The iPad Opportunity – A Decent EMR Interface

Yesterday, I created a post on EMR & EHR called The Must Have EMR Feature – An iPad Interface. that post has driven quite a bit of discussion on Twitter and Google Plus. One comment from @2charlie hit me the most though:

2charlie – Charlie Gaddy
A decent web interface wouldn’t hurt either. RT @ehrandhit: The Must Have EMR Feature – An iPad Interface dlvr.it/tYkN7

Charlie’s twitter response highlights a number of interesting ideas. The first point that every SaaS EHR company will point out is that he said a web interface. We could go into the semantics of what is “the web”, but I have little doubt that Charlie meant a browser based interface when he said web. I’ll leave the rest of the discussion of “web” EMR interfaces for another post (plus, we’ve had that discussion many times on this site).

Instead, I want to focus on his use of the word “decent.” That adjective is interesting because no one would really argue that there aren’t plenty of web EMR interfaces out there. If you look at the EHR Scope EMR Comparison site, you’ll see a huge number of web based EMR companies listed. However, when you add the word “decent” to web EMR interface, I think we could have some really interesting discussion.

At least a couple times a week I get a doctor sending me an email or posting a comment on my website saying that “all of the EMR interfaces are terrible.” I don’t necessarily agree that “all” EMR interfaces are terrible, but a lot of them do fit the description quite well. I’m sure at this point all the EMR companies are thinking about their competitors and agreeing with me.

The iPad Opportunity for EMR Interfaces
As I thought on Charlie’s comment of a “decent web interface” as compared with an iPad EMR interface, I realized that the iPad provides a unique opportunity for EMR vendors with less than stellar web interfaces. While it would be great for EMR vendors to create stellar web interfaces or improve their current web interfaces, that’s much easier said than done. Many are working on older technologies. Others have so much company culture built into their interface that it’s hard to change. Many have large user bases that will freak out at the idea of a new web interface. Etc etc etc! The point being that the culture and history of many EMR interfaces make it hard to change.

In these cases, I see the iPad as a great opportunity to start fresh with your EMR interface. Many EHR vendors could use the iPad as a way to be able to create a new interface for their EMR with all the knowledge they’ve learned over the years baked in. Doctors expect the iPad interface to be different and unique.

I’ll be interested to see which EMR companies take this opportunity and make something of it. It’s the perfect chance for EMR companies to create a paradigm shift in their EMR software without having to admit publicly the mistakes they made in their first EMR interface. Unless you happen to be from an EHR company who built the perfect EMR interface from the start. Then, this need not apply.

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

  • Until EMRs feel as good to use as any Intuit product, I wholeheartedly agree with the statement that interfaces are terrible. I think health delivery systems made the mistake of demanding complex functionality at the outset instead of simple products that were a joy to use and then building meaningful functionality from there. I respect MU but think it puts further pressure on EMRs to focus on functions rather than design and usability.

  • As a designer I can tell you that some of these companies don’t have a single skilled designer on their teams. This is shown by the fact that their systems break basic rules taught in first year design courses. Simply following some fundamental design principles doesn’t require a technology overhaul. Even changing the size and weight of type can improve things.

  • I think if the EMR companies knew how to make a useable product, they’d have done it by now. It’s not just EMR companies that fail us, it’s Microsoft. When I need information I need it now. I don’t care if I have unused icons on my desktop, if my virus definitions are out of date, or if flash wants to install. I don’t want to press control-Alt-delete. Just like Apple came along and gave us a new operating system, I would look to new companies to come along and give us the better interfaces that use the better OS.

  • The iPad, or any tablet for that matter, is lousy input device.

    No matter how many cool twisty wheels or slides are put on a screen, it is still clunky on a tablet.

    A major reason for apps is this poor interactive capability.

    Tablets can be great for pulling up data, reviewing images and making minor data input, but beyond that you really want a keyboard and mouse…no matter how much apple juice you drink.

  • John, try Keynote, Garage Band, Codify, or App Cooker on your iPad2 for examples of applications that support incredibly complex workflows. Now imagine that plus voice recognition. The mouse and keyboard were always an impediment, require considerably more hand-eye coordination, and come between you and the application. I don’t know anything about other tablets which may be, as you say, clunky.

  • Great discussion.

    Brian,
    Apple was actually an existing company that was almost left for dead and came back with the iPod, the new desktop and then the iPhone and iPad. So, that example actually indicates that the right EMR company could use the iPad as I described above and revive their company by leveraging a new interface to revolutionize who they are as an EMR company. It definitely takes a unique individual and company to execute on that vision, but the opportunity is there.

  • The real game changer is Siri, Apple’s new voice recognition for the iPhone 4S. It not only recognizes speech but intelligently acts on it. When it gets opened up to all iPhone and iPad app developers things will get very interesting. There will be some incredibly innovative things done with it. It’s safe to say we’ll all be typing less and talking more in a few years.

    Also, Siri is more than just a feature. Siri is what Google dreams of being. Intelligent search with action attached. In a few years Google may be second in search behind Apple.

  • Hi,

    At Sydney’s North Shore Medical Group we’ve been trialling Claydata’s iPad EMR interface (http://www.claydata.com) for almost two years now – naturally there were a few bugs but once they were ironed out it seems to work really well. It’s got a good balance of GUI and actual functionality, stability and it plugs into the rest of our EMR systems.

    Dr Cape

  • Got this item yesterday in my daily HealthIT Strategist email published originally in CIO on Monday.

