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Archive for February, 2012

Large Screen All-In-One Touchscreen Devices in Exam Room

We implemented large 24″ HP 9100 and 9300 All-In-One touchscreen devices in our clinic’s exam rooms nearly a year ago for several reasons.

New interactive exam room monitors

  • The monitor is as much for the patient and whomever is with them as it is for the nurse or physician using it to document the encounter or provided education
  • Documenting at the point-of-care is easier and more intuitive when it can be shared with the patient
  • The device can be used for interactive diagnostic procedures as well as education
  • Improved productivity with large screens as multiple parts of the chart can be viewed simultaneously or part of the chart (we often have the patient summary open beside the note being created.  This allows the patient and the physician to make sure chronic disease management can be seamlessly worked into a visit for an unrelated acute problem.
  • Touch screen allow us to capture patient input in on-line surveys (pain, anxiety, depression, mental status exams, etc.) as well as display and capture procedure consents that may contain multimedia content and then also capture the patient’s signature  without having to resort to static paper forms that require manual effort to customize and then need to be scanned in.  This has the potential to increase productivity.

    Paperless point of care services

    Everything at the Point-Of-Care

  • Many imaging devices can be connected to these computers and then images captured be displayed on the screen in real-time for the patients to see, learn and be reassured that the diagnosis being made is correct. We are currently using
    • An inexpensive dermatoscope from Bodelin (Proscope) with two lenses; 10x and 30x.
    • Earscope from Dino-Lite
    • Spirometer from Winspir
    • All of our cameras have Eye-Fi cards in them so any photos taken wind up on the network server in a shared drive that we can then open and display on the screen (transfer usually takes less than a minute and begins automatically as soon as the shutter is snapped) and then imported into the EHR.

      Things to Connect into the EMR

  •  Have also experimented with the Littmann 3200 electronic stethoscope with BT connectivity to record WAV filesand capture images of murmurs.  However, BT connectivity issues, cost of Zargis software and length of time to capture a workable waveform interferes with normal visit and until those a resolved we find just playing back a murmur works well.Everyday new devices are being made available daily and we’re constantly being constrained by the limitations of most of the device-centric software and the inability to connect multiple devices at the same time.
  • But the biggest impact for my patients has been the use of the touch screen devices using Google’s BodyBrowser from Google Labs.  This tool is essentially Google Earth for the body and enables the provider and the patient to touch the screen and have that anatomic item identified, rotated, zoomed in and out.  When Google Labs was shut down this application was unavailable for a month or so and not only we physicians but the patients really missed that application. Fortunately this application is now available for free through Zygote Media at Zygotebody.com.

    Showing What Most Patients Never See

  • Secondly, the device is very useful during the examination where we can use our hands as well as the keyboard to illustrate and educate at the same time.  Most patients have no idea what a normal ear drum works like and now we have a lot of anecdotal stories of parents bringing in their children and wanting to see for themselves the child who’s complaining of earache does or doesn’t have a florid otitis media.  They are becoming accustomed to seeing the proof rather than just taking the physician’s word.
    Children also are very tolerant of the the probes if they are seeing on the screen and also can reach out and touch the screen to capture the image.

In addition to these type of uses we’re noticing and beginning to use these for knowledge search and patient education.  It’s not unusual for us to have various web pages, Youtube videos and also getting the patient to show us what they’ve been seeing.

Other use cases that are very handy is for those deaf patients or foreign language patients where we exchange the keyboard to interview them and can have our own words translated automatically in their language (sometime with interesting and comical results).

Going forward we are already noticing that 24″ is too small and are looking forward to upcoming devices and operating systems that would allow us to use MS Surface computing devices from Samsung as the standard exam room device.  The key is that the visit should be something special and be leveraged to engage the patient, increase transparency and generate magic moments where teaching and learning can take place.