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ClearPractice’s Nimble brings a comprehensive EMR to the iPad

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”.

IPad_Dashboard

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.

IPad_PatientChart

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.

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19 replies »

  1. These products look promising but they still have to go a long way…
    Dr chrono is still very young and leaves a lot to be desired in real life. I tried their demo version…
    Nimble seems to be somewhat more grown up but they are asking for 6000 dollars opera year for the rest of your or their life… With data in the cloud… You are always held hostage and i agree with the post above…
    I still have to see an emr that is intuitive rather than just capable.
    The price of EMRs is too high for a small practice or a solo practitioner for really basic stuff that is needed to be done.

  2. I have enjoyed reading the posts. As a user of EMR for almost 8 years, and having been through 4 companies, I will never again buy a product that requires a monthly fee or “license” fee. I have been yanked around too many times. The last software I “bought” had a “service” fee that went from about $500 dollars a year to over $3600 a year in three years, then I was told I would have no support and that this was actually a license fee and I had to pay it. $500 a month to “keep my data”? I have an awesome Mac server in my office and do just fine with a Windows product on Parellels that I access via VPN. It is somewhat basic, but I “own” it and bought it 4 years ago with a minimal support fee (optional) of several hundred a year. The data is not on my laptop, but on my server in the office. I feel it is plenty safe with the safeguards I have and the backup we utilize. I have never needed support and the product works fine. I wish it was a bit more robust and pretty, but it is a very solid product that I OWN, no recurring fees, and I host on my server in the office. I am waiting for a Mac product that I can “buy” and own and manage myself on my own server. Why can’t EMR companies just produce a product we can “buy” and host on our own servers rather than “rent” them with recurring fees and licensing agreements. Buyer beware, the first three companies I bought in with increased their monthly/yearly fees astronomically with little recourse but to put precious time and effort into transferring data into another product.

  3. It is pretty interesting to hear that software that is specifically made for the ipad are being made. Pretty exciting stuff. Great article!

  4. Nice post about EMR.
    The Electronic Medical Record will have all the health documentation for each of your patient thus lessening any paperwork done in your office.
    Thanks.

  5. The Electronic Medical Record will have all the health documentation for each of your patient thus lessening any paperwork done in your office.

  6. Does the Dr. Chrono application have an integrated practice management system and patient portal, i think that is one of the main differences between the two products. From what i understand, with ClearPractice you get Practice Management, eRX, patient Portal, PQRI integration with CMS and Nimble for the iPAD. The complete system is $499 per month for everything, including practice management. The first 500 physician who sign up also get a free iPAD. To my knowledge, Nimbel is the first “fully integrated” iPad application, but Chrono was the first EHR only for the iPad. Both Dr. Chrono and Nimble are clearly ahead of the rest of the market, congratulations to both.

  7. John is correct. Dr. Chrono was the first native emr app on the market and a fine product from what I have seen. I applaud them for being first to realize the ipad’s potential. We also felt that the iPad could be a transformative device, that when properly leveraged, could enable us to truly reinvent the emr experience and remove many of the impediments of traditional emrs that often frustrate doctors and impede workflow and the care delivery process. I am quite proud of what we have developed with Nimble and I look forward to seeing many new and exciting healthcare apps from various vendors in the future. Just make sure they are native and cloud based like Nimble and Dr. Chrono. There will be many “iPad compatible” emrs on their way, but they won’t likely be native and you will easily be able to see and feel the difference. I encourage anyone with an iPad to download Nimble from the app store and check it out. While not the very first, we believe it is the most comprehensive emr solution on the iPad, but ultimately it is up to the doctors to decide.
    Joel Andersen
    President
    ClearPractice

  8. Cloud-based EMRs have capability to store only minimal patient data on the hardware at any given moment, and have that to be encrypted…the system times out and requires user to log in. Let them steal your iPad; just get another one, log on to the cloud server again, and take up wher you left off – with no lost data. Awesome stuff!

  9. Thanks, Christian–that’s good to know–as long as the doc knows if and when was stolen. I love iPads, and EMRs, and am not being critical–just realistic.

  10. botetourt – Smart EMR vendors store patient information on cloud servers, not on the device. If a doctor reports a lost iPad, there are security measures that can be taken.
    Christian Bonawandt
    Public Relations
    DrChrono.com

  11. Great concept and innovative. Can’t wait for the HIPAA violations to roll in as these ‘pads get lost or stolen. No innovation will go unpunished.

  12. There is so much to be done via the iPad. This is only the beginning for all of us in the industry!
    At DrChrono interface and usability are key. We think about workflow all of the time and how can we make life easier for a healthcare professional.
    We have more coming down the pipeline as we go. Some things are truly innovative. (E.G.: From a physician posting his schedule on Vitals.com to seeing the appointment via an iPad, as well as our soon to come “Patient Pad”. Patients should be able to “bring” health records to a doctors appointment via an iPad as well!
    ~Daniel from DrChrono

  13. It can’t be “first” if it’s 5 months late to the party. Sorry, boys, but DrChrono.com’s EMR was announced and in doc’s hands back in April. It’s a great product; see for yourself:
    https://drchrono.com

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