Windows 8 Gets Its Foot in Healthcare's Door

Scott Mace, for HealthLeaders Media , April 9, 2013

http://www.healthleadersmedia.com/print/TEC-290929/Windows-8-Gets-Its-Foot-in-Healthcares-Door

Last June, I bemoaned the
fact that in the midst of everything that healthcare is facing on the
technology front, it was the worst possible time to upgrade to a new
version of Windows.

The fall came, and Windows
8 started showing up on new PCs and tablet computers. The reviews were mixed.
"I found the transition to Windows 8
rather jarring," wrote WindowsSecrets editor-in-chief Tracey Capen. The
months since have continued to see unkind reviews in the technology press. One
that ran this week called the operating system "clunky and
cumbersome."

But as the months have
ticked by, it's clear that Microsoft is determined to stay the course with
Windows 8, and healthcare providers are starting to make the best of it.

They don't really have a
choice.

Like the rest of corporate
America, healthcare has a massive investment in Windows. The quarterly Piper
Jaffray CIO survey released in February found Microsoft "the most critical 'mega-vendor'
for the future," according to Redmondmag.com.

Moreover, I've recognized
since Windows 8 shipped that this latest Microsoft operating system contains
some elements that could serve healthcare well, despite all the negatives.
Among these are

  • The
         superiority of today's touch-and-gesture interfaces to yesterday's
         point-and-click interfaces
  • The
         inevitable move toward tablet-friendly computing
  • Widespread
         physician unwillingness to jettison keyboards entirely
  • The
         inertia of an installed base of millions of Windows PCs that aren't going
         away any time soon

One clue to understanding
this is to note that while the iPad has become the darling of healthcare, many
of these iPads are actually running Windows software throughout the day,
through virtualization software from companies such as Citrix. That pattern was
prominent 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 the
multi-touch tablet interface and gestures in ways that older Windows software
cannot.

Electronic health record
software has
to get more intuitive,
and the answer is not simply to count the clicks
on older software and try to reduce that click count while clinging to
keyboards and mice.

The Apple approach was to
go 100 percent to touch, but being Apple, there were design decisions that
worked against the interest of information technology executives. Of greatest
concern to healthcare, Apple has yet to provide that management with a granular
enough way to manage deployment and upgrades to applications through its App
Store.

This gives Microsoft and
others 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 a
flurry of litigation and threats, Apple hasn't been able to keep competitors
from implementing most of the slicker concepts of the iOS user interface.

The final advantage Apple
had maintained was that it had captured the imagination of developers. But a recent survey of 450 software developers revealed
that more than two-thirds identified Microsoft as the platform most relevant to
their development plans.

Case Study

Pediatric
Associates is a private, pediatrician-owned practice in Bellevue, Washington,
with 80 pediatricians across 7 offices seeing about 250,000 patient visits per
year. The practice is piloting Windows 8 tablets running Greenway Medical
Technologies' EHR for Windows 8.

"It's caused a fair
amount of excitement within our organization," says Brock Morris, CIO of
Pediatric Associates.

Windows 8's ability to support different input styles—touch, stylus, and
keyboard—is the winning combination, Morris says.

"[Users] can pull up
the mobile application and the full client side-by-side, [getting] quick reference
to patient information that they need through the mobile application, and then
for more intensive documentation that they need to do in the full client
version, side-by-side, quick and easy," Morris says.

It's worth noting that
every new wave of technology starts with similar optimism. Too often, that wave
washes ashore as another example of the productivity
paradox
, where technology advances continually surpass productivity
advances.

In part, this could be
because each new computing paradigm jettisons a set of skills that were useful
during the previous wave of tech. For instance, tablets without keyboards can
be cumbersome ways to input clinical narratives. Speech input is an option, but
still not in widespread use.

Still, technology marches
on, and in Windows 8 I see incremental progress. As Morris admits, some
physicians 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 the
ability to honor the autonomy of the clinician, how do you best work taking
care of patients," says Josephine Young MD, chief operating officer of
Pediatric Associates.

Now I'll be honest,
Pediatric Associates was brought to my attention by Microsoft. Its business is
in Microsoft's backyard, the greater Seattle region. But consider the
first-mover advantage for the firm if Windows 8 endures. It has the ear of one
of the first EHRs for Windows that looks past mouse-clicks and towards touch
and gesture.

As Greenway's software
matures, the workflow preferences of Pediatric Associates will make a bigger
imprint than those of customers who come later. The more mature a piece of EHR
software gets, the less influence later customers have on its design and
development. (See: Epic.)

Windows 8 is it

So, if you are a Windows-powered provider through-and-through, it's probably
time to give Windows 8 a look. Remember that on April 8, 2014, just 12 months
from now, Microsoft will officially stop supporting and patching Windows XP.
While Windows 7 isn't going away anytime soon, there are still thousands or
millions of XP machines running in hospitals or doctors' offices, and it won't
make sense to upgrade them to Windows 7 this year. Windows 8 is it.

Because of Windows Vista
and Windows 7, a long freight train of older Windows versions will continue to
trail the current version, much of it determined by when older PCs wear out, or
any number of other factors not directly related to the mission of the
healthcare provider.

Pediatric Associates is in
the process of building out its Windows 8 use cases. And because there are
already 1,500 different systems running Windows 8—everything from traditional
desktop PCs to futuristic all-in-one monitors and even "phablets"
(combination phone plus tablet – and a horrible mutant word)—if anything, the
design of future technology systems for healthcare is likely to be a creative
art.

But I take heart that we
are at least moving away from the consistently ugly user interfaces that EHR
software exhibited as recently as a year ago. Designing for touch and gesture
is 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 as
Pediatric Associates deliberately plan for acquiring tablet-style technology,
and doctors can get back to doing what they do best, rather than relying on their
own devices and the nearest app store. There will be physicians who will cling
to their iPads as part of that autonomy Young mentioned.

Where will Windows be when
the Windows XP clock runs out next April? By then, Pediatric Associates expects
to have a larger base of its pediatricians running Windows 8.

It will be interesting to
see if they settle on one or two particular form factors, and are carrying just
a single machine on rounds, or if a mix of desktops, laptops and tablets
continues to make Windows a sometimes jarring experience, and from a workflow
perspective, an overly complicated one.