The biggest challenge, however, is the clinical decision support piece, which for medications includes drug interaction and allergy alerts.

"If doctors use the mobile app, they're not going to get decision support," Probst said. "But it could be built in."

EHR vendors such as Allscripts, Epic and Cerner have integrated speech recognition into their mobile offerings for documentation purposes, but have not yet offered speech-enabled CPOE.

Joe Petro, an executive of Nuance Communications, MModal's largest competitor, told InformationWeek Healthcare last fall that although Nuance's speech recognition could recognize simple medication and lab orders, it still wasn't advanced enough for the much more complex order sets used in CPOE.

Paul Brient, president of PatientKeeper, which specializes in mobile solutions for hospitals, said in an interview that "voice enablement doesn't have a lot to do with decision support [in CPOE]. The real challenge is incorporating decision support onto a mobile device."

PatientKeeper recently introduced a mobile CPOE application for iPhones and iPhones that "complements a hospital's existing CPOE solution," according to its website. In the first two months of 2013, the company says, its mobile solution was adopted by 19 hospitals that use Meditech, McKesson or other EHRs.

The PatientKeeper system includes clinical decision support for common orders. Brient said it had been difficult to build this in because it requires the ability to access complete patient order histories and run analytics against them in a "reasonable time." But for users, he said, the result is the same as if he or she were entering orders in a desktop application.

PatientKeeper's mobile CPOE uses a combination of methods for order entry. "Our system relies on favorites and one-tap orders extensively, but also supports voice enablement for searching and ad hoc orders," Brient said. To recognize speech, PatientKeeper uses the Siri speech engine on the iPhone, he said. This is good enough to bring up the name of the correct medication if the voice recognition is close to the correct term, he said.

Brient doesn't believe that complete speech enablement is necessary or desirable in mobile CPOE. Not only does it take doctors longer to enter orders using speech than through a touch-screen interface, but it could present safety problems if the speech recognition is slightly off on, say, drug dosage. "If you don't have decision support to check it, that would be very scary," he said.

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