7 ms·

IPad in Business: St. Louis Urgent Cares

94 points by pg 15y ago

simonsarris 15y ago
It looks like the same app is available for android, though it doesn't have all the features yet: https://market.android.com/details?id=com.drchrono&rdid=com.drchrono https://market.android.com/details?id=com.drchrono&rdid=... If the versions are the same in the future (so the same app is available for android tablets), why would doctors/hospitals choose the iPad over an Android device? Would there be any compelling reason for doctors/hospitals to want one over the other?
- sudont 15y ago
  It's harder to provision an Android device to HIPAA requirements. iPads are also cheaper.
  - josteink 15y ago
    My Asus Eee Pad Transformer with maxed specifications (32Gb storage, 3G & wifi and keyboard dock with SD-card reader, USB-slots and about 8 hours extra battery-time) costs me the same as an 16GB 3G iPad 2. That's a 16GB storage and keyboard dock in delta, and not in Apple's favour. It may be a more favourable comparison if you go for the plain iPad, but Apple doesn't sell them any more, at least not where I live. Anyway: Putting out "iPads are cheaper" as blanket statement like that is either uninformed, dishonest or plain trolling.
    - sudont 15y ago
      Fewer ports are better with HIPAA. You don't want somebody sneaking out data on a card. You don't want doctors with all their personal crap on the tablet, so what does it matter if there's 2x the storage on a Transformer? Do you put 2-3x times the ram in a dedicated app server just because? In this case, everything a consumer wants is antithetical to what the hospital wants. I think you're the one trolling, talking about consumer needs in a locked down situation. Also, seriously? 'My old account evidently got flagged "troll" for speaking against the Apple-worship cult found on HN.'
      - josteink 15y ago
        My point was that compared to the Android-option the iPad is more expensive. The minimum config Transformer is cheaper than the minimum config iPad. I've even backed my statement up with numbers. What part about that is trolling? You are the one with blanket-statements and no data. Also, seriously? 'My old account evidently got flagged "troll" for speaking against the Apple-worship cult found on HN.' PG emailed me telling me I had been a bad boy. Now that account is thrown in the deep end of the QOS pool and the site is slow as fuck unless I log on with another account. Besides that votes are not recorded (which is easy to verify using two accounts) and the account is not allowed to submit stories to HN at all. So yes. Seriously. Edit: Sigh. Downvotes?
      - absconditus 15y ago
        HIPAA does not enforce anything related to the number of ports or any other such nonsense. Most hospitals use standard laptops and desktops with more ports than a tablet will ever have.
    - azulum 15y ago
      for many, the value proposition of apple products means that they less expensive—that is, they cost less frustration. this is not always so—you consider a card reader and usb-slot and keyboard dock to be a net win, but not everyone feels that way, and considering the dearth of honeycomb apps still, it's no surprise that not everyone feels that way. anyway: putting out (and i paraphrase) ipads aren't a better value for most is either uninformed, dishonest or plain trolling. for the record, i like the transformer—great screen, pretty fantastic hardware, but good is hardware without great software?
  - absconditus 15y ago
    You are grossly overestimating the difficulty of complying with HIPAA.
- joelhaasnoot 15y ago
  I'm working on a project with this and my weekend research found while there's a ton of Android 2.2 tablets that are cheap, none of them can rival the build quality or battery life of the iPad. The iPad in a kiosk sense does have a nasty issue: there's no way to block the home button but to build a case around it, or jailbreak it (which isn't a very sound thing to do operations wise)
deleted 15y ago
[deleted]
prosa 15y ago
For those who didn't know, the featured app, "drchrono" is from a YC W'11 company. Congrats!
gacba 15y ago
I love that they're doing this. It does, however, bring up one disadvantage that the paper record does not. Suppose you're sitting in the room with your loved one and you want to see what the doctor wrote about their condition and treatment suggestions. You can pick up the records and look through them, and ask questions about what you don't understand. With the iPad, you're kind of left out in the cold and at the mercy of whoever is there. That's a weakness of the system I'd like to see them address. BTW, I'm not saying that you'd be able to understand all the medical shorthand on the charts, which is definitely a language unto itself, but you'd at least be able to have a starting point for a conversation. "Hey, what's this..?"
- inuhj 15y ago
  I've never had a patient ask for their medical records...and frankly they wouldn't understand them if they saw it. It's filled with doctor's handwriting, abbreviations like OM(otitis media), PRN(take med as needed), etc. It's mostly a reflection of what the patient has told the doctor and doesn't contain much information that is useful to the patient. It would be better to ask the doctor your questions directly. If you read the chart and asked me "hey what's this?" for every question I would be tired of you within 2 minutes and tell you not to worry. If it was important I would tell you.
- absconditus 15y ago
  Hospitals generally print out a copy of electronic records if patients want to see them.
dmix 15y ago
Having real people using the app in a video demo is 10x more effective than a cute animation explaining your features.
inuhj 15y ago
