Agreed 100% -- all I wanted to convey is that many (if not most) physicians that have not embraced EMR, and who may not embrace the iPad, are not Luddites, but most have sound reasons for doing so.

We actually use Athena, which gives the most crucial benefit to us -- instant remote access -- but not their EMR, because it simply did not help enough to offset the costs, and did slow a few things down. Don't get me wrong; I would dearly love us to find a EMR, and every few months, I look at it again. I also do not know if the iPad will work in this theater, but I will probably justify my own iPad purchase as research

And I said bribe/cut payments because it sounded somehow cleaner than extortion, but, now that you put the word out there, I am not going to disagree, there, either

(disclaimer: I'm a vascular surgery PA-C who has used several EMRs and a previous tablet input device)

The point of my earlier statement was that the iPad itself would not neccessarily equal attention taken away from patient care.

I personally do not know if the iPad would work as an adequate form factor for patient documentation. IMO (based upon my experience with the iPhone), Apple has a better chance of implementing such a device , but it has many hurdles to overcome. Such as the hardware being embraced by the third party emr. Data input would have to be simple and quick (a good speech to text option should be included). No one denies that scratching out a few lines on the paper chart is not quicker and probably easier but that does not mean better.

The fact is the government is not bribing practices into using EMRs, they are extorting them into it. The conversion was tough, and to change brands was also tough. Although, it does have a few advantages. First and foremost , it is legible. Another important feature is remote access (from the hospital, or other offices).

Many of your points I agree with, many physicians (some older and some not) do not embrace change. That however does not mean as an industry that we should not look to technology to assist where it can. This is one of those times when exploring the possiblities is important.

(Why am I yelling, and where the heck did this soapbox come from?)

It is not a question of open-mindedness, though a lot of (especially older) doctors are resistant to change. It is a question of streamlining the patient care pipeline, which tablets in general have failed to do. Specifically, for doctors requesting information, in non-emergency situations most clinics have it down to a science; somebody has retrieved all necessary information by the time the doctor gets around to needing it. The doctor (and PA/RN) time is what keeps the business running, so any changes that hurt (or just do not help) them will be met with skepticism. In other words, it is not enough for the iPad to be quicker -- it has to be quicker for the right person. If it is:

Pad and Paper

• 3 minutes for dr + 12 minutes for office worker = 15 minutes total

iPad

• 8 minutes for dr +0 minutes for office worker = 8 minutes total

Even if the iPad is overall faster, it will still lose out in most practices, because with paper the doctor has already moved on to the next patient, or given the current patient extra attention, in that extra 5 minutes. The office worker's having to spend extra 12 minutes will neither hurt the patient nor the practice's bottom line.

It may seem small, but that, as much as any luddite tendencies, is the reason so many practices have not even embraced electronic medical records -- because almost all implementations save the administrative staff some time but make it harder on the clinicians (doctors/nurses) and/or hurt the practice's bottom line.

EMR (and the iPad's possible role) do have many systemic advantages, though, which is why the government will essentially be bribing doctors to switch by a target date, and cutting payments to those who do not ( http://www.medscape.com/viewarticle/588354 ). Still, as long as the day-to-day incentives go the wrong way for most physicians, it will be a tough sell, which is why there will be that eleventy kajillion dollars there for the people who nail it perfectly.

In a doctor's office or a hospital setting and implemented properly the iPad(s) can increase productivity as patient data can be retrieved and updated instantly. And in cases of emergency requiring multiple doctors assessments who are far way or en-route they can would all be able to view the same records simultaneously and be ready upon arrival. So the time spent using the iPad should be no more but possibly less than with pen and paper. At the same time it can also prevent wasted time by giving doctors access themselves when necessary instead of asking and waiting for an assistant to retrieve said information. But it all depends on proper implementation, proper software, and doctors who are are open-minded enough to see the benefits.

And who says it won't be droppable? Anyone who owns this is going to buy the apple case or a case of another manufacturer.

(DISCLAIMER: I help run the computers for a private practice)

Actually, efficiency is exactly what has kept tablets from taking off in healthcare. Efficiencies in "they system" aside, what matters to a practice is what is efficient FOR THE DOCTOR. Simply put, the doctor's time is the engine for the whole business, and any practice would much rather pay an office worker before/after each appointment to fetch/data entry charts and let the doctor focus on patients.

Every minute the doctor spends with a tablet is less time she spends with a patient. With previous tablets, the time difference was substantial enough that it projected to several less patients per day, which over the course of a year is a huge hit to the bottom line. The iPad will no doubt be better, but still not as fast as shorthand on a chart for most offices. Tablets will make inroads first in imaging centers and large hospitals, where other functions and sharing of data are large enough benefits to compensate, but, for a huge number of doctors, the economics of switching to tablets just do not add up, because it hurts their business' efficiency.

That said, I would LOVE for my practice to pick up a couple of iPads, and most doctors I know under 40 want to switch. As long as the doctor time differential is there, though, the economics say no -- but there is about eleventy kajillion dollars out there on the table for the shop who can make hardware/software that allows doctors to fetch/retrieve patient data as quickly and easily as whatever their current preferred method happens to be.

where does it say the ipad is droppable?

In order for the ipad to be successful in the healthcare industry, it's going to have to open up the platform significantly. When has anything from Apple ever played nice with non-Apple devices and software?

With HIT Stimulus kicking in starting 2011, they'd need to hustle something to market, get certified and beat entrenched solutions.

http://www.emrandehr.com/2010/02/01/apple-ipad-emr/

It's not like your doctor is going to be playing skeeball vs. auscultating breath sounds. The idea of a tablet inputting device has applealed to the medical community for years, but all the incarnations thus far have proven disappointing. All medical records are being converted to electronic, and quicker input means more time for patient care. Reimbursement continues to drop and being efficient is a necessity.