By Teresa A. Martin
Electronic Medical Records have been around in one form or another for dozens of years. Back in the late 1980s I worked on documentation for a product in this category - those attempts, while hinting at the promise, were pretty klunky and not all that easy to integrate into a workflow, largely because they were tethered to a desktop and weren't terribly user-friendly.
Since then, I've heard the topic discussed in the abstract many times. I've read about its spreading use. I've heard about how bottlenecks in networks halt its used. Finally, this week, I was able to get at first hand look at a typical system currently in the early stage of adoption at a local pediatrics practice.
Know what? It was pretty cool! The combination of tablet laptops with more user-focused software is letting this group, with offices in Sandwich and Yarmouth, take a leap forward without having to walk on the bleeding edge - and is lettings its doctors experience the joys of mobility that other professionals have long had.
Hardware is a key piece in the picture. A big advantage to moving to electronic records - at least from the individual provider's perspective - is to be able to access patient and other key information from any location at any time, in a secure way. And, as needed, to be able to act on that information. By definition, this means portable devices.
The IBM/Lenovo ThinkPad Tablet, which began shipping late last year, is the touchable, tangible chart-and-prescription pad at the heart of this particular solution. Frequent readers may well remember that if I can't have my beloved Mac, my choice of non-Mac quality hardware is the ThinkPad line. The tablet model received rave reviews of PC Magazine and with good reason. It looks nice, balances, nice, and has the kind of flexibility you need to accommodate a direct move from paper to digital by a group with very mixed digital abilities and use styles. It just feels good. And the tools we use need to feel good if we're really going to use them to their capacity.
Several applications make up the digital suite. None are particularly exotic - they are all variations on secure network connections, databases, and document management systems. But the end result is useful and productive.
I followed one of the doctors on his evening routine. He used the table to take a quick look to see the patients in the ER queue. And then quickly scanned updates on admitted patients of his. If you're a doc on call, it turns out that this is a pretty useful, quick, and non-intrusive check in.
I also watched him pull up some CT images to reference some information he was reviewing. Reviewing, that is, from a remote location using a secure login to the patient data.
He moved through another review, using the digital pen to highlight - in blue - some key facts in a digitally faxed report and with another couple of clicks to send comments back to the provider of the report. It will be waiting in the provider's office in the morning.
One patient had left a message for some routine prescriptions to be renewed. Once again, it was a couple of clicks to review the patient record, another few clicks to create and sign the prescription, and with one more one pen to table motion and it was en route to the patient's preferred pharmacy.
Nothing I was watching was wild or groundbreaking or revolutionary -- And that's what is indeed earthshaking about this all.
That we've reached a point with both our hardware and our applications where they are now able to being to transform core business processes in a way that is a natural evolution to the way we already work.
This system, for example, combines existing elements - databases at several hospitals, medical information databases, images management systems, document management systems, prescription management systems - and assembles them for use and consumption by the point of integration - the front line doctors.
There are still bottlenecks. There were a couple a points where the software didn't quite follow the intuitive path and created a few moments of "where's the function again?"
And, the connectivity of our region continues to be an issue. In the practice's Sandwich office, the lack of available bandwidth limits the uses from within that office.
But time will settle these out.
There's always going to be a physician's black bag, only now the black bag will also contain a tablet and wireless cards. Like every industry, primary care medicine is staying the same ... but changing to reflect wider trends. Good practice is still good practice, but the transformation of the business is underway.
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