tldr: Drchrono does the exact same thing as any other EHR...but on an iPad. "Physicians can each create their own exam templates and enter data quickly by tapping checkboxes or selecting from menus, rather than having to write or type. For physicians who don’t type well, the touchscreen makes information-gathering a lot simpler than trying to use a keypad, says staff physician Dr. Carol Ann Smith, who also takes advantage of the speech-to-text feature in drchrono EHR to dictate notes." As someone who spent the last hour charting(takes me about 2 minutes a patient with templates) I think this part of the article glosses over the real difficulty of using a tablet for EHR--namely that when patients are sick you have to manually enter a lot of data that wouldn't be in your template. For example: Subjective Findings: Patient presented to clinic for a 4 day history of cough and 2 day history of vomiting. He has vomited 3 times and there is phlegm in the vomitus. He also complains of a rash on his forehead that has spread down to his trunk that is maculopapular and itchy. The patient denies any fever, chills, dizziness, or headache. A template can't do that for me...and it's a pain to enter that on a tablet. It effectively nullifies the use of tablets as effective EHR. In my opinion the ideal solution is a macbook air(or similar ultralight) based EHR.
- ericd 15y ago
  I think a keyboard dock could make those cases bearable, though, no?
  - inuhj 15y ago
    Yes, indeed. That's what I suggested to my attending...that he have keyboard docks in every exam room for the tablet. That would solve the data entry problem but we would then essentially have a laptop that has a touchscreen instead of a mouse. I'd like to try it but my attending already made up her mind against getting a tablet.
    - ericd 15y ago
      Cool. I think the touchscreen itself could probably get you there 80% of the time without being docked, so a bit different from a laptop with a touchscreen :-) Might require thinking about the flow of an encounter, though, so that it's docked at the appropriate times. That could be a problem?
baptiste 15y ago
It's all about internal purpose. Any experience with iPad in public access that all the customers of the point of sales can use?
- dmix 15y ago
  Lowe's is deploying 42,000 iPhone apps for use on the retail floor. http://www.appleinsider.com/articles/11/09/08/lowes_deploying_42k_iphone_based_pos_systems_in_retail_overhaul.html http://www.appleinsider.com/articles/11/09/08/lowes_deployin...
logjam 15y ago
We've tried iPads in our practice for EHR, including a trial of Dr Chrono. It is unusable because: - it takes too long to enter notes on a tablet. A "template" system is way too inflexible. - the dictation feature didn't work. - nobody has ever been able to even begin to convince us that our patients' data was secure. Laptops work MUCH better. We do use tablets for patient education purposes, for which they are much better suited.
- r00fus 15y ago
  Consider the iPad all by itself doesn't do EHR, what software packages did you try out before bailing? Aren't there any packages that check all the regulatory and usability requirements for usage in a hospital/clinic?
- Duff 15y ago
  What is the security concern?
- RyanKearney 15y ago
  >nobody has ever been able to even begin to convince us that our patients' data was secure. Just use Citrix then instead of some random third party application?
- dr_ 15y ago
  I haven't tried it, but maybe with iOS 5, which is rumored to offer markedly improved speech to text capabilities, it might make a difference. I agree that templates don't work great.
- brandon 15y ago
  If you're already using laptops in your practice, you might take a look at ElationEMR. I got a chance to try their browser-based app a few months ago and was impressed with how well they handle data entry. For all that I like my iPad, typing is still something of a sore point.
- rdl 15y ago
  I worked on PACS and incidentally integrating with EHRs in the past -- I'd be very interested in talking with you about exactly what security concerns you have with this kind of solution and figuring out how a system could satisfy them. I think the dictation issues are non core; either apple fixes it in iOS 5 or drchrono could integrate with a third party transcription provider. The template and macro thing is definitely at the core to a good ehr
jannes 15y ago
Aren't you asked to turn electronic devices off when you enter a hospital? I don't understand why there's an exception for the iPad. And at least from what you can see in the video their iPads are not in airplane mode, but are actually connected to WiFi and the AT&T network.
- r00fus 15y ago
  I've been in waiting rooms, recovery rooms, at the bedside of post-surgery family, and never been told to shut off my iphone (despite written warnings saying exactly what you mentioned).
- Duff 15y ago
  When cell phones were new, there was some hand-waving regarding the risks of planes crashing, respirators stopping, etc. As is often the case, these risks were not very credible. The signs stay up because while the RF signals won't kill anyone, listening to people jabbering on the phone is very annoying. For example, my wife's pregnant, and we spent some quality time in her OB/Gyn's waiting room the other day. Hearing another patient screaming into phone with a graphic recounting of the bursting of some sort of cyst for 30 minutes made the experience of sitting in a 90 degree waiting room for a half hour that much more noxious.
- rdl 15y ago
  Inside radiology rooms it may be the case, and is absolutely the case in MRI (no metal includes no iPhone...) I'm sure there are quiet area no cellphone rules for patient/staff sanity, not RF concerns, elsewhere.
- absconditus 15y ago
  Most hospitals use WiFi networks already. Most clinicians use their cell phones in hospitals already.
CrystalKoo 15y ago
Wouldn't the iPad be a good way to spread germs?
littlegiantcap 15y ago
Laptops are going to be cheaper, last longer, and going to be harder to break IMHO. IPad's are fun and I definitely use mine, but I'm not sure if they are the best bet for this application. Outside of looking cool and making patients think their doctor is really technologically advanced I'm not sure what they bring to the a table that a much cheaper netbook couldn't.

