Tablet PC's future hangs in balance
Does the Tablet PC have a place in healthcare computing and is it a format that clinicians will want in the future?
It depends on whom you ask.
The tablet has fans and foes alike. At this point the jury is still out on whether it occupies an awkward space between PDAs and laptops or whether it provides the best performance features of both. For the time being, it appears safe from going the way of the eight-track and Betamax videotape, yet nagging concerns persist if studies like one done recently by Menlo Park, Calif.-based Spyglass Consulting accurately reflect wider industry preferences.
"Nurses overwhelmingly said it was not the right device," said managing director Gregg Malkary. Several factors accounted for the unfavorable opinion among 100 nurses surveyed, including fragility, heavy weight, cumbersome size and limited battery life.
"Number One was durability – they thought it was too fragile to be practical," Malkary said. "A three-foot drop is sufficient to crack the screen. There are too many instances where it could break, such as falling off a patient bed or a workstation ledge.
"The next big issue was the weight. At about three pounds, the unit is light enough to be transported, but gets heavy after carrying it around for any length of time, he said. What's more, the tablet format is too large to fit into a lab coat pocket or fanny pack, so it must be carried.
Admittedly a "tablet skeptic," Russ Cucina, M.D., says the unit's main problem is that it gets in the way of patient care.
"Medicine is a full contact sport – you need to touch the patients without anything in your hands," said Cucina, assistant professor of internal medicine at the University of California-San Francisco.
Placing the tablet on a patient bed also raises hygiene issues, he said. "If you're a patient, do you want a physician handling you when that computer is being put on the beds of other patients? It's an object that is being set in rooms and it can't be washed," Cucina said.
Size-wise, tablets are caught in a netherworld between the hand-held portability of the PDA and the optimum functionality of a desktop or laptop, said Patrick Campbell, principal of BCC Consulting, Durham, N.C. Basically, it's too big to be portable and the keyboard and screen are smaller than the laptop, making it inferior for either purpose, he said.
"The problem is that everything the tablet can do, something else can do better," he said. Moreover, the format emulates the paper chart, which Campbell sees as an archaic approach.
"If you're starting over from scratch, why would you devise a paper chart?" he said. "You're limiting yourself. I just don't see people making a leap to it."
The drawbacks cited by tablet critics don't seem to apply in the group practice setting, which may explain why physicians at the Shannon Clinic in San Angelo, Texas, are embracing the technology.
"We're only nine to 10 months into the conversion but it has been working great for us so far," said Jim Fajkus, CEO of the multispecialty group practice of more than 100 physicians. After reviewing the choices, the clinic settled on the Gateway tablet, which physicians considered to be a versatile format."It has the functionality we're looking for – it's like a small PC," Fajkus said. "It's great for data input and retrieval."
The clinic presently has 70 units in use and the plan is to equip all physicians and some nurses by the end of the year.
Tablet PC maker Motion Computing dismisses the criticisms leveled against the format, pointing to accolades bestowed upon the Austin, Texas-based company's Motion Tablet PC. Among them: PC Magazine's "Editor's Choice Award," Laptop Magazine's "Best Buy" selection and Planet PDA's "Product of the Year" for 2003.
"These are all testaments to the product's excellence," said Elizabeth Clark, director of product management. Acknowledging unit durability as a rational concern, Clark points out that the Motion Tablet PC has rubber edges to soften impact and that protective casing is also available.
Mounts can be used to dock the unit in the patient room, outside the door or on a cart, she said, offering clinicians many options.
Clark also touted the advantages of the slate format, which offers digital pen functionality as well as audio technology called Speak Anywhere, consisting of two microphones and software that suppresses echo and background noise. Though most functions can be performed with the digital pen, a snap-on keyboard can be attached when needed, she said.
"That way you're not burdened by having to carry it around all the time," she said.