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Thoughts, comments, news, and reflections about healthcare IT from Microsoft's worldwide health senior director Bill Crounse, MD, on how information technology can improve healthcare delivery and services around the world.

A “right-sized” EMR? Tablet PC + Microsoft Office OneNote

A “right-sized” EMR? Tablet PC + Microsoft Office OneNote

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Bill Crounse 2007 05 While the media will be focused today on Apple’s Tablet announcement,  I’d like to remind HealthBlog readers that there’s nothing new about Tablet devices.  I have been evangelizing the use of Tablet PCs in health for nearly a decade.  And over the last several years, particularly with the release of Windows Vista and now Windows 7, the Tablet PC value proposition for healthcare providers just gets better and better.

First of all, the devices themselves are better.  And, healthcare providers have more choices than ever before (I have four Tablet PCs on my desk right now).  There are excellent Tablets available from most major manufacturers including ones made expressly for clinicians such as the devices offered by Motion Computing, Panasonic, Tablet Kiosk and other vendors.

image Of course, it’s not really so much about the device as it is what you can do with it.  First and foremost, these are full-function computing and productivity solutions (unlike that shiny new Apple).  Tablet PCs more closely mimic the familiar patient chart.  They can be used, digital pen in hand, without feeling intrusive in the physician-patient encounter.  They accommodate multi-modal data input including keyboard (when docked), digital inking, point and click, voice and even touch including multi-touch with Windows 7.  The inherent speech engine in Windows Vista and Windows 7 is so good, it is even possible to do excellent speech recognition dictation if you are willing to put in a little effort up front.  When connected wirelessly to a corporate network or the Internet, Tablet PCs provide instant access to the information you need, when and where you need it.  They can also run all of the other applications you might want to use in your office or home.

imageAll of this functionality hasn’t been lost on clinicians.  Just  yesterday I was contacted by Dr. Alan Rosenbach.  Dr. Rosenbach runs a very successful solo dermatology practice in the Los Angeles area.  He called me because he wanted to share his enthusiasm for his Tablet PC running Microsoft Office OneNote.  He said for the last three years, he has been using OneNote as the official EMR for his office.  He does all of his chart notes and tracks all of his patients with OneNote.  He uses a Tablet PC from Fujitsu. He makes extensive use of digital inking for both data entry and illustrations on clinical findings.  He also embeds photos in his patients’ “charts” and attaches transcriptions and other documents to each patient’s record.  Most remarkably, he says, OneNote has never gone “down” for even a second.  And of course, he loves the low, low price.

What Dr. Rosenbach didn’t know until I told him, was that there is actually a company that has for many years been selling an EMR solution based on Microsoft Office OneNote for the Tablet PC.  That company is the Ablet Factory.  I received an update from company founder, Fritz Switzer, in this morning’s mail.  I had asked him to tell me what medical specialties where particularly drawn to his company’s solution.  He replied:

“With regard to the mix of specialties we see using our OneNote EMR products, a large number of psychiatrists and podiatrists lead the specialty roster. I have referred to this fact as “we provide a head to toe solution”. Chiropractors and pain management specialists are also recurring practice types. We have seen a common thread with this usage mix. The practices have a large number of “graphically oriented” forms/templates. The digital inking of a Tablet with drawing capabilities of OneNote provide a platform where a conventional EMR falls short”.

image image

The Ablet Factory also offers a medical vocabulary plug-in for their EMR solution called WordMgr 2010.  It takes care of spell check, digital inking recognition and improved speech recognition for more than 100,000 medical terms and abbreviations.

If there is a downside here, it is that this EMR solution isn’t “certified” by ONCHIT.  It also may not meet “meaningful use” criteria.  So, if you are looking for a government handout to pay for your EMR, you are likely out of luck.  On the other hand, thousands of docs in solo or small group practices have found an easy pathway to digitizing patient records that is simply “good enough”, at least for now.  And this solution will only set you back about $700 for software.  Add another $250 if you want the medical vocabulary plug-in.  At those prices, who needs a bailout from the government anyway?

Bill Crounse, MD  Senior Director, Worldwide Health   Microsoft

  • Indeed, it's true that for the past decade Microsoft has had a tablet OS.  Unfortunately, Microsoft has done very little to push tablets toward the mass market in the way you *know* Apple will.

    I love the slate form factor.  Seriously love it.  I've even got plans for a tablet-friendly custom house sitting in my head centered around casual computing as an ambient feature.  But the offerings are increasingly poor and non-slate, and still expensive.  Apple's price points are great.  They're using flash drives on top of it all.  It's quite tempting to snag one and reinstall with Win7, and I expect a dozen other people to already be doing so within a month.

    Microsoft didn't give up on the home tablet market.  They just never even seriously bothered to target anything but medicine and field techs.  They could have had this market secured, I think, some time ago, enough to have made the iPad less newsworthy than it obvoiusly, currently, is.

    And that makes me grumpy.  I honestly feel let down.

