Last June, I bemoaned thefact that in the midst of everything that healthcare is facing on thetechnology front, it was the worst possible time to upgrade to a newversion of Windows.
The fall came, and Windows8 started showing up on new PCs and tablet computers. The reviews were mixed."I found the transition to Windows 8rather jarring," wrote WindowsSecrets editor-in-chief Tracey Capen. Themonths since have continued to see unkind reviews in the technology press. Onethat ran this week called the operating system "clunky andcumbersome."
But as the months haveticked by, it's clear that Microsoft is determined to stay the course withWindows 8, and healthcare providers are starting to make the best of it.
They don't really have achoice.
Like the rest of corporateAmerica, healthcare has a massive investment in Windows. The quarterly PiperJaffray CIO survey released in February found Microsoft "the most critical 'mega-vendor'for the future," according to Redmondmag.com.
Moreover, I've recognizedsince Windows 8 shipped that this latest Microsoft operating system containssome elements that could serve healthcare well, despite all the negatives.Among these are
One clue to understandingthis is to note that while the iPad has become the darling of healthcare, manyof these iPads are actually running Windows software throughout the day,through virtualization software from companies such as Citrix. That pattern wasprominent in my recent cover story about tablet computers.
The Citrix experience,however, as compelling as it can be, is not the immersive tablet experience.Software written natively for the tablet is more responsive, and utilizes themulti-touch tablet interface and gestures in ways that older Windows softwarecannot.
Electronic health recordsoftware hasto get more intuitive, and the answer is not simply to count the clickson older software and try to reduce that click count while clinging tokeyboards and mice.
The Apple approach was togo 100 percent to touch, but being Apple, there were design decisions thatworked against the interest of information technology executives. Of greatestconcern to healthcare, Apple has yet to provide that management with a granularenough way to manage deployment and upgrades to applications through its AppStore.
This gives Microsoft andothers lots of room and time to copy some of the better ideas from the iPad,just as years ago it copied the user interface of the Macintosh. Despite aflurry of litigation and threats, Apple hasn't been able to keep competitorsfrom implementing most of the slicker concepts of the iOS user interface.
The final advantage Applehad maintained was that it had captured the imagination of developers. But a recent survey of 450 software developers revealedthat more than two-thirds identified Microsoft as the platform most relevant totheir development plans.
Case StudyPediatricAssociates is a private, pediatrician-owned practice in Bellevue, Washington,with 80 pediatricians across 7 offices seeing about 250,000 patient visits peryear. The practice is piloting Windows 8 tablets running Greenway MedicalTechnologies' EHR for Windows 8.
"It's caused a fairamount of excitement within our organization," says Brock Morris, CIO ofPediatric Associates.Windows 8's ability to support different input styles—touch, stylus, andkeyboard—is the winning combination, Morris says.
"[Users] can pull upthe mobile application and the full client side-by-side, [getting] quick referenceto patient information that they need through the mobile application, and thenfor more intensive documentation that they need to do in the full clientversion, side-by-side, quick and easy," Morris says.
It's worth noting thatevery new wave of technology starts with similar optimism. Too often, that wavewashes ashore as another example of the productivityparadox, where technology advances continually surpass productivityadvances.
In part, this could bebecause each new computing paradigm jettisons a set of skills that were usefulduring the previous wave of tech. For instance, tablets without keyboards canbe cumbersome ways to input clinical narratives. Speech input is an option, butstill not in widespread use.
Still, technology marcheson, and in Windows 8 I see incremental progress. As Morris admits, somephysicians will prefer narrative input and opt for their keyboard as before.Others will take to the touch-and-gesture interaction of newer tablet software,and make admirable progress on that front.
"All of it adds to theability to honor the autonomy of the clinician, how do you best work takingcare of patients," says Josephine Young MD, chief operating officer ofPediatric Associates.
Now I'll be honest,Pediatric Associates was brought to my attention by Microsoft. Its business isin Microsoft's backyard, the greater Seattle region. But consider thefirst-mover advantage for the firm if Windows 8 endures. It has the ear of oneof the first EHRs for Windows that looks past mouse-clicks and towards touchand gesture.
As Greenway's softwarematures, the workflow preferences of Pediatric Associates will make a biggerimprint than those of customers who come later. The more mature a piece of EHRsoftware gets, the less influence later customers have on its design anddevelopment. (See: Epic.)
Windows 8 is itSo, if you are a Windows-powered provider through-and-through, it's probablytime to give Windows 8 a look. Remember that on April 8, 2014, just 12 monthsfrom now, Microsoft will officially stop supporting and patching Windows XP.While Windows 7 isn't going away anytime soon, there are still thousands ormillions of XP machines running in hospitals or doctors' offices, and it won'tmake sense to upgrade them to Windows 7 this year. Windows 8 is it.
Because of Windows Vistaand Windows 7, a long freight train of older Windows versions will continue totrail the current version, much of it determined by when older PCs wear out, orany number of other factors not directly related to the mission of thehealthcare provider.
Pediatric Associates is inthe process of building out its Windows 8 use cases. And because there arealready 1,500 different systems running Windows 8—everything from traditionaldesktop PCs to futuristic all-in-one monitors and even "phablets"(combination phone plus tablet – and a horrible mutant word)—if anything, thedesign of future technology systems for healthcare is likely to be a creativeart.
But I take heart that weare at least moving away from the consistently ugly user interfaces that EHRsoftware exhibited as recently as a year ago. Designing for touch and gestureis making all EHR software designers clean up their act, and it's about time.
The bring-your-own-device(BYOD) phenomenon also seems to be settling down, as organizations such asPediatric Associates deliberately plan for acquiring tablet-style technology,and doctors can get back to doing what they do best, rather than relying on theirown devices and the nearest app store. There will be physicians who will clingto their iPads as part of that autonomy Young mentioned.
Where will Windows be whenthe Windows XP clock runs out next April? By then, Pediatric Associates expectsto have a larger base of its pediatricians running Windows 8.
It will be interesting tosee if they settle on one or two particular form factors, and are carrying justa single machine on rounds, or if a mix of desktops, laptops and tabletscontinues to make Windows a sometimes jarring experience, and from a workflowperspective, an overly complicated one.