I used to say that mobility, or rather the lack of mobility, was a leading factor that has limited the widespread adoption of electronic medical records by physicians. Indeed, until just a few years ago we really hadn't cracked the code on ubiquitous wireless connectivity, the mobile devices and form factors that truly enable clinical computing. Healthcare providers are mobile information workers. Solutions that chain doctors to desktop computers really don't meet the workflow needs of healthcare professionals providing services in busy ambulatory or hospital settings.
We've come a long way in the last few years and the story is getting better and better. Powerful, light weight and long-lasting notebooks, Tablet PCs, Pocket PCs and Smartphones provide the needed horsepower and flexibility to meet the needs of most clinicians. These devices are also starting to morph and merge into single computing machines that begin to look like a platform for managing all of your communication and collaboration needs. An example of this trend can be seen in the DualCor; a very cool 5-inch Tablet PC / Windows Mobile 5.0 combination device that serves as both a cell phone and full-featured computer. Microsoft's Office Communicator application running on a wireless Tablet PC or notebook computer also takes us in that direction since I can now manage telephone, messaging, e-mail, web conferencing, and even video conferencing from my mobile device as long as it is connected to the Internet.
All that is good and well, but we are still confronted by one very thorny issue when it comes to clinical computing, and that is data input. It doesn't make economic sense to require or expect that our most highly educated and expensive workers should spend their time typing at a keyboard or laboriously entering vast amounts of data into dozens if not hundreds of fields on some form.
One of the things I have observed when visiting countries renowned for their use of electronic medical records in healthcare is that physicians are often not the ones entering data into these systems. It is still very much a world of docs barking orders at clerks who enter the data for them. This may not be ideal, but it certainly works well for the physicians. Here in America and elsewhere, this problem is usually solved with voice dictation and transcriptionists. It's an efficient, but expensive practice that often serves as a kind of gold standard for data input speed when clinicians compare what they know (dictation) with what they are expected to do when using many of today's electronic medical record systems.
All of this points to the need for much better ways to capture and document the vast amounts of data that swirl around the typical physician-patient encounter. I sometimes think that we should just wire up our healthcare facilities with video cameras and microphones and digitally record everything that transpires, leaving doctors and nurses with nothing more to do than just take care of patients. Of course, that idea would probably never get past the privacy police. None-the-less, it is appealing. I believe the reason physicians so much enjoy doing charity work in the third world is because they are allowed to take care of people who really need and appreciate their services without the associated hassle of exquisitely documenting everything than transpires.
So, how do we solve this dilemma? Does the Tablet PC take us in the right direction with digital inking? Is the holy grail of data entry computerized speech recognition? Do we hire more clerks? Do we hook up those video cameras? Do we continue to dictate all of our notes and patient encounters?
What do you think? We'd like to know.
Bill Crounse, MD Healthcare Industry Director Microsoft Healthcare and Life Sciences