Desktops still dominate at physician offices
■ Despite rising adoption of tablets and smartphones, a survey shows three in four doctors use a desk computer for practice management tasks.
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More people are turning to computer tablets and other new forms of technology, but pediatric hospitalist Rishi Agrawal, MD, MPH, favors a desktop computer for doing his job.
It’s not that he’s a technophobe. It’s that using the desktop makes more sense to him: He can easily and quickly access the hospital’s electronic health record system. The computer has a large monitor that allows for multitasking, and it’s secure.
“I think they are here to stay in physician offices, and that’s not necessarily the worst thing,” said Dr. Agrawal, who works at La Rabida Children’s Hospital in Chicago. “Sometimes you have to do a lot of multitasking, so you need a lot of computing power and screen real estate.”
The mainstay of physician computing has a slew of newer, portable rivals — laptops, tablet computers and smartphones. But the desktop remains the go-to computing tool for many doctors.
A survey of 1,190 physicians published in June found that 75% of doctors use their desktops for practice management tasks. By comparison, 25% used a laptop for such work, 10% an iPad or another tablet and 6% a smartphone. Doctors could choose more than one answer.
Desktops also were the most common tool used for clinical tasks (59% of respondents), electronic prescribing (52%) and accessing an EHR (44%). The online and fax survey was conducted in January by the health care directory named little blue book and its parent company, Sharecare, an Atlanta-based online community where patients post health-related questions for a panel of experts.
Following desktops, the next most popular tool for clinical tasks was the laptop, used by 35% of surveyed doctors.
“I think the desktop is going to stay dominant in physician offices,” said Ben Piper, a health IT consultant based in Woodstock, Ga., who works with small and large medical practices.
He said desktops make sense for physicians, in part, because of uncertainty about the security of mobile devices. In addition, their longtime presence has given rise to a “desktop ecosystem” built around them, including EHRs and printers.
Outside the physician’s office, where consumer applications are tailored to mobile and tablet computing, smartphones and tablets are threatening to eclipse the popularity of other types of computers.
As of August 2011, 55% of U.S. adults owned a desktop computer, a decline from 68% in 2006, according to the Pew Internet & American Life Project. The percentage of adults with a laptop increased from 30% in 2006 to 57% in 2011.
Adults are turning to tablets rapidly. As of January, 19% owned a tablet computer, nearly double the 10% who owned one in August 2011. When Pew began tracking tablet ownership in May 2010, just 3% of U.S. adults owned a tablet.
Physicians aren’t immune to those trends. A Manhattan Research report issued in May showed that 62% of 3,015 surveyed physicians owned a tablet computer, and half used them at the point of care.
Keith Steward, MD, senior vice president for medical affairs at Sharecare, said he expects the shift in technology to be more gradual among physicians than for the general population.
“We’re creatures of habit,” he said. “You see younger doctors, they’re more apt to use advanced technology, so the trend is clearly changing.”
Regardless of the technology in their offices, some doctors won’t bring a computer into the exam room.
At Natick Pediatrics in Framingham, Mass., Rob Lindeman, MD, PhD, decided 10 years ago to leave computers outside the exam room, partly out of concern they would end up “trashed by a kid,” he said. The unexpected benefit has been the lack of a barrier between him and a patient.
“There’s nothing in my lap. I’m not looking at anything else,” he said. “It’s all face time with mom and with baby.”
That isn’t to say he hasn’t embraced mobile technology in other ways. He accesses his EHR on a desktop in his office. His patients send him text messages on his cell phone, which doubles as the practice’s emergency line. He commonly asks patients to send photos of their children’s rashes from their smartphones so he can save parents from coming into the office when it’s unnecessary.
Shift may come with new software
Part of what has kept physicians anchored to their desktops, particularly for clinical tasks, is a lack of confidence in the security of mobile devices, said Gregg Malkary, founder and managing director of Spyglass Consulting, a health IT firm based in Menlo Park, Calif.
In a January analysis of more than 100 interviews with physicians, Malkary reported that 83% of respondents continued to use desktop computers as their primary means to access patient records and other computing tools for work. Eighty percent of the doctors thought the iPad had great potential, but were skeptical of its ability to “transform patient care delivery today.”
Most EHR and practice management systems were created to run on desktops, he said. Once developers adapt their clinical and practice management software to mobile devices rather than just making the desktop application accessible in miniature on a tiny screen, he believes mobile and tablet adoption will take off.
Dr. Agrawal agreed that EHR optimization would be crucial to persuading him to give up using a desktop. Along with a desktop in his office, he said he typically uses a computer on wheels at bedsides.
Ideally, he said, he would like a tablet small enough to fit into his lab coat pocket, complete with an EHR made for that size screen, and with a high-resolution display.
“Once that happens, I will use my desktop a lot less,” he said.