9 Mobile EHRs Compete For Doctors' Attention

Electronic health record vendors are responding to pent-up demand among doctors for EHRs they can access on mobile devices, including smartphones and computer tablets. According to a new national survey by Washington, D.C.-based Black Book Rankings, 122 companies said they would introduce fully functional mobile access to their EHR products, native iPad versions, or both by the end of this year. Another 135 EHR vendors said that mobile apps were in their strategic plans.

Among the leading vendors that already offer mobile versions of their EHRs are Greenway, NextGen, Cerner, GE, Allscripts and eClinicalWorks. Interestingly, however, drchrono, one of the first iPad-native EHRs, garnered the highest customer satisfaction scores in a follow-up poll of more than 1,400 practices.

Although the Black Book survey results clearly show a shift toward mobility in the EHR market, the details are somewhat murky. First, it's unclear how many current or future applications are or will be iPad-native. That's important, because most doctors don't want an EHR system on their mobile device that replicates all of the features in the desktop version -- they want a simplified version, according to Black Book. So "virtual desktops" for mobile devices are out.

[ If your state is leaning hard on doctors to adopt EHR guidelines, you need to read this: EHR Mandate Riles Massachusetts Doctors. ]

Second, although vendors have designed some mobile EHRs for iPhones and other smartphones, their functionality is limited because of device size. In fact, 95% of doctors surveyed by Black Book said their biggest problem with mobile EHRs is the smartphone's small screen.

The survey found that 89% of primary care doctors and internal medicine subspecialists use smartphones to communicate with staff, and 51% of all clinicians use them to perform medical research on the Internet. Eight percent use a mobile device for electronic prescribing, accessing records, ordering tests or viewing results. But 83% of the respondents said they'd use mobile EHRs to update patient charts, check labs and order medications if those features were available to them on their mobile devices.

A quick check of some of the top mobile EHRs in Black Book's poll indicates that they're designed mainly for doctors' use when they're rounding or out of the office. Despite Black Book's assertion that doctors would buy such EHRs as replacements for traditional EHRs that they dislike, the major vendors are not creating standalone products that would cannibalize their own sales of desktop/laptop EHRs. They're leaving that to smaller companies like drchrono.

Another thing they're leaving to this upstart firm, for the most part, is speech recognition, although one might expect that to be part of any iPad-based EHR. Even Greenway, which has put a lot of emphasis on its PrimeSpeech natural language processing application, does not advertise it in conjunction with its mobile EHR. A year ago, eClinicalWorks said it would release a voice recognition app called Scribe at the same time as its mobile EHR, but eCW Mobile does not include Scribe. And, although Allscripts bundles speech recognition with its Sunrise Mobile app for inpatient use, its iPad-native Wand EHR for ambulatory care apparently lacks voice enablement.

Wand, however, is more complete than most mobile EHRs, allowing clinicians to complete a variety of tasks: add or update clinical information for a patient, view patient summary information, obtain a longitudinal view of patient data, capture the history of the present illness, e-prescribe and communicate online. The version for Allscripts Professional EHR even lets users complete a review of systems and document a physical exam, enter orders, and submit charges for an encounter.

Other mobile EHRs from leading vendors provide the ability to view key parts of the EHR including lab results, e-prescribe, pull up appointment lists, search for patients, e-mail or fax messages, and capture charges. But documentation in most of these products is limited to editing clinical summaries and charges.

Black Book's survey, like others before it, found that doctors prefer iPads and iPhones to other types of mobile devices. Nevertheless, some mobile EHRs such as Greenway's also can be used with Android phones and tablets.

Finally, the survey found that most hospitalists, primary care doctors, office-based physicians, rheumatologists and nephrologists looked forward to the availability of mobile EHRs. But only 14% of surgeons, including orthopods, ophthalmologists and ENT specialists, had any interest in these applications.