94 points by pg 15y ago

It looks like the same app is available for android, though it doesn't have all the features yet: https://market.android.com/details?id=com.drchrono&rdid=com.drchrono https://market.android.com/details?id=com.drchrono&rdid=... If the versions are the same in the future (so the same app is available for android tablets), why would doctors/hospitals choose the iPad over an Android device? Would there be any compelling reason for doctors/hospitals to want one over the other?

sudont 15y ago
It's harder to provision an Android device to HIPAA requirements. iPads are also cheaper.
- josteink 15y ago
  My Asus Eee Pad Transformer with maxed specifications (32Gb storage, 3G & wifi and keyboard dock with SD-card reader, USB-slots and about 8 hours extra battery-time) costs me the same as an 16GB 3G iPad 2. That's a 16GB storage and keyboard dock in delta, and not in Apple's favour. It may be a more favourable comparison if you go for the plain iPad, but Apple doesn't sell them any more, at least not where I live. Anyway: Putting out "iPads are cheaper" as blanket statement like that is either uninformed, dishonest or plain trolling.
  - sudont 15y ago
    Fewer ports are better with HIPAA. You don't want somebody sneaking out data on a card. You don't want doctors with all their personal crap on the tablet, so what does it matter if there's 2x the storage on a Transformer? Do you put 2-3x times the ram in a dedicated app server just because? In this case, everything a consumer wants is antithetical to what the hospital wants. I think you're the one trolling, talking about consumer needs in a locked down situation. Also, seriously? 'My old account evidently got flagged "troll" for speaking against the Apple-worship cult found on HN.'
    - josteink 15y ago
      My point was that compared to the Android-option the iPad is more expensive. The minimum config Transformer is cheaper than the minimum config iPad. I've even backed my statement up with numbers. What part about that is trolling? You are the one with blanket-statements and no data. Also, seriously? 'My old account evidently got flagged "troll" for speaking against the Apple-worship cult found on HN.' PG emailed me telling me I had been a bad boy. Now that account is thrown in the deep end of the QOS pool and the site is slow as fuck unless I log on with another account. Besides that votes are not recorded (which is easy to verify using two accounts) and the account is not allowed to submit stories to HN at all. So yes. Seriously. Edit: Sigh. Downvotes?
    - absconditus 15y ago
      HIPAA does not enforce anything related to the number of ports or any other such nonsense. Most hospitals use standard laptops and desktops with more ports than a tablet will ever have.
  - azulum 15y ago
    for many, the value proposition of apple products means that they less expensive—that is, they cost less frustration. this is not always so—you consider a card reader and usb-slot and keyboard dock to be a net win, but not everyone feels that way, and considering the dearth of honeycomb apps still, it's no surprise that not everyone feels that way. anyway: putting out (and i paraphrase) ipads aren't a better value for most is either uninformed, dishonest or plain trolling. for the record, i like the transformer—great screen, pretty fantastic hardware, but good is hardware without great software?
- absconditus 15y ago
  You are grossly overestimating the difficulty of complying with HIPAA.
joelhaasnoot 15y ago
I'm working on a project with this and my weekend research found while there's a ton of Android 2.2 tablets that are cheap, none of them can rival the build quality or battery life of the iPad. The iPad in a kiosk sense does have a nasty issue: there's no way to block the home button but to build a case around it, or jailbreak it (which isn't a very sound thing to do operations wise)

