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EncounterPRO can run on the three major platforms--networked, wireless dockable, and wireless LAN--using a variety of interfaces. The list below summarizes the advantages and disadvantages of each of these systems.

I. Wired & Networked
The majority of our physicians use client/server configurations with touchscreen data input because of the speed and simplicity of data entry and maximization of the workflow system. However, other user interfaces are also available.

PC with Touchscreen Monitors
Advantages:
--Client/server is generally faster.
--Client/server will accommodate more workstations on one server.
--Tried and true standardized system. The technology is very mature with few error potentials.
--Touchscreen requires the use of only one hand. The hand can be gloved or ungloved.
--Touchscreens provide for rapid data and orders entry. Automatic prescription writing is virtually a one-touch process.
--The large screen displays are easier to see and easy to use.
--No batteries or pens are needed.
--Takes full advantage of workflow; therefore is faster than any other interface peripheral.
--Signature capture capability is available as an integral benefit.
--"The most powerful Quality Assurance (QA) tool possible" for querying databases
----Good fit where information is collected and exchanged within a defined area such as ambulatory clinic
--May be combined with thin client technology.

Disadvantages:
--PC and touchscreen needed in every exam room.
--Space is always a consideration.
--Physicians may fear patient damage to computers in exam rooms. This fear has not been substantiated in actual practice.

Thin Clients with Touchscreen Monitors
Advantages:
--Can accommodate touchscreen and other types of displays.
--Enables tight, centralized desktop management.
--May achieve lower total cost of ownership (TCO) than general purpose PCs.
--Security improves because all software is stored on central servers. The users cannot copy files or add their own software on their desktop or the network.
--Easier to manage than individual mobile computing devices
--No worry about the batteries necessary for mobile computing solutions.
--Thin client technology can be adapted to mobile computing platforms if the physical environment dictates or there is a desire for mobile connectivity.
--Accommodates workflow system.
--Easier to maintain than client/server.
--May be a good fit where information is collected and exchanged within a defined area such as ambulatory clinic.
--Old computers can become thin client devices with appropriate software

Disadvantages:
--Some applications can't run on thin clients; may slow to a halt with multiple users.
--Initial costs may be higher than PCs.
--Will not work with most digital signature capture software.
--Will not work with voice recognition software available today.
--Difficult to quantify lower cost of ownership.


II. Wireless & Dockable
This system allows the clinician to have access to applications running directly on a transportable device with enhanced freedom of mobility. The connection with the main network occurs bi-directionally throughout the workflow. Information is available from or can be entered into the clinical database. The true advantage is that data is "available at the point-of-clinician." Clinicians can be anywhere they want or need to be, within the range of the wireless access points. User acceptance of all portable devices remains greater among nurses, pharmacists and physical therapists compared to physicians. Physician acceptance appears to be premised on four factors: (1) viewability of the data on the portable device, (2) battery life, (3) how easy is it to input and receive information on the portable device, and (4) desire or reluctance to carry mobile computer.

Laptop/Notebook Computers
Advantages:
--Mobility; systems are completely portable.
--No radio frequency or infrared transmissions are needed.
--Docking can occur when break in workflow permits.
--Because there is no broadcast of information, security can be well maintained.
--Frequently used with portable carts.

Disadvantages:
--Laptop models change frequently and are generally not upgradeable or are expensive to upgrade.
--May be difficult to acquire additional models of same type for docking.
--Screens, keypads may be too small or have less desirable display functions.
--Weight of portable device is always a consideration.
--Battery life and replacements costs are quite variable.
--Problems of dropping or theft are important considerations.

Pen-based Tablet Computers

--Here is an example.


III. Wireless Networks
This system also allows the physician to have complete freedom of mobility and operates on a wide variety of interfaces. There are a growing number of institutions throughout the country applying IR (infrared) and RF (radio frequency) technologies in daily practice. The obstacles of display technology and power supply technology are constantly improving as new equipment becomes available.

As in desktop solutions, information may be input on thin clients, laptop/notebook computers, and pen-based tablet computers. Analysts predict that the thin client will continue to expand in the mobile markets, led by Microsoft, Cisco, and Citrix. The advantages of each of these interfaces are listed above.

The major advantages of the wireless networks are:
--Mobility
--Real-time access to patient files
--Improved data security since patient files can be stored and protected on the client server.

The disadvantages are:
--Diagnostic images may not be available because of transfer speeds and display resolution.
--Power requirements for the wireless network technology may reduce the battery life on mobile device.


References:
Bria, W. F, R. L. Rydell. 1996. Pp. 99-120 in The Physician-Computer-Connection. American Hospital Association.

Jacobs, Donald M. "Candid Comments on Wireless," Health ManagementTechnology, July 1999, Pp. 8-10.

Van Bemmel, J.H., M.A. Musen. 1997. Pp. 473-493 in Handbook of Medical Informatics. Heidelberg, Germany: Springer-Verlag.