What's the Range of Features?
Indeed, there are myriad choices when it comes to portable computing for medical professionals. Each has its advantages and drawbacks for different clinical scenarios.
Laptops and Notebook Computers
Laptops and notebook computers have just about everything a traditional desktop PC offers, including fast processors, lots of memory, big hard drives, easy-to-read screens, full-size keyboards, proven software, and support for all kinds of peripherals -- including telemetry devices -- via USB ports. The price of these computers can be as low as $300 these days, although some high-end models go for close to $2000.
What laptops and notebook computers lack are true portability and enough battery life to get through an 8-hour shift, in contrast to some tablets and netbooks without power-hogging hard drives. The former devices also might not be easy to disinfect to healthcare standards.
This lightweight, inexpensive class of computers might be described as the laptop's younger sibling. Most lack DVD drives, and some have solid-state memory instead of true hard drives; they often are essentially Internet appliances made to run Web-based apps, such as Google Documents and Medscape clinical reference tools. Netbooks rarely cost more than a few hundred dollars.
Variations on the netbook include Intel's Ultrabook™ and Apple's MacBook Air®. Both of these products tend to be larger than netbooks, are super-thin and light, and have no DVD drive. Some high-end Ultrabook models do have traditional, mechanical hard drives, but most have only solid-state memory, typically 64 to 256 gigabytes of internal storage -- far less than a hard drive. Such computers range from about $700 to $1200.
PC-style tablets can be just as powerful as a laptop, and more versatile. But this kind of computer, which may have already had its peak, can be heavy and not durable enough to withstand hospital-grade disinfectants. Expect to pay at least one third more for a PC tablet than for a comparably equipped laptop. The premium is even higher for "ruggedized" models that can survive falls and sealed units that stand up to repeated disinfecting.
One form of sealed, heavy-duty tablet is the healthcare-specific computer, such as Intel's Mobile Clinical Assistant (MCA) platform. The MCA, available from several hardware manufacturers, often features a sealed, antibacterial case, a built-in barcode reader, and an integrated handle to make it easy to tote around a hospital or clinic. Models from Panasonic and from Motion Computing can run $2500 each.
Most of the buzz has come from the consumer-grade multimedia tablet segment, which includes not only the iPad but also all manner of models running the Google Android operating system, including the Samsung Galaxy Tab™ and Amazon's Kindle Fire™. Traditional PC manufacturers have developed tablets for Windows® 7, and Research in Motion offers the BlackBerry PlayBook™, although the latter device has been unsuccessful in the marketplace.
Entry-level tablets, such as the Kindle Fire, start as low as $200; however, these less expensive devices may lack many features that doctors typically find useful. In contrast, the top-of-the-line 64-gigabyte iPad 2 with cellular Internet connectivity retails for $829, plus monthly data service. This class of computer is super-portable and tends to have long battery life, but there have been plenty of growing pains trying to adapt consumer tablets to healthcare.
How Are They With Electronic Health Records?
In 2011, Seattle Children's Hospital reported a failed experiment with iPads in clinical settings. A group of 5 physicians and 2 nurses tried to access the hospital's electronic health record (EHR) through the Web browser on iPads, but the setup proved unwieldy. Clinicians reported it was inadequate for day-to-day clinical work.
It turned out that certain elements of the EHR were designed for viewing on 21-inch desktop computer screens, not the 9.7-inch iPad, so users had to do a lot of scrolling to view pertinent data. "The software is not designed to run on a 10-inch screen size, and it's still a very mouse/keyboard-driven piece of software that isn't optimal for the finger pinching and other manipulation methods of the iPad," Seattle Children's Hospital Chief Technology Officer Wes Wright told Medscape. "That's pretty cumbersome to a provider who has to enter orders."
More recently, some nurses and nursing shift administrators have been using Dell netbooks with 10-inch screens, according to Wright. "They're not doing much entry into the EHR system; they're mostly using it for reference" and to manage workflow, Wright explained.
Quality of Screen and Images
Images are an entirely different story. The first 2 iterations of the iPad have had sharp, beautiful displays, and many modern laptops have the 1080p resolution (1920 by 1080 pixels) found in high-definition televisions, but they fall short when compared with radiology workstations.
Like a typical desktop monitor, the iPad 2 has a screen density of 130 dots per inch (dpi) -- far less than the 508 to 750 dpi found in primary radiology viewing stations. For this reason, in presenting research at SPIE, the International Society for Optical Engineering's medical imaging conference, in January, Australian radiologist Mark McEntee, MD, said that tablets should only be used as "secondary" displays when high-resolution screens are not immediately available.
That warning is similar to a caveat that the U.S. Food and Drug Administration imposed in granting 510(k) clearance to mobile medical image viewing apps from MIM Software, GE Healthcare, and Calgary Scientific. "This device is not intended to replace full workstations and should be used only when there is no access to a workstation," the agency said in its clearance notice to Mobile MIM, an iPad and iPhone® app developed by Cleveland-based MIM.
Medscape Business of Medicine © 2012
Cite this: iPad®, Notebook, Laptop, Netbook: What's Best for Doctors? - Medscape - Apr 19, 2012.