An Apple tablet would be the ultimate UI for electronic medical records. With a touch-screen display like the iPhone, using the EMR during an encounter would be simplified. For example, selecting an evaluation and management (E&M) code could be as easy as “dialing in” the code with a swipe of a finger.

Using the iPhone’s intelligent keyboard technology, the device could have a very sophisticated automatic coding tool. Some EMRs can already auto-generate E&M codes based on information collected during the patient encounter. Combine this with the iPhone’s keyboard word suggestion tool, and physicians could rapidly select codes. Additionally, just as the iPhone adapts its keys and layout for different applications, the Mac Tablet could display a unique keyboard setting for each EMR function.

Using iPhone speech recognition technology, physicians could dictate directly into an EMR to create notes, draft narrative reports or generate custom patient instructions. Mac design programs could be repurposed to make a really slick tablet drawing tool for anatomical diagrams that illustrate procedures and diagnoses.

There is no question that I think tablets are underutilized in healthcare. I have pushed them into the hands of pharmacists at my facility and have tried various different things to encourage their use. While I would love to see tablet computers adopted in mass among healthcare systems, I just don’t think it’s in the cards for the iSlate for several reasons.

- Most of what I’ve read about the mythical Apple tablet is that it will be marketed to consumers as an entertainment device. Whether that is true or not remains to be seen. The device has been described by many as a “large iPhone”. Would that be the best device for healthcare? That’s a good question and one that I would like to answer some day.

- Apple computers have yet to be accepted in the healthcare industry on a large scale. Individual healthcare providers have embraced Macs, but overall large facilities continue to overwhelmingly use the Windows operating system. I just don’t see facilities testing the Mac waters with the iSlate.

- The healthcare industry needs to rethink their IT infrastructure. Moving away from the desktop and toward the “cloud” would be a good start. In order to integrate new operating systems into mainstream healthcare, we must develop a system independent of the platform chosen.

- The unknown. Apple has proven that they can create quality devices, but the iSlate is an unknown commodity at this point. Many CIOs aren’t willing to spend tens of thousands of dollars on something they aren’t comfortable with.

- Lack of quality IT service personnel. I’ve worked at several healthcare facilities here in the Central Valley and I can say without hesitation that my current facility is fairly tech savvy and progressive. With that said, when I wanted to purchase my own Mac laptop for use as my primary work machine our IT department almost had an MI. Their view of Mac was that of a high maintenance, high cost, all fluff system. I have three desktop Macs and a Mac laptop at home and I think they are great machines. My point is that many IT departments are not ready to support an Apple device, no matter how popular it is.

- General lack of interest in tablet technology. While there is tremendous interest in the iPhone platform, it remains to be seen if that will translate into interest for the Apple tablet. Currently interest in tablet technology among healthcare professionals is lukewarm. Mostly users complain about weight, poor handwriting recognition, battery life, poor wireless connectivity, etc.

The iSlate has clearly generated interest among the technology community. This combined with the strong showing of tablets at the annual CES show this year may indeed usher in the era of tablet computers in healthcare. However, I think the platform to do this has yet to be designed. Here’s to the future.

- Inglourious Basterds was #1 at the box office last weekend. My wife I saw the movie this morning. It was good, but nothing I couldn’t live without.

- For those of you with your head in the sand this week, Senator Edward Kennedy died from malignant glioma at the age of 77.

- DUO by KCI Communications is a neat little gadget. DUO adds pen input to a PC screen up to 17”. The device uses a base station attached to the top of a computer monitor to track the XY coordinates of the pen as you move around the screen. With this product you can basically turn a standard laptop into a tablet PC. Cool! Go to the website and watch the videos. It’s hard not to be impressed.

- Last year a guy named Wei of Weistudio developed a Mac Tablet created from a Wacom Intuos tablet and a MacBook. He affectionately called it the iTab. Well he’s done it again, but this time he created a great looking portable version dubbed the iTab Mini. Apple should take lessons from this guy. The iTab Mini has a 2.16GHz Core2Duo processor, a 12.1” resistive touch screen, and a whole lot more. The website chronicles the process and makes for some very interesting reading.

- There are two new developments for the iPhone that are going to make note takers very happy. First, Evernote has added web clipping to its list of incredible features. For those of you that don’t already know, Evernote is a great way to keep track of notes, web clippings, documents, etc. Second, there is a new application for the iPhone called MobileNoter that allows users to sync their OneNote notebooks between their desktop and iPhone. MobileNoter is in early beta testing, but looks promising. Anyone that owns, or uses, a tablet PC knows about Microsoft OneNote. It’s a great product.

