Over the past month E-Health Insider readers have debated the relative merits of PDAs and Tablet PCs in healthcare. This week we publish two further perspectives, in a debate that appears more timely than ever with the announcement of the merger between iSoft and Torex.
Which device will the new merged health IT giant be pushing? ISoft are proponents of Tablet PCs, and were Microsoft launch partners for the Tablet. While in June Steve Garrington, chief executive of Torex Health, explained in E-Health Insider why PDAs are better suited to healthcare.
The first of the latest contributions to the debate comes from NHS orthopaedic surgeon Mr Boyd Goldie, who relates his experience of using a Tablet PC and PDA and comments on his frutrations at trying to ensure he contributes to the national IT programme for the NHS. An international perspective, meanwhile, is provided by Dr Graeme Hart, deputy director Department Intensive Care and clinical co-ordinator of the Electronic Health Record Project, Austin Health, Victoria, Australia.
Tablets on the wards
I have only used the Tablet without keyboard on one occasion within the hospital (to impress at an IM&T committee!) At present there is no indication of when we will be able to walk around without a keyboard as we do not yet have wireless environment in wards. If we did then maybe…
Wireless connection may be a problem as when one walks out of the wireless environment, you lose connection to the Intranet and may not be able to get back onto it without logging in again. Wait to see.
The Tablet gets quite hot so one would not walk around with it too long in summer! The battery lasts about three hours, just long enough to do a clinic, not long enough to leave power cable at home, certainly no good for a doctor on the wards.
For any Tablet used by a doctor on a ward or in A&E, the likelihood of it ending up on the floor must be high. A device for general use needs to be ruggedised.
The Tablet has a special "pen" for using on the screen. Unlike a PDA the Tablet’s screen is not pressure sensitive. The pen has a microcircuit in it and is costly to replace ($40). I wonder what the attrition rate for pens would be if Tablets were given to all hospital doctors?
The Tablet has a slot for a Harrington security lock but it can only be used when the screen is detached from the keyboard or if the keyboard is folded behind the screen. This is exactly when one would be walking around with the Tablet and would not want it secured!
All connections with both the Tablet and the docking station use a USB connection. So if you want to use a keyboard or mouse with the docking station they must be USB connected.
You can only draw into Word documents if you install Word XP (including all Service Packs) and then download "Office XP pack for Tablet PC". You can then insert a special "ink drawing" into a text box. You cannot just annotate a Word document as the adverts imply – perhaps this is in the next release or just the demo!.
It is easier to draw into the special Tablet program "Windows Journal". This can import Word documents but once converted, the documents cannot be read as a Word document by anyone else.
I have been using voice recognition on the Tablet and have also tried using the Handwriting input using the pen. Even though I regularly input into my PDA with the stylus, this method of input on the Tablet did not work for me. It proved too irritating to be of use.
Although I have added extra RAM, the Tablet seems surprisingly slow. It only has a 900Hz processor. The screen has a special coating of some sort. As a result it is not as crisp as one would expect from a "normal" laptop. This is a slight problem when viewing x-rays. A Tablet is not pocket-sized! How is a doctor expected to carry it around? A Tablet must be a target for opportunistic theft in most hospitals.
We live in hope that EPR providers have considered how Tablets would be implemented to enhance their products. Have they further considered how a junior doctor would use a Tablet, and in particular do they envisage one Tablet per doctor or a few Tablets per ward? If it were the latter, how would one ensure that the tablets would stay on the ward. How many is enough? If you stuck the Tablet without its keyboard onto a trolley, it would merely defeat the purpose of the Tablet. A WiFi laptop would do the same job.
PDA for accessing EPR
I personally am a big fan of PDAs and presently have a Sony Clie. The screen is small but crisp. I have repeatedly suggested that EPR providers should talk to someone such as Avantgo, as I believe they could configure their commercial application.
It seems simple enough to me to have most doctors equipped with a PDA which would fit in their pocket (unlike a Tablet) The cost would be much more affordable, could store cumbersome literature such as the BNF, and add ‘real’ value to junior doctors lives!
Using a product such as Avantgo, any PDA could access web pages, so whether we went Palm OS or Pocket PC would not be a problem. Most EPR providers have a web-based interface for accessing data I believe – it’s so easy!
I believe there are hospitals in the USA that use synch stations that take a variety of devices. Most doctors do not need absolutely instant information. A setup whereby either the doctor chooses which patient’s details he wants on his PDA or, better still, the EPR product knows which are his patients would be ideal. Then one could scroll through pages in the same way that I currently look through my Avantgo for the Times newspaper or the RAC traffic news.
However, our EPR provider has never followed up this suggestion and seems set to only develop an EPR product to be used on a Tablet. I do not expect that PDAs would be the only way to access the EPR, but I feel that they do have a role for the doctor who is not tied to a desk!
Clinicians in IT implementation
I have tried to get involved in the selection process for the London ICRS, which involves evaluating three providers over 18 days. Since the choice has to be made by October (for some reason) the selection process begins in mid-August – i.e. holiday season.
Although I am prepared to arrange to free myself to attend over 18 days, there is no way I can cancel my annual leave that was booked a year ago. The notice for the need for clinicians has been somewhat short and I would be surprised if many are able to attend. I worry that a product will be chosen with inadequate clinical input.
Then the retort if we complain about the chosen product, will be that few clinicians "could be bothered" to attend. The truth is that the setup of the process seems to have been made deliberately difficult for clinician involvement. I am going to attend a clinicians’ workshop but doubt whether my input will have any effect.
Mr Boyd Goldie, Orthopaedic Surgeon, Whipps Cross University Hospital NHS Trust
Evidence needed to make an informed decision
This [Tablet v PDA debate] is quite a germaine and important discussion at present as both of these technologies are maturing at the same time as clinical, business cases and budgets are aligning.
However, I think it would be totally counterproductive to try and settle this discussion based on anecdotal reports. We don’t accept such anecdotes as evidence justifying changes in clinical practice nor should we in this area of care delivery.
An appropriate "user needs" assessment must be set up and formally assessed against both product types. Remember that there are many different user types and each user has different tasks during the clinical encounter which may be best addressed by one or other device.
The other major advantage of Tablets (i.e. the screen real estate) has not really been assessed against the prime functionality of wireless enabled access to the entire medical record, X-rays nor for access to decision support or other information relevant to the workflow.
It behoves us all to provide best evidence to maximise the benefits and justify the expense of these new technologies. Appropriately powered and designed studies should be as much a part of the roll out of electronic health records/device utilisation as any other new treatment.
Dr Graeme K Hart, deputy director of the Department of Intensive Care, and clinical co-ordinator, Electronic Health Record Project, Austin Health, Victoria, Australia.
Previous Contributions to the PDA vs Tablet Debate
- In June Dr Andrew Harrison wrote about his experience of using a Tablet PC on the wards – The Tablet PC on Test .
- In response Steve Garrington, CEO of Torex Health, argued the case in favour of PDAs as the best mobile devices for clinicians – Open Source – Tablet PCs wrong for Doctors
- Then Counsultant Anaesthetist Dr Ian Paterson, joined the fray arguing that the technology has potential but must first mature – Tablet PCs or PDAs, the debate continues…
So where do stand in the mobile health debate? PDA or Tablet PC? Let us know what your experiences are of using mobile technology to support care and how you think it should be used in delivering 21st century IT for the NHS. Email firstname.lastname@example.org.