  • To me, Microsoft just doesn't get healthcare.  

    I've worked for too many "Microsoft Gold, Microsoft Certified, Microsoft Grand-Poobah Partners" that are just all about the OS and development software - but not about real world solutions.

    Gimme a HUG?

  • Keith and ShimCode,

    Thanks for your comments.  As you know, there is no longer a separate OS for Tablets.  With Vista and Windows 7, the Tablet functionality is built-in.  I think Windows 7 (and certainly the new Apple device) will re-engerize consumer interest and adoption of the form factor.  Competition is good.  So, bring it on.

    To say that Microsoft doesn't "get" healthcare suggests you may not have visibility to all the things we are doing.  I'll give you that it has been slow going.  I've been here 8 years, but I can tell you that some very important things are happening.  We are now building solutions specifically for the industry.  Our research units are very focused on health.  We have health groups all around the world; more than 1200 employees focused on health and healthcare.  And, it just keeps getting better.  Health isn't an industry that you change overnight.  Change will be incremental, but it is happening and it will be disruptive.  Stay tuned, and thanks again for your comments.

    Bill Crounse, MD

  • I am interested in working with anyone who would like to put together a 'handwritten' EMR solution. I do not mean the pen instead of mouse idea, but which is able to recognise handwriting within a context and deal with it. The context free handwriting recognition has been a real problem due to complexity and diversity.

    We use openEHR as our platform, clinicians agree the structured content (see http://openehr.org/knowledge) and these are then put into templates for a purpose.

    I am talking about choosing BP (through a command interface - might be writing ':bp' or choosing from a list - and then getting an entry environment where I can put in all sorts of complex information 120/80 sitting, paradox 20mmHg, cuff Large adult...whatever I want. It is because the context is clear and clinicians have set the possiblities, I think the pen can really liberate us from the document (non-processable) and the click-click field paradigms.

  • I think Microsoft have another chance now after yesterday. Lets hope the HP slate can do a few more things like multitask and voice calls. It will be all about the Apps though.

  • I guess I feel compelled to kick in here about Tablets and the Ablet Factory.  A few years ago we talked about collaborating when I was still writing and know Fritz.  He produces good products and have worked with his software.  I have featured Ablet Factory quite a bit over at the Medical Quack.

    http://ducknetweb.blogspot.com/2010/01/microsoft-office-onenote-and-ablet.html

    On the tablet side of the discussion, been using a touch screen tablet for over 2 years with speech recognition and a good tablet is worth the money by all means!  I saw value when tablet pcs first arrived on the market and was sold from day one and haven't regretted one moment.  I am no longer a slave to carrying around what I call an "open pizza box" (meaning a notebook) and can be productive walking or sitting down anywhere!  

  • The Ablet factory does look good. Now I need to store all the data 'in the cloud' (Health Vault?) and customise it for the UK. Thanks for highlighting it.

  • Don't forget about HP's upcoming "Slate", and HP has also recently partnered with McKesson healthcare.

  • Cool, looking forward to using the Slate too!

  • I do believe that tablets has a purpose, and as you proclaim there isn't much /new/ about the iPad, but there is something that makes it viable as a mass-market device. You seem to confirm it through feeling the need to "I’d like to remind HealthBlog readers that there’s nothing new about Tablet devices".

    If there was nothing new about the iPad you wouldn't felt the need to reaffirm your mantra.

    I thoroughly believe that the iPad can blow all the old slates and pads and tablets out of the water. This is what the iPhone was to the smartphone. It's a simple device, so simple that even your grandmother can use it.

    As I see it, it is better to have a tablet that works rather than waiting for the tablet with the correct battery-life, multi-tasking, camera, flash and all the other things Apple gets criticised for. The fact of the matter is that there are no good alternatives and the critique is almost akin to envy rather than actual defects with the iPad.

    Rather than spending the time on criticising the iPad the other manufacturers should pick up their pace and realise that usability is becoming more important than having the technologically most advanced device.

  • Bobby,

    Thanks for weighing in, but you are reading me wrong.  I wasn't bashing the iPad.  I think it is a wonderful consumer device that will spur innovation across all Tablet devices.  But experts seem to agree with me.  This isn't a device that, as currently engineered, is likely to find its way into enterprise healthcare applications.  That was my point.

    Bill Crounse, MD

  • We're using the Panasonics in our new state-of-the-art hospital, CircleBath (http://bit.ly/9FCQoK).  The nurses are loving them, and more importantly, using them.

  • yikes... Courier denied, HP's acquisition of Palm, Oh My..

    NOT good for MSFT in this space

  • Jack,

    Although I'm disappointed that Microsoft has put aside Courier, there are plenty of convertible and slate tablets on the market and several made specifically for healthcare by Motion, Panasonic, etc.

    Bill Crounse, MD

  • How can OneNote become a practice's legal patient record if a note is endlessly changeable without user authentication and an audit trail?

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