- Italian researchers have shown that long-acting testosterone on top of optimal medical therapy seems to improve a host of symptoms in elderly men with chronic heart failure. The article appears in the September 1, 2009 issue of Journal of the American College of Cardiology. I can see it now, every elderly man in the country with a heart condition will be lining up at their cardiologists office with a copy of the article in hand.

- The September 1, 2009 issue of Clinical Infectious Diseases is reporting that the total cost associated with the treatment of an MRSA infection is the same regardless of the drug being used. The conclusion of the authors states that “when all costs of therapy were considered, the cost‐effectiveness of daptomycin and vancomycin‐gentamicin was similar, even if the cost of vancomycin was $0.” Ouch, that’s going to make the pharmacist’s job just a little bit harder.

- Crabapples.net: “Ok, so we can’t offer trials at the App Store, but I sure wish we could. As a result the App Store is full of paid and free versions of the same application. The free version is basically a limited functionality version of the paid app. Silly isn’t it? If app developers could offer trial versions that could be upgraded to the full version after a period of time, even if that time period is fixed by Apple, would be a huge step forward.” – I agree 100%. Apple should definitely support trial applications.

- I discovered the Non-Clinical Medical Jobs website this week. I found the site very interesting, as I consider my current position as an IT Pharmacist a “non-clinical” job.

- IT World: ” Why Excel beats iCal for to-dos on the Mac – While I generally keep track of long-term deadlines in iCal’s calendar view, every Sunday night or Monday morning I make a list of all my discrete tasks for the upcoming week in trusty old runningtodos.xls. I’ve been doing this for as long as I can remember; I knew in theory that iCal had to-do list functionality, but I had never bothered with it, for reasons I can’t now remember.” – I do the same thing. I’m a very visual type of guy and I need to see things in list form to make sense out of them. The other thing I typically do is create a running 12 month calendar using Excel that contains important dates; cheer meets, volleyball games, vacations, etc. I know it seems strange, but this has served me well for nearly 10 years now.

- Want to use your TV remote to blog or Tweet? Well, apparently IBW thinks you should be able to. Techcrunch is reporting that IBW has filed a patent for just such a device. Sweet!

- Football, it’s all about football people. The NFL season opener is quickly approaching and I can’t wait.

Have a great weekend everyone.

- The Wall Street Journal: “The Food and Drug Administration’s top medical-device regulator said Tuesday he is resigning. The departure follows internal dissent over device-approval decisions that the regulator’s critics said were too friendly to industry. Daniel Schultz said his move comes “by mutual agreement” with FDA Commissioner Margaret Hamburg, who took office in May.” The article goes on to say that a group of division employees “wrote to the House Energy and Commerce Committee last October to complain that the division’s leaders had approved devices despite formal safety and efficacy concerns raised by FDA. They also alleged some scientists who objected to the decisions faced retaliation from leaders of the device division.” In addition, The Journal is reporting that Janet Woodcock, the director of the FDA’s Center for Drug Evaluation and Research, is being investigated “from an ethics complaint filed by Amphastar Pharmaceuticals Inc., a California company that says it has been delayed in its six-year effort to win approval for a generic version of Lovenox, a multi-billion-dollar blood thinner.” It looks like the FDA has some explaining to do.

- An online article published on August 10 in Pediatrics describes the results of a study in a pediatric ICU in Israel. The study looked at 1250 PICU drug prescriptions from each of the following periods: 1 month before computerized order entry (period 1); 1 year after computerized order entry (period 2); after clinical decision support system implementation (period 3); and after a change in prescription authorization allowing only physicians to prescribe prescription drugs. The results of the study demonstrated only a small decrease in prescription errors. CPOE systems are difficult to design and implement in pediatrics secondary to all medications using weight based dosing. If you want to see a great CPOE system used in a pediatric environment, plan a visit to Denver Children’s Hospital. Two years ago I attended a presentation by their pharmacy director on their design and implementation. It was well done.

- Medsacpe: “Many family physicians, internists and other prescribers continue to meet with drug company representatives and think these meetings are worthwhile, new research shows. In a series of focus groups with prescribers of various training backgrounds, researchers found that most prescribers believe overall that these interactions improve patient care and the health of their practice.In general, prescribers also felt that meeting with a drug detailer does not impact their prescribing habits, despite an abundance of research showing that drug detailing by pharmaceutical representatives does influence prescribing. Most prescribers indicated that they either trusted the information from pharmaceutical drug detailers or felt that they are well equipped to evaluate and filter information presented to them, Dr. Fischer and colleagues report.” – Wow! Any pharmacist that believes a pharmaceutical rep has the patient’s best interest in mind with the information they provide, please raise your hand. What, no takers; didn’t think so. Anyone interested in my take on the issue can read more here.

