Section1.3Adopt – Select

Section 1.3 Adopt – Select – Input Device Planning-1

Input Device Planning

Use this tool to assist you in determining the most appropriate input devices for your health information technology (HIT) applications.

Instructions for Use

  1. Members of the HIT steering committee should compare input device capabilities when making recommendations for a specific product acquisition.
  2. Although one size does not fit all, you want minimal variation between devices. Too many different devices, or even the same type of device from different manufacturers, can be costly to maintain. Parts are not interchangeable, system installation and maintenance are different, and upgrades come at varying times.
  3. One of the best ways to evaluate products is to test them. While a thorough test cannot be performed without the actual application in place, provide a small number of different devices to different users early in the process of HIT planning for testing using routine email, Internet access, and other uses. This process not only helps evaluate the devices, but builds computer skills and helps the end users evaluate how they will use the devices at the point of care.

Types of Personal Computers (PCs)

Desktop PC / Tablet PC
Requires space for monitor and keyboard
  • User position
  • Patient position
Some space issues can be overcome by:
  • Computers on wheels (COWs)
  • Suspended/flat panel monitors
  • Special trays for keyboards
Infection control
  • Liquid-proof keyboards available
  • Do not wrap in plastic wrap
Require log-on/log-off
Always available
  • Network connection
  • Power
Lower cost / Slates and convertibles
Issues of:
  • Weight
  • Heat
  • Space
  • Navigational precision
Mobility
  • Affords continuous log-on
  • More like pen and paper
  • Requires wireless network or docking stations
  • Battery life issue
More expensive today
Not all electronic health records (EHRs) are designed to work optimally on a tablet
Notebook PCs
  • Notebook PCs may substitute for desktop PCs, especially when some degree of mobility is desired, or when affixed to carts (COWs). When used as a desktop, they take on the characteristics of desktops.
  • Notebook PCs also come with tablets (called convertibles). When used as a tablet, they take on the characteristics of a tablet.
  • In general, notebooks are more expensive than desktops and somewhat more expensive than a slate-type tablet.

Speech/Handwriting Recognition

Some chiropractors prefer to dictate or handwrite. Be aware of issues and plan carefully to determine ifspeech/handwriting recognitionshould be considered in your HIT selection.

  • Speech recognition, except when used to issue voice commands to a structured data template, does not generate discrete, or structured, data values. As a result, the computer cannot process the information into reports or perform clinical decision support with the information dictated.
  • Speech recognition is notnatural language processing. Although natural language processing may be performed using speech recognition, handwriting recognition, or simply keyboarding narrative notes, natural language processing is a highly sophisticated process of extracting structured data values from unstructured information. Although natural language processing is improving and embedded in a few of the more sophisticated EHR systems, in general, it is not available.
  • Speech is digitized and matched against coded dictionaries to recognize words
  • Older voice recognition systems required discrete speech, requiring pauses between each word
  • Newer speech recognition systems accommodate continuous speech without pauses
  • Many systems must be trained to understand all words or a sample of words that will be spoken by user
  • New systems are speaker-independent, requiring no training (in some cases systems improve accuracy with use)
  • Speech recognition is improving in accuracy. Errors are more likely with commonly used terms. For example, next week may be spoken as “nexweek” which the system cannot understand.
  • Correction mustbe performed, either:
  • Retrospectively by a correctionist
  • Concurrently by the user
  • Speech recognition at the point of care can be cumbersome, unless used primarily to issue voice commands to a structured data template. Even then, many chiropractors find this more awkward/less natural than navigating a template by hand, keyboarding, or using standard dictation.
  • Speech recognition is most successful in areas that have a high degree of standardization/repetition and a small amount of content to be dictated. Standard templates are used to supplement the narrative notes that result from speech recognition.
  • Handwriting recognition is a very similar process to speech recognition, although not as mature.

Bar Code Versus Radio Frequency Identification (RFID)

The U.S.Food and Drug Administration required manufacturers to apply bar code labels for all human drug and biological products by April 26, 2006. Bar codes/RFID on packages of drugs have been used primarily for pharmaceutical inventory. More recently, they are being used in hospital medication administration, when patient wrist bands, nursing badges, and unit dose medications are available. Such identification processes are also being used to manage lab specimens and track movement of patients, expensive equipment (e.g., computers), narcotics, and employee badges.

Some chiropractic offices use bar code technology to allow patients to check themselves. Patients swipe a key tag/magnetic card in a scanner located in the front office. The key tag contains basic information about the patient (encrypted for HIPAA compliance). It also includes a practice logo and phone number for a patient reminder. The system finds the patient’s SOAP notes and informs the front office person about any outstanding patient balance or waiting messages.

Comparison of Bar Code and RFID

Bar Code / RFID
Line of site requirement, person needs to directly scan bar code / RFID tag can be detected hands off
Must be visible on outside of product packaging, patient (wrist band), etc. / RFID tags can be placed inside of packaging or in the product itself to reduce counterfeiting and black marketeering
Bar codes can be impaired by abrasion, dirt, moisture, or packaging contours / RFID tags withstand such issues
Bar codes have a short read range / RFID tags have a longer read range, range varies by type of tag (can extend several miles)
Bar codes have no read/write memory capability so can only store the data limited to the bar code and cannot be altered as needed / RFID tags are electronic and have read/write memory capability, can store more data and can be altered as needed
Bar codes are very inexpensive, but cannot be reused / RFID tags are more expensive, and may be reused (the cost of erasing and re-recording data may not be worth the effort)

For information on document scanners, see2.2 Utilizing EDMS and Hybrid Record Risk Management.

Copyright © 2011 Stratis Health. Funded by Chiropractic Care of Minnesota, Inc. (ChiroCare),

Adapted from Stratis Health’s Doctor’s Office Quality – Information Technology Toolkit, © 2005, developed by Margret\A Consulting, LLC. and produced under contract with the Centers for Medicare & Medicaid Services (CMS), an agency of the U.S. Department of Health and Human Services.

For support using the toolkit

Stratis Health Health Information Technology Services

952-854-3306 

Section 1.3 Adopt – Select – Input Device Planning - 1