Yesterday at the Digital Health Conference I had the chance to catch up with George Cuthbert from Medent. He’d emailed me a few months back about the potential benefit of Windows 8 in the EHR world and the deep integration of Win 8 that they’d been working on to leverage the unique abilities of Windows 8 for their EHR users.
I admit that since I’ve become more of a health IT blogger and less of a techguy, I haven’t kept close track of all that was happening with Windows 8. I knew that it was designed to incorporate touch as a major focal point of the new Operating System and I knew that it was Microsoft’s attempt to integrate the best of touch together with the advantages of data input using a keyboard and mouse.
Based on the short demo that George did for me of Win 8 and the Medent EHR, it has some real promise. In fact, as the title suggests, I think that if an EHR vendor does it right this could solve the issues that so many EHR vendors have of trying to create an iPad EHR application.
This may sound a little outlandish and certainly many doctors have a special love affair with Apple products. However, I think that most doctors don’t care if it’s an iPad or Windows 8. They just want the iPad like touch interface which allows them to smoothly consume data from their EHR. The Fujitsu model that George showed me has the potential to do just that. In fact, it was quite beautiful how seamlessly you could go from the tablet to a laptop workstation and back.
The biggest challenge that most EHR software will have with this idea is that their EHR isn’t built for touch. Just because Windows 8 makes touch possible doesn’t mean that it will be a good experience to use that way. That’s true for iPad as well and is the major reason why Citrix access to your EHR on your iPad isn’t a great solution. Touch requires a very different interface. George and Medent realize this and you could see the thought and effort they’ve been putting in to transform their interface into a touch optimized experience.
Obviously, I think we’ll still see plenty of iPad in healthcare and iPad EHR. However, I have a feeling that many in healthcare will be just as happy with the Windows 8 touch implementation.
John,
Your above assessment sounds viable but is missing two main points. The first is that the EHR vendors using VPN to access a windows environment on an iPad rather than properly creating a “resident iOS app” on the iPhone is due to those vendors not investing in true mobile technology and its associated architecture. Secondly, most of the physicians I’ve been working with actually do prefer the $500-1000 iPad vs the much heavier and substantly more expensive Fujitsu tablet PC. More and more physicians are buying iPhones and the seamless iOS integration is so well thought out, that I’ll bet you Microsoft will have an eye-opening experience in the mobile space. They have already seen that with their windows mobile OS for handsets. So, if you said android, as a substitute, then ok, but they still need resident apps as opposed to the dying HTML5 & Flash apps which just won’t cut it in the healthcare and security arenas. Mobile architecture is not only different than window, but is as different as a Monet was painted versus a Picasso; and I wouldn’t put windows 8 mobile products in the ranks of Monet’s or Picasso’s but more like stick figure drawings trying to be incorporated into a complex money painting ;-).
Your friend,
Steven Landau
A touch-based interface is only as good as the experience it provides. And that’s why doctors love iPads vs. any other tablet out there. They love the iPad/iOS experience. Approaching touch as a touch-based version of a desktop OS is a sure-fire way to lose. Development teams that put desktop people on touch projects are setting themselves up for failure. Take OS X and iOS for example. I’m a huge fan of OS X for what it does, and iOS for what it does. But, as a developer, I have chosen to focus on iOS. Because that’s where the puck is going. Most would say it’s here and now, but I think we have barely scratched the surface of how touch-based computing changes everything. There is a paradigm shift happening in how we not only consume but create data. Take spreadsheets and ledgers, for example. Touch apps are largely still treating this data presentment paradigm the same. That’s flat wrong. There is a better way. And you don’t have to look further than at any one of several popular games out there in which the user interacts with volumes of data, in an entirely different and much more pleasing manner, to find inspiration. Game developers get UX better than anyone else, because they’ve had to create the entire user experience from the ground up. Games stand the test of time (across multiple iterations of the operating system on which they were built) because they mastered the UX. Business software needs more game developers. And, in my opinion, what will be the most successful EHR–which, given, will be touch-based–still hasn’t seen a single line of code written yet. The big question is, when? Probably not until 2014, when the cement hardens around the rules of engagement in MU.
Both of you guys make good points: you can have the greatest tablet device in the world, but if the software does not bode well to touch, then you still have a battle ahead of you.
I do think touch based computer is has it’s place though, and it isn’t going to take over the world.
For instance, why are there so many website specific apps? One big reason is surfing the web with a touch based device is not a great experience.
Lenova has a new desktop PC that has a huge touch screen display. My initial reaction was, “that is fricking cool, I’m getting one”…then I realized, why do I want to touch the screen and goop it up when I have a mouse.
A mouse is arguably the greatest OS interface that exits.
Tablets are mostly an output device…not an input device.
A properly written interface can fix this, but docs still need to type in specifics, and without a keyboard, this is a pain on a tablet.