- The Mac Tablet continues to make headlines, but this time it’s to the chagrin of excited people like me. Several sources this week have written that the Mac Tablet will not debut in September as originally thought, but sometime in 2010. Bummer. Until then, I will continue to drool over all the cool mockups that continue to show up on the internet; like the image to the right.

- MedGadget.com: “Complicated pediatric cardiac surgeries, such as staged Fontan reconstruction in children born with an univentricular heart, present great challenges when planning for each procedure. Unique anatomies bring unknowns into the physiologic (hemodynamics) equation, often requiring surgeons to make difficult decisions when predicting the outcome of a specific approach. Now scientists at Georgia Tech and clinicians at Children’s Hospital of Philadelphia have developed a software tool that analyzes patients’ own MRI scans to simulate various possible surgical options and their outcomes.” – I love this type of 3-D animation. Drug researchers have been doing this for years as a way to develop new medications by rendering 3-D images of receptor sites. Cool technology.

- Medicine And Technology: “My wife and I have debated this topic. Should our daughters get the HPV vaccine? There are so many potential implications associated with this question. CNN has a story that asks the same question: Should your daughter get Gardasil, the vaccine against HPV? Right now, Gardasil (made by Merck) is the only HPV vaccine that is approved by the FDA. There are other vaccines in the pipeline, but who knows if/when they will get approved. The FDA has been so slow these days. Someday, we’ll probably have a single vaccine that includes all of these major shots. This way, you won’t have to poke people multiple times. Kids (and adults) don’t generally like needles. HPV causes warts. It can also cause cervical cancer. So by vaccinating children, you could be preventing cancer. From a public health view, it seems like the right thing to do. However, HPV is also sexually transmitted. So if you’re vaccinating children, what type of message are you conveying regarding sex and sexually transmitted diseases? If you tell your child “abstinence before marriage” and then give her an HPV vaccine, are you communicating mixed signals? So what do you think about this topic? If you had a young daughter, would you have her get the HPV vaccine?” – This is a timely topic for me as my wife and I have also been discussing whether or not our daughters should get the HPV vaccine. I won’t tell you our decision, but if you have daughters this topic should be near the top of your list of things to talk about.

- barcode.com: “The American National Standards Institute, or ANSI, recently approved a new set of standards from the Health Industry Business Communications Council for using RFID tags to label and track medical products. ANSI/HIBC 4.0, the new decided upon standard, provides guidelines for tagging healthcare products in a way that will prevent RFID interference with medical devices, which had previously been causing some major issues. In fact, in a June 2008 Journal of American Medical Association study, it was found that ultra-high frequency tagging interfered with the operation of electronic medical devices in almost 63% of the cases tested. Since a smaller read range is less likely to interfere with medical devices, the council’s new standards recommend that healthcare products be tagged with 13.56mhz high-frequency coding.”

- Thankfully the NFL preseason has arrived. It’s time for some football!

Have a great weekend everyone.

Here’s a peek at what’s been going on:

EMR and HIPPA.com ran a blog entitled Tablets vs. Convertibles vs. Laptops and EMR. The information presented was very enlightening. The most interesting statement in the blog: “there was one feature of the convertible tablets that was used quite often. The swivel screen. Yes, the least technical part of the convertible tablet technology is what they found so useful.” Maybe laptop and netbook manufacturers should give the idea of a swivel screen another look. The concept would be ideal in combination with the new LCD screen from Pixel Qi.

- CrunchGear claims that “the year of tablets will never come – at least not in the next decade.” I humbly disagree as the tablet PC will find its way to freedom. Never count Microsoft out.

- Gottabemobile thinks that tablets are excellent for certain functions, but not the ones that most users want. The author believes that tablets will become “consumption devices for web surfing and playing music, games, video, and the other distractions from life that we all enjoy“. That would be a great design, but I still think the fully functional tablet has a place.

- LIVEdigitally blasts the tablet PC by listing several reasons why they “suck”. Most of the reasons listed don’t make any sense, such as “Tablets suck to carry around” and “Tablets make you tired“. I’m not sure who this guy is, but my 11 year old daughter carries the one I use for “work” around and loves it. I have to tackle her and take it back when I need to use it (figuratively speaking of course). Fortunately, I didn’t have to defend my position on the subject of tablet PCs as Gottabemobile did that for me. Some of my favorite quotes from the Gottabemobile post include, “Tablets suck at handwriting recognition. No, you suck at handwriting” and “Tablets make you tired. No, you tire easily because you’re a wuss.” Take a second to read the entire article; it’ll give you a good laugh.

