Creating a paperless office starts with choosing the electronic health record software that's right for you. But then another choice rears its head: What hardware will you use to view and enter data at the point of care?

Your decision will influence how much you spend for an EHR system, how easy it is to use, and even how it affects patient satisfaction. There are no cookie-cutter answers to the hardware question, and that's good news. Every doctor's needs and preferences are different. But first, understand your options.

As a rule, EHR software programs work equally well on desktop PCs or wireless laptops and tablet computers, says computer consultant Rosemarie Nelson in Syracuse, NY. The story is different with PDAs—their tiny screens render them impractical for EHRs except for specialized chores, such as hospital rounding. More than two-thirds of physicians, Nelson and other experts say, select laptops and tablets for the sake of portability. The majority of the mobile crowd favors tablets, especially "convertible" models that can switch from a laptop configuration to a "slate" that accommodates handwriting and tapping with a stylus or electronic pen. In the slate mode, held like a paper chart, such tablets preserve doctor-patient eye contact more than other devices, according to devotees.

Portable vs stationary computers—what's less expensive?

For the price of a top tablet computer, you can buy two or maybe three desktops. However, once you calculate how many desktops vs tablets you need, the price advantage tilts toward mobility. A two-doctor practice with six exam rooms, two private doctors' offices, and two nurse's stations, for example, would require 10 desktops for patient care, but only five tablets (one for each doctor and nurse plus a spare). The numbers favor laptops even more, since they generally cost less than tablets. If EHR licenses are based on the number of workstations as opposed to users, you'd save money with portable computers, adds FP Lou Spikol, a consultant for the Center for Health Information Technology at the American Academy of Family Physicians.

While pondering hardware, don't forget the related issue of "user interface"—how you put information into the patient record. To create a searchable database, most EHR programs rely predominantly on "structured" data entry, says Spikol. In a template for review of systems, for instance, you could check off "night sweats" in a list of conditions under the heading "constitutional." These so-called pick lists are designed for mouse clicks or pen and stylus taps.

However, most EHR designers also include fields for free text, knowing that a pick list won't let you report unusual circumstances or air your mind in the assessment section of the note.

Select your hardware only after settling on an EHR program. Make sure the gear satisfies the software vendor's specifications for such items as memory and hard-drive storage space. Trial runs are imperative, notes Dave Ott, vice president for technical services at NextGen Healthcare Information Systems, an EHR vendor. "Try it out in your workflow," says Ott. "If it's a mobile computer, hold it in your hands, feel its weight. How easy is it to enter data?"

In the following pages, we'll take a detailed look at your hardware and user interface options.

TABLET COMPUTERS

Slates and convertibles. A slate resembles a giant PDA. It lacks a physical keyboard, but you can plug one in or tap on-screen keys. When you write on the screen with a special electronic pen, your script is captured as "digital ink." You save the writing as-is or transform it into searchable text.