4 ms·

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 tapp

by 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?
tealtan 15y ago
I thought it allows for dictation as input?
- tealtan 15y ago
  I also think you're underestimating the usefulness of a tablet form factor when physicians are sharing information with their patients. Harder to do that with a laptop.
- ChuckMcM 15y ago
  This would seem to be an advantage of the voice input API in Android. Something the iPad lacks.
  - saturdaysaint 15y ago
    Android certainly has an advantage here, but a smattering of iOS apps, including the EHR in question, seem to licence speech-to-text and integrate it fairly seamlessly. Siri (before Apple acquired them) and Orchestra (a new to-do app) are good examples. It's also worth mentioning that screenshots of internal builds of iOS 5 have a microphone on the keyboard, seeming to imply speech-to-text could be a surprise feature of iOS 5.
  - deleted 15y ago
    [deleted]
ugh 15y ago
“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.” Entering so little text on a tablet is definitely not a pain for me and, though quite a bit slower than typing on a hardware keyboard, it’s also quite a bit faster than handwriting for me. I don’t get why so many people seem to think that tablet keyboards are unusable, I never had any problems typing a few paragraphs of text on them. This seems like some kind of weird meme demonizing all software keyboards as inferior to everything.
- inuhj 15y ago
  It's not a "weird meme". It's my personal experience. You may be able to enter data quickly on a tablet but many of the physicians I work with still type(painfully slowly) with 2 fingers. Maybe drchrono will be appealing to younger physicians who are comfortable with tablets...but the average physician is old. If I demo'd drchrono and it was slower than my current system you're not going to sell me by telling me that "I'll get used to it." They're definitely not going to sell any major hospital on drchrono unless they also offer a computer based interface. The "old dog" physicians will never figure out how to type on it.
  - deleted 15y ago
    [deleted]
  - tsunamifury 15y ago
    If I saw a phsycisan painfully typing with two fingers I'd be running from that hospital.
  - ugh 15y ago
    The weird meme are the grandiose claims of failure. I can’t square those with reality.
  - azulum 15y ago
    "but the average physician is old." this is a curious statement to me for three reasons: 1) the ipad has been hailed as a device for first time computer users—the very old and the very young or even the physically/mentally challenged. 2) if they type painfully slowly with two fingers on a tablet, how do they type on a laptop? 3) the layers of abstraction are much greater on a laptop than a tablet. true, data input may be a little more tedious, but it will still be infinitely less tedious than dealing with paper files, with the added bonus of being instantaneously transferable should the patient be traveling. and if they are already using a laptop, then what is the dilemma? anyway, the "old dog" argument strikes me as a lazy cop-out—but if true, doesn't bode well for the mental acuity of said old dogs. i've always assumed that doctors are innately curious, always trying new things tempered by the old things that work†. if these old dogs can't step out of their comfort zone to try something new, it doesn't give me much hope for their patients. † i understand the toxicity of the new, when science claims to have found no difference between breast milk and formula, for instance, but gathering information does not necessarily equal an endorsement. and for the record, touch screens are very old technology, we just haven't been able to implement them in a mostly non-frustrating way until now.
absconditus 15y ago
The system that I work on could definitely handle that with a template. Of course we have spent over a decade working on our tempting system and we employ numerous clinicians. Unfortunately our system is designed for a specific area of the hospital and our website is very vague (enterprise system), so giving you further information is unlikely to be helpful.

by inuhj 15y ago

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?

tealtan 15y ago

I thought it allows for dictation as input?

tealtan 15y ago
I also think you're underestimating the usefulness of a tablet form factor when physicians are sharing information with their patients. Harder to do that with a laptop.
ChuckMcM 15y ago
This would seem to be an advantage of the voice input API in Android. Something the iPad lacks.
- saturdaysaint 15y ago
  Android certainly has an advantage here, but a smattering of iOS apps, including the EHR in question, seem to licence speech-to-text and integrate it fairly seamlessly. Siri (before Apple acquired them) and Orchestra (a new to-do app) are good examples. It's also worth mentioning that screenshots of internal builds of iOS 5 have a microphone on the keyboard, seeming to imply speech-to-text could be a surprise feature of iOS 5.
- deleted 15y ago
  [deleted]

ugh 15y ago

“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.” Entering so little text on a tablet is definitely not a pain for me and, though quite a bit slower than typing on a hardware keyboard, it’s also quite a bit faster than handwriting for me. I don’t get why so many people seem to think that tablet keyboards are unusable, I never had any problems typing a few paragraphs of text on them. This seems like some kind of weird meme demonizing all software keyboards as inferior to everything.

inuhj 15y ago
It's not a "weird meme". It's my personal experience. You may be able to enter data quickly on a tablet but many of the physicians I work with still type(painfully slowly) with 2 fingers. Maybe drchrono will be appealing to younger physicians who are comfortable with tablets...but the average physician is old. If I demo'd drchrono and it was slower than my current system you're not going to sell me by telling me that "I'll get used to it." They're definitely not going to sell any major hospital on drchrono unless they also offer a computer based interface. The "old dog" physicians will never figure out how to type on it.
- deleted 15y ago
  [deleted]
- tsunamifury 15y ago
  If I saw a phsycisan painfully typing with two fingers I'd be running from that hospital.
- ugh 15y ago
  The weird meme are the grandiose claims of failure. I can’t square those with reality.
- azulum 15y ago
  "but the average physician is old." this is a curious statement to me for three reasons: 1) the ipad has been hailed as a device for first time computer users—the very old and the very young or even the physically/mentally challenged. 2) if they type painfully slowly with two fingers on a tablet, how do they type on a laptop? 3) the layers of abstraction are much greater on a laptop than a tablet. true, data input may be a little more tedious, but it will still be infinitely less tedious than dealing with paper files, with the added bonus of being instantaneously transferable should the patient be traveling. and if they are already using a laptop, then what is the dilemma? anyway, the "old dog" argument strikes me as a lazy cop-out—but if true, doesn't bode well for the mental acuity of said old dogs. i've always assumed that doctors are innately curious, always trying new things tempered by the old things that work†. if these old dogs can't step out of their comfort zone to try something new, it doesn't give me much hope for their patients. † i understand the toxicity of the new, when science claims to have found no difference between breast milk and formula, for instance, but gathering information does not necessarily equal an endorsement. and for the record, touch screens are very old technology, we just haven't been able to implement them in a mostly non-frustrating way until now.

absconditus 15y ago

The system that I work on could definitely handle that with a template. Of course we have spent over a decade working on our tempting system and we employ numerous clinicians. Unfortunately our system is designed for a specific area of the hospital and our website is very vague (enterprise system), so giving you further information is unlikely to be helpful.