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Windows 8 Gets Its Foot in Healthcare's Door

 |  By smace@healthleadersmedia.com  
   April 09, 2013

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.

Scott Mace is the former senior technology editor for HealthLeaders Media. He is now the senior editor, custom content at H3.Group.

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