deleted 15y ago

[deleted]

prosa 15y ago

For those who didn't know, the featured app, "drchrono" is from a YC W'11 company. Congrats!

gacba 15y ago

I love that they're doing this. It does, however, bring up one disadvantage that the paper record does not. Suppose you're sitting in the room with your loved one and you want to see what the doctor wrote about their condition and treatment suggestions. You can pick up the records and look through them, and ask questions about what you don't understand. With the iPad, you're kind of left out in the cold and at the mercy of whoever is there. That's a weakness of the system I'd like to see them address. BTW, I'm not saying that you'd be able to understand all the medical shorthand on the charts, which is definitely a language unto itself, but you'd at least be able to have a starting point for a conversation. "Hey, what's this..?"

inuhj 15y ago
I've never had a patient ask for their medical records...and frankly they wouldn't understand them if they saw it. It's filled with doctor's handwriting, abbreviations like OM(otitis media), PRN(take med as needed), etc. It's mostly a reflection of what the patient has told the doctor and doesn't contain much information that is useful to the patient. It would be better to ask the doctor your questions directly. If you read the chart and asked me "hey what's this?" for every question I would be tired of you within 2 minutes and tell you not to worry. If it was important I would tell you.
absconditus 15y ago
Hospitals generally print out a copy of electronic records if patients want to see them.

dmix 15y ago

Having real people using the app in a video demo is 10x more effective than a cute animation explaining your features.

inuhj 15y ago

tldr: Drchrono does the exact same thing as any other EHR...but on an iPad. "Physicians can each create their own exam templates and enter data quickly by tapping checkboxes or selecting from menus, rather than having to write or type. For physicians who don’t type well, the touchscreen makes information-gathering a lot simpler than trying to use a keypad, says staff physician Dr. Carol Ann Smith, who also takes advantage of the speech-to-text feature in drchrono EHR to dictate notes." As someone who spent the last hour charting(takes me about 2 minutes a patient with templates) I think this part of the article glosses over the real difficulty of using a tablet for EHR--namely that when patients are sick you have to manually enter a lot of data that wouldn't be in your template. For example: Subjective Findings: Patient presented to clinic for a 4 day history of cough and 2 day history of vomiting. He has vomited 3 times and there is phlegm in the vomitus. He also complains of a rash on his forehead that has spread down to his trunk that is maculopapular and itchy. The patient denies any fever, chills, dizziness, or headache. A template can't do that for me...and it's a pain to enter that on a tablet. It effectively nullifies the use of tablets as effective EHR. In my opinion the ideal solution is a macbook air(or similar ultralight) based EHR.

