Feature March 21, 2012 David Rossi

Bringing the touch experience to your EMR

Touchscreen tablets are all the rage lately, light and portable with easy-to-use “apps” that are intuitive and graphically appealing. So why wouldn’t a clinician prefer to use an Electronic Medical Record (EMR) system on an iPad or Android-based device? While an increasing number of EMR companies are venturing into the iPad/Android tablet arena to meet this growing demand, a few challenges remain. One such challenge is whether or not clinicians will be willing to sacrifice their beloved physical keyboards, the mechanism via which they frequently customize generic EMR software. Will the pop-up virtual keyboards offered by these tablets prove productive, or will clinicians soon grow tired of “tapping on glass”?

Well written touchscreen software applications appear to be a natural fit for fast-paced, walk-in ambulatory care environments, such as emergency departments, urgent care centers, and retail health clinics. The ordering of screens should mirror the facility’s clinical workflow and seem intuitive to the end user. The user interface (UI) should feature big buttons, magnifying only those choices to be decided upon at a specific time in the clinical encounter. As the clinician eventually learns to rapidly move through the succession of big-buttoned screens, speed and accuracy will generally improve.

A proving ground for such touchscreen applications has been the food service industry, which touchscreen applications have proven effective in loud, think-fast-on-your-feet, frequently chaotic environments. The systems, however, have mostly been built around traditional PC work stations with large touchscreens and physical keyboards at the ready. The advent of the touchscreen tablet formats, namely the iPad and Android varieties, have replaced physical, tactile keyboards with “virtual” keyboards that pop-up on the glass screen. Do these on-screen virtual keyboards add to or detract from the whole touchscreen paradigm, in which the intent is to speed up the process, reduce errors, and increase productivity?

Whatever your preference for “keyboarding”, it is clear that many owners of iPads and Android-based devices struggle with the challenge of giving up their traditional, physical keyboards. This is evidenced by the sheer number of Bluetooth, folio, and accessory keyboards on the market today. As much as mainstream “apps” are designed to minimize keyboard use, in the healthcare arena, where significant input is often required to document atypical findings or exceptional follow-up instructions, physical keyboards are still as commonplace as stethoscopes. Surrendering these traditional keyboards for the touchscreen offerings of the iPad/Android devices comes at a price. The most noticeable deficiency is the loss of the tactile feedback your fingers have become accustomed to on a physical keyboard. Having to keep your eyes on the keyboard the entire time you are typing, and not being able to look up at clinically relevant content will likely, at least initially, reduce speed and accuracy. Similarly, having to shift back and forth between alphabetic and numeric screen overlays will also prove tedious.

A Washington D.C.-based research firm recently highlighted several pitfalls of using virtual keyboards with EMR applications. The Advisory Board Company found on-screen keyboards to pose a “significant threat to patient safety.” The study contends that “Pop-up virtual keyboards obscure a large portion of the device’s display, blocking information the application’s designer intended to be visible during data entry.” Such information, in the case of EMRs, could be escalations, alerts, or other relevant data that clinicians may rely on to make informed treatment decisions. Neil Versel also does a good job of covering this topic in Mobi Health News.

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