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12/10/2012
12:22 PM

9 Mobile EHRs Fight For Doctors' Attention

Mobile versions of electronic health records (EHR) systems help healthcare providers document and review patient information. We compare some leading options.




Consumers love their iPads and smartphones, and research indicates doctors do, too. A recent study by KLAS, titled "Mobile Healthcare Applications: Can Enterprise Vendors Keep Up?" revealed that the mobile wave is surging. Seventy percent of healthcare providers claim that they are using smartphones and tablets to access their clinical software. The respondents included physicians, CIOs, IT directors, IT managers and other C-level executives.

The ability to access patient records and prescribe medications via an iPad or smartphone anytime, anywhere, is a huge plus for physicians and is changing the way they practice medicine. But as with any new technology, there are a lot of wrinkles to iron out. For instance, the KLAS study cited usability, documentation and missing information among the weaknesses of mobile technology. "[Clinicians] like flexibility, they like being able to see the data. What they're cautious about is making sure that all the data is present, not just pieces of it," said Erik Westerlind, research director at KLAS and lead author of the Mobile Healthcare Applications study.

End users want apps on a mobile device to be functional. "When I think of mobile I think more of tablets. Phones ... can use data but it's such a small screen that you have to be careful because you have to be able to see the appropriate data about the patient," said Westerlind.

"Most of our clients have experimented with remote desktop on an iPad where they're trying to run their full EHR literally in their iPad," said Stanley Crane, chief innovation officer for Allscripts. That meets with predictable success, Crane said, and it works well for some people who say it is fine in an emergency. "So if you're an administrator and you have to reset somebody's password at the soccer game you can do it. But it's not something you'd want to do all day, every day."

On the other hand, Allscripts customer Lennox Hoyte, MD, a Florida-based urogynecologist, said that the vendor's iPhone/iPad version is a view into the EHR that allows docs to very quickly access patient information. "It's a direct connect to the database and it doesn't go through all of the usual database querying mechanisms," said Hoyte, who added that direct access to the database is quite fast.

Sally Ginsburg, MD, a Massachusetts-based pediatrician, has been using Athenahealth's mobile app on both the iPhone and iPad platforms for about a year. "I can retrieve visits, patient caseload notes, write prescriptions, as well as email from the iPhone and iPad. It allows me to give better patient care because I can respond to things in a way I couldn't before." Another plus, said Ginsburg, is that when she's on a call she has access to information specific to the patient. "I'm not flying by the seat of my pants asking them what their allergies are or what medications they are on or what illnesses they have. I have that all in front of me."

Dr. Ginsburg said that mobile EHRs save healthcare dollars because they save time. "Time costs money whether it's clerical staff on one end or medical clinical staff on the other. I think it makes a big difference for us that we can do things more efficiently and I think it decreases doctor time too."

The KLAS study also revealed that Apple dominates the mobile EHR market with 94% of organizations saying that they use Apple products and support the Apple operating system. Nevertheless, Google's Android and Microsoft have made inroads in the market with 49% and 44% of organizations supporting those platforms, respectively.

Westerlind said that the problem with Android is that its operating system is open source and each device has a different version of Android. "So it interacts differently with each device, it's more complex to use, but Android will continue to grow."

Take a look at nine popular mobile EHR programs and see which ones match your needs.


Allscripts entered the mobile applications market several years ago. According to the company's chief information officer, Stanley Crane, the apps run on the iPad, iPhone and iPod Touch as well as BlackBerry and Android devices.

The company has two iPad products: Sunrise Mobile MD is an acute-care product focused on the things that physicians and nurses need to do while they are taking care of patients in the hospital.

Allscript's Wand, on the other hand, is a native iPad app to help clinicians simultaneously interact with patients and the physician's office. Wand was built, according to Crane, to help nurses check patients' vitals and update medications and allergies. Allscripts is releasing a physician-oriented product in the next few weeks that does complex orders, clinical documentation and charges.

Crane said that what vendors want to avoid is just taking the layout seen on a full-sized laptop screen and making it run in a tiny screen with lousy network connectivity and no keyboard and an inexact mouse. "That's a recipe for disaster," he said.

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On Nov. 19, eClinicalWorks signed a deal with the National Football League (NFL) that will deploy its EHR across the organization, allowing team doctors and athletic trainers to have access to player health records on the sidelines via tablets including iPads, Windows Surface tablets and smartphones, according to Girish Navani, CEO and co-founder of eClinicalWorks.

Navani also believes that the iPad is not just for use outside the office. "We put the comprehensive electronic health record on the iPad and we expect it to be used." To date, eClinicalWorks' mobile app has been downloaded 1,500 times. "We expect the iPad to become a primary device even inside the clinic," said Navani, who added that he thinks that iPad Mini might become the device that nurses and physicians use inside and outside the practice because it fits inside the coat pocket.

Navani said that end users can do everything from completing order entry to looking at lab results and radiology studies on an iPad over a 3G network outside the office. "We offer both an iPad app and eClinicalMobile for smartphones. With an iPad, users want full functionality, but with a smartphone, it is difficult to do that," said Navani. He pointed out that there are some features, such as charge capture at the point of care, viewing messages, responding to refill requests and viewing schedules, that are perfect for clinicians using smartphones away from the office, but do not need the full capabilities of their office EHR.