ericd 15y ago
I think a keyboard dock could make those cases bearable, though, no?
- inuhj 15y ago
  Yes, indeed. That's what I suggested to my attending...that he have keyboard docks in every exam room for the tablet. That would solve the data entry problem but we would then essentially have a laptop that has a touchscreen instead of a mouse. I'd like to try it but my attending already made up her mind against getting a tablet.
  - ericd 15y ago
    Cool. I think the touchscreen itself could probably get you there 80% of the time without being docked, so a bit different from a laptop with a touchscreen :-) Might require thinking about the flow of an encounter, though, so that it's docked at the appropriate times. That could be a problem?

baptiste 15y ago

It's all about internal purpose. Any experience with iPad in public access that all the customers of the point of sales can use?

dmix 15y ago
Lowe's is deploying 42,000 iPhone apps for use on the retail floor. http://www.appleinsider.com/articles/11/09/08/lowes_deploying_42k_iphone_based_pos_systems_in_retail_overhaul.html http://www.appleinsider.com/articles/11/09/08/lowes_deployin...

logjam 15y ago

We've tried iPads in our practice for EHR, including a trial of Dr Chrono. It is unusable because: - it takes too long to enter notes on a tablet. A "template" system is way too inflexible. - the dictation feature didn't work. - nobody has ever been able to even begin to convince us that our patients' data was secure. Laptops work MUCH better. We do use tablets for patient education purposes, for which they are much better suited.

r00fus 15y ago
Consider the iPad all by itself doesn't do EHR, what software packages did you try out before bailing? Aren't there any packages that check all the regulatory and usability requirements for usage in a hospital/clinic?
Duff 15y ago
What is the security concern?
RyanKearney 15y ago
>nobody has ever been able to even begin to convince us that our patients' data was secure. Just use Citrix then instead of some random third party application?
dr_ 15y ago
I haven't tried it, but maybe with iOS 5, which is rumored to offer markedly improved speech to text capabilities, it might make a difference. I agree that templates don't work great.
brandon 15y ago
If you're already using laptops in your practice, you might take a look at ElationEMR. I got a chance to try their browser-based app a few months ago and was impressed with how well they handle data entry. For all that I like my iPad, typing is still something of a sore point.
rdl 15y ago
I worked on PACS and incidentally integrating with EHRs in the past -- I'd be very interested in talking with you about exactly what security concerns you have with this kind of solution and figuring out how a system could satisfy them. I think the dictation issues are non core; either apple fixes it in iOS 5 or drchrono could integrate with a third party transcription provider. The template and macro thing is definitely at the core to a good ehr

jannes 15y ago

Aren't you asked to turn electronic devices off when you enter a hospital? I don't understand why there's an exception for the iPad. And at least from what you can see in the video their iPads are not in airplane mode, but are actually connected to WiFi and the AT&T network.

r00fus 15y ago
I've been in waiting rooms, recovery rooms, at the bedside of post-surgery family, and never been told to shut off my iphone (despite written warnings saying exactly what you mentioned).
Duff 15y ago
When cell phones were new, there was some hand-waving regarding the risks of planes crashing, respirators stopping, etc. As is often the case, these risks were not very credible. The signs stay up because while the RF signals won't kill anyone, listening to people jabbering on the phone is very annoying. For example, my wife's pregnant, and we spent some quality time in her OB/Gyn's waiting room the other day. Hearing another patient screaming into phone with a graphic recounting of the bursting of some sort of cyst for 30 minutes made the experience of sitting in a 90 degree waiting room for a half hour that much more noxious.
rdl 15y ago
Inside radiology rooms it may be the case, and is absolutely the case in MRI (no metal includes no iPhone...) I'm sure there are quiet area no cellphone rules for patient/staff sanity, not RF concerns, elsewhere.
absconditus 15y ago
Most hospitals use WiFi networks already. Most clinicians use their cell phones in hospitals already.

CrystalKoo 15y ago

Wouldn't the iPad be a good way to spread germs?

littlegiantcap 15y ago

Laptops are going to be cheaper, last longer, and going to be harder to break IMHO. IPad's are fun and I definitely use mine, but I'm not sure if they are the best bet for this application. Outside of looking cool and making patients think their doctor is really technologically advanced I'm not sure what they bring to the a table that a much cheaper netbook couldn't.