This article will discuss the use of mobile tablets with their mobile app technology at our office in Front Royal, Virginia (Skyline Family Practice). I won't discuss the use of the electronic medical record per se' since that is assumed. This is an article that describes the use of mobile tablets in interfacing the patient directly with the 'systems' at Skyline Family Practice.
I looked at 3 different tablets and was impressed with each of these for various reasons. However, I finally chose one for the particular purposes we have in mind at Skyline Family Practice. I will explain which one I chose later.
First, it became quite obvious that many of the applications that are available for mobile devices exist in the Apple iOS or Android OS market presently. Although there may be Windows or Linux devices out there, the applications (a.k.a. "apps") for potential medical office use are far and few between (IMHO). Certainly, in the next 2 years the gap between the Apple iOS apps, Android OS apps and other OS apps will be narrowed but currently Apple iOS apps dominate the market.
Second, the apps for the medical office that are presently available seem to exist predominately in the Apple iOS market. These are generally found in the Apple iTunes store (http://www.apple.com/itunes/). These apps will run on iPods, iPhones and iPads. Some of the Apple iOS apps are optimized for the larger screen of the iPad.
Eventually, I narrowed my search down based on what mobile tablet was best aligned to do in our office. This was the Kindle Fire supplied by Amazon. The Samsung Galaxy 10.1 tablet was nice but it was too big and this was true for the iPAD. The Kindle Fire has an additional benefit of it's use of the SILK web browser. SILK uses "cloud based" web browsing which help pages to load much faster than Internet Explorer, Safari or FireFox. Additionally, the Kindle FIre is priced at about $200. I didn't show the Galaxy by Samsung but here is a comparison between the iPAD2 and the Kindle Fire:
We did purchase a protective cover (Marware) that has a nice soft cover that covers the screen. The battery life has never been a problem in the office (we have an 8 hour day and it goes into a sleep mode after 5 minutes).
So here is what we are doing with the Kindle Fire:
· Signature capture after reading consent forms
· Use of Instant Medical History (by Primetime Software) using the tablet as a "mobile kiosk"
So far, we are in what I would call "late beta testing" of the Instant Medical History and are in the early phases of signature capture using mobile tablets.
Let's move on to Instant Medical History and the use of mobile tablets.
Did you know that you can create a specific hyperlink to a specific questionnaire of all the different questionnaires available with Instant Medical History? This is particularly useful if you create a webpage with all the different questionnaires which could then be used as a "pick list" forced asked to get to the questionnaires quickly.
Certain questionnaires lend themselves well to questionnaire while the patient is in the exam room (or the reception area, if you choose to do this). Some good examples of these questionnaires might be an adult ADD questionnaire, low back pain, dizziness, fatigue, insomnia or sleep disorder (etc).
In the picture below, we search for the questionnaire we want. We give the patient the tablet after we have included the patient's name, gender, date of birth and Social Security number. They then fill out the questionnaire using the touch screening of the mobile tablet. It is relatively easy for them to use the touch screen to answer the simple questions as noted below. Below is a good example.
Below is our page (we created) which we access on the internet using the Kindle Fire.
Here is a sample of a close-up of the web page above:
Once the patient goes through the questionnaire, the form is submitted to the secure Primetime Software server which did then serves it to our office where we get the result in a rich text format which we then easily important to the chart. You also have the option of having this occur automatically.
The form factor of the Kindle Fire is light enough and the screen is big enough to easily navigate the questionnaires. If they want to make the screen bigger, they can always uses the "spread 2 fingers" movement they've become accustomed to with their smart phones. We introduced a stylus since some people occasionally suffer from "fat finger syndrome" (some people just have an innate ability to miss the buttons in the questionnaire when they use their fingers).
The patients have generally enjoyed the interaction with the questionnaires on the mobile tablets. Most of them are fascinated with seeing their history imported in the chart. Even though the imported results are more in the medical subjective format, they are impressed. The value of patient engagement cannot be overstated. An additional benefit is that if you have a Hispanic population, they can fill out the form in Spanish and it will be interpreted into English for important into the chart.
Thanks to Matthew Ferrante of Primetime Software and Don Stewart, MD for the innovative idea of URL linking.
UPDATE NOV 2012: So the SFP lab continues to test. I was thinking (and as mentioned in the coffee klache at the MIX Conference in Dallas) the HTML page was great for the Kindles but the HTML coding was clunky and sometimes the copy/paste process to the message section didn't occur well and was occasionally not stateful when it showed up in the IN-BOX on webview for the patient (i.e. the link didnt go through). Further thought and testing reveals that just like many of the other text sections of the chart, the message section best handles RTF (rich text formatting).
My solution was to open the HTML file in WORD and save in RTF. This kept the URL links intact and now cutting and pasting works much better (when using in the messages). Moving forward on this, staff will continue to have more message templates that push the IMH questionnaires to the patients to fill out. Since we are moving towards PMH certification and want to be efficient with same day availability, we now have a WEBVIEW FASTRAC message template (FASTRAC is our name for this and what patients know these appointments as). Please go to the file sharing part of the site -- Documents / _14 - User Group Meeting - Powerpoints Other / MIX Conference - Dallas - Nov 2012 / Updated and-or New Presentations & Materials for the Powerpoint on Using Messaging, Webview, IMH
SIGNATURE CAPTURE (from prior part of the article)
Signature capture has been little bit more challenging and a little less developed in our office. Therefore, we are trying to better wrap this process into a reasonably efficient manner process would justify its use. There is a product made by CANVAS (http://www.gocanvas.com) which has an option for signature capture associated with the use of electronic forms. We are still in the trial 30 day period but see this as a useful application of the mobile tablet with its touch sensitive capability.
As usual!Â Great application ideas.Â Always a problem with all of the forms that the front desk needs to print or find, give to the patient, gather, then to add insult to injury scan and attach back to the chart, just for the signature.Â Timely information for all as we really start moving into the Technology based generation.
Thanks for the practical experience with the tablets.Â I am a big fan of the Fire since it is priced right and does what you need it to do in an encapsulated environment.Â There are some limitations with the Fire, but as you have demonstrated, it really doesn't affect your practice with the apps you are needing.Â I am currently using a Fire and a Toshiba Thrive.Â I have to say I do pick up the Fire more often, but that's mainly because I love reading magazines on it.Â You can't beat paying .99 cents for a magazine that would cost you $6 on the news stand.Â The thrive is great because it can run all of the same apps I run on my Motorola Electrify phone, so it's just a larger extension of what I carry on my hip.Â :)