Advanced Specialty Care, however, had a difficult time finding integrated clinical applications for Tablet PCs that didn't require a lot of free text entry. Because the practice was unsure of the functionality of character recognition technology and how it could be integrated with other applications, it wanted to find a system that would enable physicians to use drop-down menus to enter most information, Lipton explains.

It couldn't find such a system, but the practice decided to go ahead and purchase practice management and electronic medical records software from NextGen Healthcare Information Systems Inc., Horsham, Pa. After purchasing the applications in June 2003, Advanced Specialty Care set about customizing them to enable about 95% of data to be entered using templates rather than free text. It also created different templates for the various specialties within the practice.

"It was not guaranteed when we selected the systems that we could use the Tablet PCs with them," Lipton says. "But we knew this software was customizable and therefore wouldn't have the limitations of other systems we looked at."

Before rolling out the software to physicians, Advanced Specialty Care purchased M1400 Tablet PCs from Motion Computing Inc., Austin, Texas, for its 13 physicians. The practice also installed a 802.11g wireless network from San Jose, Calif.-based Cisco Systems Inc. It spent about $800,000 on the hardware and software.

Advanced Specialty Care went live with the practice management system in January 2004 and began implementing the electronic medical records system in April 2004. The practice introduced the new mobile hardware and clinical software to physicians one at a time. It planned to reduce the patient volume for each physician by 40% during their first month using the technology, and keep it 20% below normal for another two weeks after that.

The physicians, however, caught on quickly and only needed to reduce their workload for two or three weeks, Lipton says. Seven physicians currently are using the Tablet PCs to access the applications via Wi-Fi networks at the practice and at Danbury Hospital, where they also practice. Advanced Specialty Care plans to have four more physicians up and running on Tablet PCs in the next few weeks, Lipton says.

"My Tablet PCs is with me at all times," says Lipton, who also uses his mobile hardware at home via a virtual private network connection to access the new systems. "When I come into the office, I use it to look at my e-mail and schedule. Then I use it to open the records system to see what tasks I have to do. Then I use it to document when I'm with a patient."

While clinical staff members aren't using the Tablet PCs, they like them because they help improve communication with physicians. For example, instead of leaving reminders on sticky notes, they can send them in an e-mail, which physicians can read on their Tablet PCs.

While Advanced Specialty Care hasn't completed a return on investment study for its new software, mobile hardware and wireless network, it has documented some efficiencies, Lipton says. For example, the practice recently added three physicians but only had to add 1.25 full-time equivalent employees, rather than its average of one FTE per physician, because so much communication can be initiated via the Tablet PCs, Lipton says.

"Everything we used to do on paper, now we do on the Tablet PCs," he says. "And for whatever it cost us to use the Tablet PCs, if we were able to establish it as hardware specific to each physician, there's a cost savings than if we had a traditional shared PC set up."