The iPad EHR can save and sync to the Epocrates' existing Web-based EHR in real time-so doctors can edit entries on a computer with a real keyboard if they so choose.
It also can cache data locally on the iPad. (At press time, Epocrates said that it would sell off its Web-based EHR, citing mixed financial results for its core business of point-of-care drug reference services, which are used by more than 300,000 physicians; the EHR had just received meaningful use certification, but Epocrates acknowledged that building out the ambulatory EHR had been a distraction.)
While fully functional, tablet-based EHR software knocks down some walls, a local storage option is not something everyone in ready to sign off on.
In the case of Seattle Children's, the organization has adopted a blanket policy of not storing organizational data on whatever tablets staff might have now or in the future.
"I don't want a thousand iPads out there with patient data on them," says Wright, the CTO.
Beyond the security concerns, some medical specialties are just more suited than others for tablet computing.
Lyle Berkowitz, M.D., medical director of clinical information systems at Northwestern Memorial Physicians Group in Chicago, does not use a tablet in his internal medicine practice.
"Tablets really aren't that useful in primary care offices," he says. But doctors who do hospital rounds might find it easier to carry an iPad when consulting at the bedside, Berkowitz adds.
To speed up rounding, Heritage Valley, for one, has added radio-frequency identification tags to some of its iPads so the user just has to touch the tag to a reader on a hospital PC to log into the main clinical information system.
The process automatically navigates the PC to whatever point of reference the doctors were at on their mobile devices.
This, according to CIO Carleton, saves Heritage Valley physicians 20 to 30 minutes per day when doing their rounds because they don't have to fight for devices or keep logging back in every time they go to a different room.
It also offers flexibility to doctors at the Pennsylvania health system's two hospitals and 70 clinics and long-term care facilities. The iPad functions somewhat like a paper chart, in that a doctor uses it for quick review of the patient's status, while data entry mostly takes place on a traditional PC.
"To think that a doctor could gather everything on one screen may be unrealistic," Carleton says, noting, for example, that radiologists are used to having three screens in front of them at a typical workstation.
Tablets, indeed, can be an interesting option in radiology-and some imaging vendors are attempting to capitalize on the potential.
Imaging software vendor Merge Healthcare uses the Web and the cloud rather than device-based applications to deliver high-resolution images and access to radiology reports to mobile devices through the company's iConnect Access system.
Users can go to a URL on the iPad or any other tablet with Internet access to view images and studies while away from their regular workstations. Aside from the mobility, touch-screen tablets also enable finger-controlled image manipulation.
iConnect has Food and Drug Administration 510(k) clearance for diagnostic image viewing on certain high-resolution monitors, but it is not approved for diagnostic use on mobile devices.
Still, tablets can be effective for quick consultations. "A radiologist may use this if he's not at his office or at home, if he's out to dinner, on the golf course, whatever it may be, and may need to see an image," says Gilbert GagnÃ©, Merge's team leader for enterprise solutions.
Merge, like many of its competitors, also is targeting the software at physicians who refer patients to specialists for diagnosis and treatment.
But the radiology market is going to be a tough nut to crack when imaging software tries to move beyond a consultative role to a diagnostic one.
A study presented in January at the International Society for Optical Engineering medical imaging conference in San Diego found that iPads are just as good as standard LCD monitors for viewing medical images, but only as "secondary" displays when high-resolution radiology displays are not available.
Both the iPad and a typical LCD monitor have screen resolutions of 130 dots per inch, far less than the 508 to 750 dpi found in primary radiology viewing stations, according to lead researcher Mark McEntee, M.D., of the University of Sydney.
"iPads and other secondary screens should not be used for clinical diagnosis," McEntee told eHealthSpace.org, an online Australian publication. "There is a range of safety concerns associated with using mobile screens."
Based on his study of eight U.S. board-certified radiologists attempting to identify intracranial bleeding, fractures and lung nodules from X-rays and other scans, McEntee concluded that high-resolution radiological monitors are much better than iPads or standard displays in allowing practitioners to detect "just noticeable differences," a clinical benchmark for reading medical images.
While the new iPad 3, which was introduced the day this story went to press, will have a higher-resolution display, Apple's tablet and many of its competitors still are consumer-oriented products.
That provides an opportunity for industry-specific devices to find a space in the big health care market, says Joseph Hogan, president of Epion Health, a Lebanon, N.J.-based start-up vendor of a custom health tablet called Smart Screen.
Bringing in patients
The Epion product, an Android tablet housed in an antimicrobial case, brings in another important health care constituency, namely patients, Hogan says.
Smart Screen is designed for educating patients in physician waiting rooms and at the point of care by providing educational games, instructional videos and opportunities to join clinical trials and receive discounts on brand-name drugs and medical supplies, based on their specific conditions.