- ReadWrite posted an article entitled “Tablets are Toys (Not Mainstream Machines)“. While little better than the post at LIVEdigitally, the message is the same; tablet PCs just aren’t going make it. Again, Gottabemobile came to the rescue with a well thought out post that punches holes in the opinions of the ReadWrite author.

This type of banter can only mean one thing, the tablet PC is here to stay for a while. If everyone hated the form factor you wouldn’t see posts like this flying around the net. Hey, even the iPhone has it critics. Building a funeral pyre for the tablet PC, and other similar devices, seems a little premature at this point. A convertible tablet computer makes a suitable replacement for almost any laptop. I, for one, am in the market for a new tablet and hope to use it to replace my aging Dell laptop. I’ll let you know how it goes.

- G-Force was #1 at the box office last weekend. Yes it’s true; the movie outperformed Harry Potter by $2 million. Ha! Take that Mr. Wizard. .

- mobihealthnews featured a great article titled “Cisco on wireless health, alert fatigue and apple carts“. Of course I thought the apple carts reference was going to be something about the iPhone, but turns out I was wrong. The reference is from the following statement: “To make any technology initiative successful in healthcare, you need to think of the impact it will have on all of the stakeholders in the system, Sands explained. For doctors, the impact will be on their “apple cart.” The doctor’s life is best described as an apple cart that is full to the top and the last thing they want to do is add on more thing on top, because they are worried it will topple the whole thing over. We have got to be sensitive to that if we are going to implement something in the doctor’s office, Sands said.” That is an interesting way to look at it. I think this metaphor applies to pretty much all healthcare professionals as we’re officially in the do-more-with-less era.

- Here’s a nifty little blog on managing online passwords from a physician who got his Facebook account hacked. I had my hotmail account hacked a few months ago, and I can tell you it sucked. It appears that I suffered no real damage, but only time will tell if that is completely true. So, keep your passwords tuff and unique. If you were to look at some of my passwords today, you might think it was a joke because they are so ridiculously long and complex.

- Looks like Sony is bringing new eReaders to the market; the PRS-300 and PRS-600. They look like updated versions of the current eReaders. I’m a big fan of eReaders and eInk and am looking forward to some “hands-on” with these. They’re about the only eReaders I can physically touch without buying first. There’s a Sony Style store in the big San Jose mall about 3 hours from Fresno. It works out well for me because my daughters love to shop.

- The rumor of a Mac Tablet is still creating waves all over the internet. The nice thing about the speculation surrounding the Mac Tablet is all the cool mockups be posted. Take a look at a couple here and here. Of course the best mockups I’ve ever seen are these. The rumors surrounding the Mac Tablet have it touted as a slate like tablet with an 8-10″ screen designed primarily for multi-meida. I really hope this isn’t true as I’d like to see the device have a full blown Mac operating system, not a watered down version like the iPhone. Until that happens, tablet PCs will remain king in my opinion. That may be more true than ever before with the arrival of Windows 7, which is supposed to be a very “tablet friendly” operating system.

- Engadget is reporting that the infamous CruchPad should arrive sometime in November. Don’t hold your breath as this device is on the verge of being vaporware. If the rumors surrounding the Mac Tablet are true, the CrunchPad may become a vague memory.

- Take a look at “Key Articles and Guidelines for the Prevention of Venous Thromboembolism: Clinical Guidelines” at Medscape Critical Care. Prophylaxis for Venous Thromboembolism is always a lively area of research and discussion.

- Last week I told you about Amazon removing illegally obtained copies of 1984 from Kindles without the user’s permission. Well, it appears someone took it personally as a student’s school notes attached to the ebook were lost when it was removed from the device. The user is suing Amazon.

- GottaBeMobile.com: “Verizon Stores Starting to Use Tablets on Sales Floor – Verizon stores in 3 Indiana towns (Jefferson Point, Kokomo, and Castleton) are piloting the use of Tablet PCs for their sales personnel. Verizon is planning on having Tablet PCs in 120 stores by the end of the year. The picture looks like a Motion Tablet PC of the C5/F5 variety.” – It appears that just about every industry besides pharmacy is using tablets to make their lives easier. You’re killing me smalls.