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Athenahealth rolled out mobile EHRs apps earlier this year for both the iPhone and iPad, according to chief technology officer Jeremy Delinsky. The apps focus on the ability to review tasks in an inbox, view a patient chart, renew or prescribe meds, and do critical business intelligence charting of medical data over time. Regarding the native app versus Web app argument, Delinsky said that ultimately people want to have an app that works; they don't care so much whether it's a native app or a mobile Web app.

"We decided to go the route of mobile Web," he said. "We release a new version every month that includes the mobile pages, and we wanted to control the release process rather than have a third party get in the middle of the process in which we release product enhancements."

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Power Chart Touch (PCT) is Cerner's mobile platform for ambulatory and inpatient settings. "We first designed it for [an iPad] iOS operating system with plans to add Android in the future. And we also support the iOS smartphone with similar work flows and capabilities," said John Gresham, VP of integrated solutions and technology group. PCT is built as a native iOS app deployed through the App Store.

Gresham said that he expects the Android platform to expand and that Cerner will be able to move into that market very quickly. "We will support Android first in the nursing space and we will leverage those capabilities back into our physician experiences."

Cerner has also partnered with Nuance for use of its cloud-based Dragon voice recognition system, believing that such capability is critical in a mobile EHR. He's seeing a lot of adoption of that technology because it cuts transcription costs for hospitals.

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Founded in 2009, Drchrono's EHR platform is Web-based and supported on the iPad and iPhone. "Doctors want to be able to have instant drug interaction checks, electronic ordering and seamless documentation and billing that is all easy to learn and use," said CEO and co-founder Michael Nusimow. "We didn't take an existing PC or Web-based solution and shoehorn it onto a mobile device. We built our EHR from day one on the iPad and took advantage of the tablet display, camera, video recording, speech-to-text and touch interface.

"We have always focused on the iPad as the main EHR interface because it is possible to be used to read a lot of data and also produce and enter in data via the touchscreen interface and using our speech-to-text product," Nusimow said.

iPhone and Android smartphones, he said, have always been used primarily to read data and, to a lesser extent, to input small or emergency notes and orders. "The new iPad Mini is a real game changer; it merges the best of both worlds and can be used just like a regular iPad at a fraction of the cost and size. I predict the iPad Mini will be the dominant device in healthcare within the next two years," Nusimow said.

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ADP's AdvancedMD EHR includes a comprehensive set of cloud clinical and medical billing tools. In November, the company unveiled a new charge-capture functionality for its iPad app, which can also be used on the iPad Mini. The goal was to help physicians focus on patient care, and not procedure coding details.

Among the market forces that are driving the mobile EHR market, said Steven Zobell, VP of product development for ADP AdvancedMD, is the proliferation of incredibly simple, intuitive Apple iOS products. He said that while there are other good tablets out there, none can even come close to the iPad's market share among physicians.

Despite the company's enthusiasm for iPads, Zobell pointed out: "There are some functions that just do not make sense on a mobile device. If a physician wants to write two pages of documentation for a visit, a desktop is a better solution. Looking at a high-res scan, give them a 27-inch monitor."

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On November 13, Practice Fusion announced the beta launch of its EHR for the iPad. Its limited release will be available to medical providers on a first-come, first-served basis. It lets clinicians view schedules, browse past patient medical records, record vitals and document patient visits. It's designed to work in tandem with Practice Fusion's Web-based EHR.

Users can login to both systems simultaneously and data is updated in real time across the Practice Fusion network. Company CEO Ryan Howard said that on the doctor side, Practice Fusion' s product is free. "There's no cost or licensing, hosting, training or support -- in contrast, most of the guys out there are as much as $300 a month," Howard said. Also, he noted, there is nothing to install because the device is Web based. "If you're a doc, we can get you registered today -- validate your identity, turn on e-prescribing, connect you to 70,000 pharmacies [and] hundreds of labs, and we can have all of that done today, where [for] most of our competitors it can take up to eight months."

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Epic's Haiku (for iOS and Android devices) gives physicians secure and portable access to patient charts, whether they are in the hallways of their practice, doing rounds at the hospital or away from work. Functionality includes chart review, patient lists, scheduling, patient search, messaging, e-prescribing, notes entry with speech-to-text recognition and clinical media capture. Haiku works on both the iPhone and iPod Touch, and also supports dictation.

Epic's Canto (for iPad) offers access to Epic charts, messaging and other EHR functions. Physicians can use Canto to check schedules, respond to messages, dictate notes and review lab results from anywhere. Physicians doing hospital rounds can get up to speed on patients before entering their rooms and dictate notes or send messages immediately after leaving. Canto works on iPads running iOS 5.0 or higher.

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Meditech offers customers a Web-based approach to mobile EHRs with its Mobile Rounding application. Because it is device agnostic, it's available no matter where the trend in technology goes.

A Web-based rounding list for mobile devices lets physicians access to up-to-date patient information from smartphones, including the iPhone and Windows-based mobile devices. Mobile rounding lists, according to Meditech officials, are designed to plainly present the most relevant patient information, as well as make the most effective use of the handheld display. In addition, physicians have the ability to view real-time information from the patient's medical record. They can also document evaluation and management information while making rounds.

Meditech software works with handheld scanning technology. That allows clinicians to perform a multitude of tasks, including bedside verification, charge capture and materials management stocking, using digital assistants.

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AirStrip Adds EHR Connectivity To Mobile Platform

WellDoc Integrates Mobile Diabetes Coaching With AllScripts EHR

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