying case, etc.) can add significantly to the cost. Support contracts for the laptop can be pricey as well, as the components are tightly integrated and difficult to replace.
- Fragile – Most laptops have moving parts (typically fans, optical drives, and hard drives; also mechanisms such as the connection between the lid and the monitor) which will wear down, and which don’t respond well to being dropped.
- Difficult to Repair – It is often not possible for the doctor or her staff to repair or replace the components of a laptop (such as the screen or keyboard) if they fail. Laptops often need to be shipped to the manufacturer to be fixed.
- Hard to Replace on Short Notice – Even if a ‘hot spare’ laptop is kept in the office for emergencies, synchronizing applications, settings, and files between a (possibly broken) machine and the spare may not be trivial, nor is updating the operating system. This effect is amplified when each doctor has their own particular configuration, and if there is no centralized management server (e.g., Apple Workgroup Manager, Windows Server Domain) in place.
- Complicated to Secure – Because they are mobile, laptops are subject to theft. This problem can be mitigated by encrypting the hard drive, but doing so creates challenges around encryption key management, especially in multi-laptop environments, and as laptops and hard drives are replaced over time. In addition, laptops accidentally left in exam rooms with patients are particularly subject to a variety of security risks, such as accidental damage, malicious hacking, etc., especially if the laptop lacks a two-factor authentication system.
- Limited Upgrade Potential – Most laptops are limited in how they can be upgraded over time (Typically RAM and the hard drive are the only user-upgradable components.) This can become an issue in keeping current with software and operating systems, as new programs often have more stringent system requirements.
- Noisy – The fans, hard drive, or optical drive on a laptop can spin up at inopportune times, creating a distraction, and making soft sounds harder to detect.
- More Complicated Backups – Because a laptop’s data is stored locally on the hard drive, the laptop must be backed up on a regular basis to protect against data losses due to breakage or theft. This typically requires action on the doctor’s part (connecting a cable, triggering the backup function, taking the backup medium off-site), though some systems come with an automated backup system which can function wirelessly. However, changes to the laptop’s files which occur between backups may be irretrievably lost if the machine is compromised.
- Require Individual Updates – Laptops which aren’t managed by an administrative server require individual patching to stay current with operating system and application updates. Furthermore, since laptops aren’t typically on for automatic updating late at night, the update process which takes place during the day may interrupt the doctor’s workflow by forcing reboots at inconvenient times. Laptop firmware also usually requires manual updating, a process which may not be especially ‘user friendly.’
Bill Horvath II is the CXO of DoX Systems, a company which offers medical office productivity solutions to physicians in private practice. Their flagship product is DoxCIS, an electronic medical records system.