EHR Hardware Basics

Objectives:

  • Become familiar with basic terms and functions related to electronic hardware.
  • Learn about the differences between desktops, laptops, and tablet PCs.
  • Learn about the basic functions of all components of a computer network.

Hardware Basics for Electronic Health Records

Basic Terms

  • Workstation - This refers to the hardware that holds everything a physician or office staff worker needs to perform their jobs: word processing, practice management software, EHR software, fax software, etc.
  • Desktop - One of three basic types of workstations. This describes a fixed, hard-wired computer that does not move around. The computer can actually sit on the top of the desk (desktop) or on the floor (tower).
  • Laptop - One of three basic types of workstations. This is a portable computer that has a keyboard and either a touchpad, stick, or mouse for moving the cursor around the screen. It is a fully functioning computer that can be carried or placed on a cart and moved around the office.
  • Tablet PC - One of three basic types of workstations. Tablet PCs contain built-in handwriting recognitions software that allows the user to "write" on the screen using a stylus, much as they would write on paper attached to a clipboard. Tablet PCs can have add-on keyboards for instances when typing is preferred.

Desktops

The basics:

  • A desktop computer usually has a standard configuration consisting of a CPU, monitor, keyboard, and mouse.
  • It is stationary; it resides in one location and cannot be moved from room to room.
  • It can stand alone or work with any of a variety of network arrangements.

Advantages:

  • Desktops are low-cost and available from a wide variety of vendors.
  • Because desktop PCs are standardized, it is relatively easy and inexpensive to find spare parts and support, or to replace a machine.
  • Desktops will run just about any software you need.
  • Additional devices such as microphones, speakers, and headsets are readily available at low cost.

Disadvantages:

  • Because it's stationary, you need to buy a desktop PC for each room in which you need access to your EHR software.
  • Desktops typically take up more space than a laptop or tablet PC. While flat screen monitors and tower units save actual desktop space, the standard desktop computer requires more room than either a laptop or tablet PC.
  • You must purchase additional equipment to take full advantage of voice recognition and/or handwriting recognition programs.

What your peers have to say:

"Have had wired computers [desktops] in the exam room since 1998 and think it is the best way. I find it less hassle than carrying a computer around all day, worrying about batteries running out or losing wireless connectivity or dropping the computers. The computers are much cheaper both to buy initially and fix if something does happen. Tried a tablet but did not like it all. Never had a problem with children or adults interfering with the computer in the examining room and if you log out when you leave, HIPAA is not an issue."
-- Keith Stafford, MD, Greenville, South Carolina

Laptops

The basics:

A laptop is a fully functioning computer that is small enough to be portable. Laptops can take advantage of wireless as well as traditional networks. A laptop can easily serve as a desktop machine and can connect via a docking station to a larger monitor and a standard keyboard.

Advantages:

  • A laptop has a smaller footprint and can easily be turned to allow patients to view information on the screen.
  • A laptop is less obtrusive during patient interviews.
  • Most have fairly long battery life and/or an A/C adaptor.
  • Laptops use standard PC inputs such as keyboard and mouse and/or touchpad.

Disadvantages:

  • Although laptops are portable, they can be heavy to carry, typically weighing five to eight pounds.
  • Repairs and maintenance tend to be more expensive because laptops use non-standard or proprietary parts. You may have to send a laptop off-site for diagnosis and repair.

What your peers have to say:

"We work wirelessly with laptops. All [prescriptions] print from one central printer right outside the exam rooms. Benefits of laptop:

  1. Can open the note and chart before entering the room and bring up appropriate templates. Can enter the room already knowing what HM is late and what the purpose of the visit is.
  2. Can close the note right outside the room if you want to go ahead and have the patient leave before finishing a note.
  3. Can see with bifocals; no neck strain.
  4. Can have all my personal settings and programs handy all the time - PDR, links, hospital links, etc.
  5. Can look at patient easily over the top of the laptop and can easily show patients what I'm doing.
  6. Touchpad is always in the same place in relation to keys; easy to switch from it to typing or tabbing without looking. I like having a full size keyboard.

