While over 500 medical apps have been created for the iPad since its launch in April of this year, few attempt to bring an entire electronic medical record system onto the device. Today, St. Louis-based medical software company ClearPractice is releasing Nimble, which the company says is “the first comprehensive EMR solution developed in iOS to run natively on the iPad”.
With Nimble, ClearPractice aims to use the iPad to address several commonly cited issues about EMRs. They emphasize the iPad’s potential for removing barriers in EMR use and physician workflow by integrating the device and software in the care delivery process. The hope is that the iPad’s portability and accessibility will allow it (and thus Nimble) to be present wherever the doctor is—from the clinic to the hospital to the home—and make having an EMR more appealing, especially to doctors in small practices. Given that the app was built as a native iPad application, it attempts to take full advantage of the iPad’s unique interface and user experience.
I sat down this morning for a quick spin with the free, but limited, trial version of Nimble (available in the iTunes App Store) to see how it lives up to its claims. Nimble supposedly contains all of the features of ClearPractice’s existing, desktop-based EMR system, which include: scheduling, charting, prescribing, rounding, lab ordering/reviewing, messaging, automated coding, and charge capturing, among others. The app also integrates a variety of resources for physicians, such as drug information and “Evidence Based Info”, courtesy of an in-app portal that hooks into Epocrates and WELLINX. From the interface, it’s clear Nimble is trying to bridge electronic and paper records by maintaining much of the “look and feel” of hard-copy charts and documents: the colored tabs, little cards, and faux-leather background. Actually using the app to review results, write progress notes, and perform other tasks is tricky and takes some practice. Doctors used to clicking around desktop-based EMR behemoths may find this to be a great improvement, but I’m not sure the same can be said for doctors accustomed to scribbling things on clipboards. Free text data entry has always been a weak point for iPad apps, but Nimble does allow use of dictation and template-driven entry for certain fields.
I was pleased to see that after the iPad auto-locked, the app required password re-entry. Furthermore, data is stored in the ClearPractice cloud, thus sidestepping some security and HIPAA issues. Unfortunately, this means that to use the EMR requires an active internet connection at all times on the user’s end, and a functioning server on ClearPractice’s end.
Nimble is, of course, but one of many in a field that is becoming increasingly crowded. A growing number of EMR and EHR vendors have created iPad-enabled “views” of their otherwise desktop-based software, with varying degrees of integration with the iOS framework. DrChrono, whose iPad-based EHR was showcased on THCB in May of this year, has already delivered many of Nimble’s promised features. And in June, Epic was revealed to have plans to translate their iPhone-native Haiku app into an iPad version, Canto.
Some questions remain about Nimble’s actual usability in a clinical setting—how fast/easy is data entry for a doctor? how quickly can large numbers of records be accessed? Nevertheless, the release of Nimble is an exciting addition to a developing field, and highlights not only Apple’s increasing and unique influence in the health IT area, but also EMR vendors’ growing interest in porting medical software to mobile and tablet devices.
Henry Li is Associate Editor at THCB. He is a master’s student at the Johns Hopkins School of Medicine, where he studies in the Division of Health Sciences Informatics and performs clinical software research as well as cost-effectiveness analyses.