- Office Online Blog (How Bill Gates uses Office): “Of course, collaborating often means meeting with my colleagues in person or remotely over the Internet via Office LiveMeeting. I always take a lot of notes about ideas to think about or things to follow up on. I try to bring my Tablet PC to meetings as often as possible so that I can use OneNote 2007 to write notes in ink that can later be searched or converted to text. Even if I forget my Tablet, I can scan a document or piece of paper and add that image to OneNote. One of the nice new features in OneNote 2007 is that it automatically recognizes the text in those scanned documents, so that it’s easy to search for them later.” OneNote is a great product for use on a tablet. It’s like having an electronic version of your old school binder where you take notes and paste clippings. Bill also states “If you visit my office, you will probably notice right away that I have three large flat screen displays that sit together and are synchronized so they work like a single very wide display. The large display area enables me to work very efficiently. I keep my Outlook 2007 Inbox open on the screen to the left so I can see new messages as they come in. I usually have the message or document that I’m currently reading or writing in the center screen. The screen on the right is where I have room to open up a browser or look at a document that someone has sent me in e-mail.” That’s pretty cool. I have two 19″ flat screens in my office at work and wish I had a third.

- Thankfully we are only about two weeks away from the NFL preseason and I can barely contain myself. This time of year is pretty much void of any real sports action. C’mon, golf and baseball? I don’t think so. I need to see a collision sport other than NASCAR, and I need to see it soon!

- Bruno was #1 at the box office last weekend. I can already give you results for next week, Harry Potter and the Half-Blood Prince. “Potter” brought in just over $22 million on opening night.

- Florence dot com (Barbara Olson) offered an interesting look at how the medication use system resembles a bunch of train cars linked together. According to the blog “medication error literature suggests that errors originating in the prescribing car account for about 40% of all errors and represent 28% of harm-causing errors.” Many of these errors get caught by pharmacists and never reach the patient, but several errors still manage to squeeze through the cracks. CPOE is introduced as one possible means to reducing the number of errors reaching the pharmacy. This in turn reduces the number of errors that get through the cracks. Barbara goes on to give a great synopsis of information that should be included on each and every prescription (i.e. drug, dose, route, frequency, indication, etc,).

- Pharmacy Technology Resources (PTR) takes a look at how independent pharmacy can stay competitive in an ever changing market place. I remember working for a compounding pharmacy in San Jose during the first few years of my career. Their specialization in compounding, specifically veterinarian compounding, allowed them to not only stay alive, but thrive in an area ruled by large chain pharmacies. I loved working at that little compounding pharmacy. It still ranks as one of the best jobs I’ve ever had.

- It appears that nicotine replacement therapy (NRT) following coronary artery bypass graft (CABG) surgery isn’t such a good thing after all. A recent article in The Annals of Pharmacotherapy states that “the use of NRT in a postoperative CABG surgery population resulted in a significant increase in mortality when adjusted for baseline characteristics.” Of course, the article was the result of a small retrospective study in a 22-bed cardiothoracic surgery ICU. Still, it’s worth taking note of the information.

-A recent article in JAMA suggests that the use of corticosteroids in severe sepsis may reduce short-term mortality [again]. Treatment with steroids appeared to increase the reversal of shock and reduce ICU stay without significantly increasing complications. Corticosteroid use in severe sepsis has been a hot topic since I graduated from pharmacy school. Opinion changes every few years. For now, it appears we have a green light for use. Who knows what developments will spring to life next week?

- The Angry Pharmacist talks about how pharmacy has turned into a profession fighting with everyone, including patients, doctors, insurance companies, other pharmacies and technology. The blog is an interesting and slightly entertaining read, but not for the faint of heart.

-Life in the Fast Lane offers some great advice on how to handle information overload. Tips include using a feed aggregator to pull all your information to a single location, going mobile with smartphones and podcasts, and my favorite piece of advice, “relax”.

- Hoping to improve census data, India plans to fit every citizen with a biometirc ID card containing all sorts of personal data. Really? That’s over one billion biometic ID cards. Good luck.

- Apple is at it again as they have filed patent applications for object and facial recognition on the iPhone. What will they think of next? I don’t know, but I’m looking forward to what ever it is.

- The Mac tablet rumor generated lots of interest around the “tablet” form factor this week. Because I love the idea of “tablets”, I thought I would provide links to articles I found interesting this week:
1. Matt Miller: Can Apple Make Tablets Viable?
2. ‘ReiterPad’ Beats CrunchPad, Apple Tablet
3. Entelligence: Why the pen isn’t mightier than the keyboard
4. Motion Extends Superior Display Technology to the C5 and F5
5. GBM InkShow: Motion Computing J3400 vs Fujitsu ST6012 Head to Head
6. Apple Tablet to have PA Semi Chip? Two processor teams at Apple?

Have a great weekend everyone.