"I'm hooked on my laptop and am so accustomed to carrying it around that I don't even notice even though it is Dell's heaviest one."
-- Sue Andrews, MD, Murfreesboro, Tennessee

Tablet PCs

The basics:

There are two main types of tablet PCs: a slate tablet PC, which is a tablet with no attached keyboard (although one can be added), and a convertible tablet PC, which is basically a laptop computer with a screen that can swivel and fold onto the keyboard to create the tablet.

Advantages:

  • Tablets are truly portable and lightweight, typically weighing three to four pounds.
  • It is as powerful as a PC, but it doesn't require a keyboard. Instead, you add information by writing on the screen with a digital pen or stylus, much like you do in a paper chart.
  • Handwriting recognition software developed for tablet PCs is excellent, even for very poor handwriting.
  • Tablet PCs have integrated dictation capability with voice recognition software that transcribes directly into the patient record.

Disadvantages:

  • Writing with a stylus takes getting used to; there is a longer learning curve in adapting to a new way of using a computer.
  • Handwriting recognition dictionaries have not yet fully integrated medical terminology and acronyms, requiring more correction.
  • There is not as much standardized software yet available for tablets.
  • Screens are easily scratched and can become unusable without screen protectors purchased at additional cost.

What your peers have to say:

"I have been using a Gateway tablet in the room with my OB patients for the past two years. We use an ASP prenatal record called eNatal. I wouldn't trade for it. It has three methods of entering data on the screen, all vastly improved with the SP2 for Windows XP for Tablet.

"The first method is through tapping on a screen-based keyboard with the stylus (slow but very accurate). The second is through straight handwriting recognition. I have relatively poor handwriting, but it is amazing how accurate and fast this is! The only thing that seems to trip it up is some abbreviations, acronyms, or words that it can not find in the dictionary. The third option is a letter-by-letter handwriting recognition panel that is slower but extremely accurate.

"We've had no downtime. The wireless connection works well. The battery life is good (I plug it into the docking cradle between OB patients). We have used laptops and desktops for eNatal in the rooms and the tablet works best by far. As we look to add a full EMR, we hope to use a tablet-based system, probably the Motion Computing tablets with the biometric (fingerprint) access."
-- G. Jeffrey Young, MD, FAAFP, Levelland, Texas

Using EHR technology require a certain adjustment in the way you're used to interacting with your patiens and their charts. Deciding how to do this in the way that makes you the most comfortable will help guide your choice of hardware -- e.g. using a desktop, laptop, or tablet PC.

Examanation Room Setup

Read what your colleagues are trying to help you determine what might work for you.

Joan E. Wurmbrand, MD, Bexley, Ohio, says:

"Our architect designed (and the cabinet makers built) storage cabinets with a pull out desk. We can be facing patients in their chairs as we sit on our rolling stools. When it comes time for the exam, the patient can stand to move to the exam table and we can slide the desktop back into the cabinet. It has worked out well and I can set my wireless laptop on it easily."

Thurman Pedigo, MD, Nashville, Tennessee, says:

"Based on recent experience, I would have everything I can on wheels. We are wireless in exam rooms and discovered the convenience of having a computer desk on wheels so that the entire setup will move easily to another location if needed. Every exam room should be identical. My opinion is that four room clusters are a good exam room configuration, although three room clusters for slower physicians may be adequate. A very small sink and useful counter in the exam room is a must as well as access to both sides of the exam table. Position the door close to the desk-do not position patient between the doctor and the door."

David Voran, MD, Leawood, Kansas, says:

"In our on-site clinic we're going to experiment with large LCD screens positioned so the physician and patient can both view it comfortably. Each clinician will have their own wireless tablet PC and, when sitting down with the patient, can use the wall-mounted LCD as the second monitor. That way the clinician can slide those items to be shared with the patient onto that monitor, while keeping the other parts of the record or other personal productivity applications on the tablet's screen."