Finally on this off topic tangent, my wife has a team of developers and a fair number of them fawn over the Windows Phone interface.
Back to the topic: Win8 on a tablet (not a tablet PC, two different animals) may be great, but many vendors don’t want IE9 running their software, so…not sure how that would work.
I’m still of the mindset that ultrabooks are the best current answer. Thin, light, long battery life and Windows…and they look stylish.
As much as I despise Apple, if I were putting pads in doctor’s hands I wouldn’t even think about Windows 8. Though I have to admit, you have shown me one possible viable use for it besides point of sale terminals at places like McD’s.
Win 8 otherwise has no viable use in the enterprise, or even in most people’s homes. It is only viable, IMHO, on touch screens. And if you are a doctor, you need a reliable OS, one that is easy and consistent and well tested. And Apple is a lot stronger on pads then MS ever will be – if anyone even buys Win 8.
If you are about to make an expensive investment in pads, you will likely go with what you know works and what those in your office will ask for – which I rather doubt is Win 8.
Steven,
It’s true about native iPad apps, but the same is true of native windows apps. You could design an app on Windows that’s just as responsive as any iPad or Android device. Scott’s right that you need the right approach and many will have a hard time making that transition.
One thing I think a lot of you are also missing and I should have mentioned in the post is the biggest advantage that Windows 8 has is that it has a known enterprise management platform that most hospitals have been using for a very long time. The advantage and install base of things like active directory are very powerful and shouldn’t be underestimated. Thousands of hospitals will be implementing Windows 8 on thousands of desktops. It’s not a question of if, but when.
John,
Unless hospitals seem themselves as very different from other major IT users, then I see Win 8 as a non-starter. The GUI is awful, aimed at people who can barely handle smartphone touchscreens, and is useless to people who don’t have a touch screen and are used to mouse and keyboard. IT pros like myself have tried it and can’t stand it. It means complete retraining in Windows and Office for ALL users, something no one has the time and money for. The only arena where I think it will do well is for point of sale terminals and places where the average IQ is about 70. Toddlers will get a kick out of it, maybe even pets.
Win 7 is a whole different story. It’s very popular, not hard to learn after XP, and doesn’t require everyone to have a large touchscreen. And it has management tools that IT people are comfortable with.
Have any of you seen Win8?
I fiddled with it a little and its not all those “blocks” like on the win phone.
You can get to a “normal” windows interface and get things moving.
Yet, unless the EHR software will work on this latest version of IE, this won’t work out too well.
Couple of things. The normal windows interface is missing the START orb, which is the quick easy access to all the apps you have on your PC. And MS has sworn publicly to block every attempt to restore that START orb. And they’ve deeply hidden all sorts of system functions, especially for people who don’t have touch screens. IT pros despise it.
IE10, the next version of Internet Explorer, comes in 2 flavors; the same basic form factor of IE 9 and earlier, and crippled / full screen only big block mode METRO interface. Under the covers it is far more HTML5 compliant and may eventually lose use of FLASH, a critical part of some EHRs today.
If things hold the way they normally do, it will be about 2 years before Win 8 is debugged enough to take a chance on using it for medical applications.
I definitely need to play more with Windows 8 before I can respond to all of the comments. I’ve just read stuff on the side and seen a short demo of an EHR on it. However, I’m still confident that many in healthcare will use Windows 8 because of the nice enterprise integration with active directory and other windows products. Whether the touch portion of it takes off, we’ll see. I just wouldn’t count it out yet.
I’ve spent a fair amount of time with it and absolutely despise it. It may be improved under the skin, but the skin makes it nearly useless and will require massive retraining. I’m guessing that it will make Vista look very popular.
I wouldn’t mind IF MS would allow a user or shop to switch from the METRO (or what I call MUTTRO) gui back to the Win 7 gui. But they’ve promised to block every single attempt to do so. They insist that Windows look like an oversize Windows Phone (something else hardly anyone wants).
Agree with #3 above: tablets are good for output, not input. Certain styles of doctoring required typed input. I’m a geriatrician and I sent back the iPad. I explain why here: http://www.geritech.org/2012/10/minority-report-why-this-doctor-sent.html
Leslie,
Your post does a good job reinforcing the idea of how Windows 8 could be a good solution. It attaches to a nice keyboard like your laptop. So, you get the consumption part of an iPad with the keyboard that helps you type your notes.
[…] EMR & HIPAA: “Yesterday at the Digital Health Conference I had the chance to catch up with George Cuthbert from Medent. He’d emailed me a few months back about the potential benefit of Windows 8 in the EHR world and the deep integration of Win 8 that they’d been working on to leverage the unique abilities of Windows 8 for their EHR users. […]
A touch screen based application that needs a full screen is likely the only good use for Win 8. However, as much as I despise Apple, I’m guessing that Apple AND Android tablet based mobile EHR access is a better idea then Win 8, which I believe is hugely unpopular.