    “iPad in Healthcare: Not So Fast”
    http://www.cio.com/article/693401/iPad_in_Healthcare_Not_So_Fast?source=cwartsnip

    I’m just a pilot … just a dumb pilot … or at least I used to be one. I’m not an IT guy … but sometimes I wonder how some folks survive in this world … especially in their area of expertise. Had this story been about a hospital testing iPads in say … southern Sudan … then I might have understood their dilemma and surprise at their test results. But this test was in Seattle.

    How is it that the CIO of this place and staff didn’t understand that an app built for a full screen monitor has to be modified if you are going to view it on another platform? Don’t they view apps on their mobile phones in Seattle?

    From the CIO piece …

    Seattle Children’s Hospital seemed like a perfect fit for the iPad. After all, Wright’s team was in the middle of a massive virtual desktop infrastructure, or VDI, rollout that would allow personal computers to run apps and access patient information and other corporate assets with only an Internet connection and a Web browser.

    On the iPad, a clinician could open up Safari, log into Seattle Children’s VDI Web site using two-factor authentication, and fire up the popular Cerner EMR app hosted on Wright’s servers—but that’s when the trouble starts. EMR apps are just not built for touch-based devices with tiny screens.

    One app was designed to be used with a 21-inch monitor. “The clinical app takes up a lot of screen real estate so you can get the big picture view of the patient,” Wright says. “The app is very point-and-click, mouse-and-keyboard driven.”

    So … maybe the CIO in Seattle knew there was liable to be a problem depending on being able to operate via remote desktop and told their EMR developer that they needed a native iPad EMR app. For whatever reason preliminary testing before the test must have given them false confidence of success.

    I think there is strong evidence that many docs love their iPad for not only their clinical use in their office and in the hospital. These physicians are going to be far more loyal to their iPad than their hospital’s EMR with its poor interface.

    Ambulatory EMR developers will have effective interfaces developed faster as EMR usability will become more and more a key competion factor. In their own office they are going to make sure there is an effective interface between the iPad they bought … and the EMR they bought.

    I would have thought that a big hospital CIO and staff knew about the criticality of ensuring an effective EMR interface … and the author of the piece blaming the iPad when it was the EMR sytem’s failed interface. Unless enterprise inpatient EMR developers with their older technology programming develop effective interfaces between their platform and the ever growing mobile computing platforms they will grow further and further at risk of failure and losing their business space to those developers who understand the first level imperative of an effective interface.

  • Don B, that is hilarious and sad. It shows how motivated people are to get mobile—but only an idiot would think you could run a desktop application on an iPad. I actually asked a few vendors at a recent conference whether they had iPad apps in the works. What I get from salespeople is this: “Of course! You just install Citrix and there you go!” And then they pinch and zoom, pinch and zoom.

    That’s why I maintain that it will be a new wave of companies that come in from the mobile space, not the old EMR companies we know and loathe. Or maybe, as John said, it will be a company on the ropes who bounces back by having the courage to abandon their old ways. But seriously, does anyone think Meditech or McKesson really has the focus or foresight?

    (I do know Epic is working on an EDIS for iPad—but what I’ve seen of Haiku doesn’t give me a lot of optimism.)

    Epic, you are our only hope (currently). If you’re reading, here’s the workflow you need to support:

    1. I walk in the room, shake hands, look the patient in the eye, then scroll through the patient problem list, medication list, and vital signs.
    2. I take a history and jot a few notes with my finger or stylus.
    3. I slip the iPad into my iPad-sized coat pocket and perform a physical exam.
    3. I pull out the device and speak a few orders “Epic, order CBC, INR, Chem-14.” Then tap to confirm and submit.
    4. I confirm the plan with the patient and dictate the HPI as I walk to the next patient room, referring to my digital scratch pad.

    See? No COWs, no looking around for a workstation, no logging in and out, no transferring MRSA from keyboard to keyboard, no point-and-click, no sitting down.

    Maybe they’re worried it will seem so simple they won’t be able to charge $50M for it.

  • Brian,
    Does Epic employ any sort of voice recognition in their existing app? Maybe they do, but I’ve never heard anyone talk about it.

  • You can use a siloed version of Dragon on the desktop with Epic–“talk to the cursor.” It’s not integrated the way Wellsoft is (i.e. you can’t use voice to place orders or navigate). Their mobile app Haiku does not have Dragon Medical Mobile, or at least it didn’t when I tried it a few months ago. It does “support” dictation, but I think this means sending audio files to a back end transcription system, not real-time.

    They seem to have all the pieces but for some reason can’t or won’t put them all together. Typical of big EMR–though they are further along than some.

  • I figured it was the standard “Every EHR vendor has voice recognition” answer since Dragon can pretty much work with any software. Definitely far from having deep integration in a seamless way.

  • At drchrono we are always thinking about how to create the best experience for our physician users, creating a great interface is key, doing that by listening to users is a big part of how we develop.

    Check us out when you have time, http://drchrono.com

    Daniel, cofounder drchrono

  • The iPad was always a native device we supported, as well as Kindle Fire, Windows 8RT, and Windows Mobile. One interface across all devices, we understand that practices should decide on the endpoints (computers, tablets etc.) that they should pick.

    John, I do agree with your statement about this being the chance for existing vendors to retool the existing interface to support a better user experience.

    Or practices can simply implement digital physician EHR with no risk today!

    http://www.digitalphysician.com

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