Pen-Based Computing Samuel Hume introduction to the market is still about a be available in late 2001. Draw your own year away, a prototype has drawn praise conclusions. Once available, it will likely A new tablet computer at recent demonstrations, and it seems to cost as much as a high-end laptop. Other shows promise of be reviving interest in pen-based tablet-type laptops exist now, but the achieving the computing. Maybe a successful pen- software and design of the Tablet PC functionality and based computer is possible after all. appear to represent advancement in the flexibility that CT current state of the art. By adding new The tablet computer technology to its tablet computer, the professionals require, Microsoft (Redmond, WA) promises the company has created a pen-based system but problems remain. re-creation of pen-based computing that just might succeed where previous (a long-treasured goal of technology systems have failed. visionaries) in a small handheld tablet computer powerful enough to run all Success where others failed? aven’t we seen this one before? existing Windows-based software. Microsoft has been working on pen- Is pen-based computing a Its tablet computer is a full-blown PC based computing for over a decade. techno-flashback or wishful capable of replacing a laptop computer. Windows for Pen computing came about thinking? It was pronounced For mobility purposes, the system weighs in the mid-1990s, presumably as an H dead in the mid-1990s. As in at just over two pounds and is about unnecessary response to the Apple happens with many overpublicized new two inches thick. It is small enough to Newton (Apple, Cupertino, CA). Pen products, the technology’s failure to meet carry in one hand, but has a 10.4 inch Windows spawned several interesting users’ expectations led to the general screen—much larger than a PDA devices and applications that served conclusion that the technology was not (personal digital assistant). Systems will particular verticals, including clinical functional. But the idea seemed sound. come with features you might expect on a trials. To date, however, a pen-based As with Don Quixote, we question the reasonable laptop such as 128 MB of system has not been truly accepted action, not the motive. RAM, a 600 MHz processor, and a 10 GB outside particular niches, and certainly Enter Microsoft. Or rather— hard drive. Internet access and Web not for clinical trials. remember Windows for Pen browsing are supported, and much of it To create broader acceptance for its computing—re-enter Microsoft. Into a can be done wirelessly. The Tablet PC tablet computer, the company focused quiet pen-based market the software supports most current and emerging efforts on the complete user experience, giant has announced a prospective new wireless standards. The company also rather than just adding pen support to the entry, the Tablet PC. Although its added instant-on start-up functionality, a operating system. A tablet computer that cradle for mouse and keyboard hookup, runs all existing Windows applications and USB (universal serial bus) provides immediate usefulness beyond connectivity to the typical peripherals. traditional pen-based computing Using a pen-like stylus, users can write applications. Additionally, this new on the tablet screen as if it were paper, system promises to make traditional easily adding comments to e-mail, eCRFs Windows applications pen-aware, perhaps (electronic case report forms), allowing pen-based access to existing checklists, presentations, or other eCRFs. Previous pen-based efforts documents. The written notes are suffered from a limited perspective. That captured as “digital ink,” so they can be is, they attempted to address pen-based sent along with the documents without applications but lacked sophistication as a Samuel Hume the need to re-enter data on a keyboard. general-purpose system. The Tablet PC is is chief technology officer for CB Technolo- gies, Inc., 1487 Dunwoody Drive, West The system includes handwriting a potential laptop replacement. Chester, PA 19380, (610) 280-7400, fax recognition software so that written A Tablet PC extends the usefulness of (610) 280-4546, e-mail: shume@ information can be converted to machine laptops by creating a mobile device. cbtech.com. understandable characters. Whereas laptops are portable, Tablet PCs The company claims the Tablet PC will are truly mobile. Mobility means that 32 APPLIED CLINICAL TRIALS July 2001 physicians can carry them into necessary. Pick lists or sets of option resolution, doesn’t break when you drop examination rooms. Wireless buttons are more commonly used than it, requires little user training, makes communication means that workers can text entry for data captured on electronic battery life a moot point, and costs next collaborate in Phase 1 units or the ICU. forms. Some of the most practical uses of to nothing. The Tablet PC, while small for Enabling wireless connection mobility for the tablet computer will be for signature a PC, is two inches thick and weighs over Web-browsing or network access capture and completing eCRFs with two pounds (Microsoft insiders say provides one of the most significant checkboxes, radio buttons, and drop- thinner, lighter versions are in the enhancements over previous tablet down lists. Navigating Web-based works). It’s also much less mobile than computing efforts. Past attempts at tablet systems, like clinical portals, also its PDA cousins, although arguably more computers were made before the requires little text entry. Keep in mind capable. widespread acceptance of the Internet that the pen is mightier than the mouse, Durability. The tablet computer will and wireless technologies. not the keyboard. Pen-based direct need to be rugged to stand up to the The Tablet PC has benefited from manipulation of the interface is much rigors that a mobile data capture system general technology developments easier than using a mouse, especially for will face in a typical health care setting. including longer battery life, higher novice users. Dropping a pad of paper causes only a display resolution, improved flat panel Capturing information at the point of minor inconvenience; dropping laptops display technology, smarter handwriting care could eliminate much of the can be catastrophic. recognition software, and improved redundant data capture performed in Writing surface. A more subtle storage technology. E-book technology, today’s clinical trial process, but it difference from paper is the writing currently available in Microsoft’s Pocket PC, improves the ability to read text on the screen. Furthermore, the prices of these newer technologies have dropped Some of the most practical uses of the tablet computer to the point where they are becoming mainstream. will be for signature capture and completing eCRFs with Handwriting recognition. The new tablet checkboxes, radio buttons, and drop-down lists. computer will feature much-improved handwriting recognition software. Providing reasonably reliable (robust is not yet achievable) handwriting necessitates providing a quick and mobile surface. Many people find that the recognition software is key to its solution. Often, conducting data capture smooth computer display surface of the acceptance. For a pen-based interface to with a patient means scribbling tablet computer makes a poor writing be functional, handwriting recognition information quickly in an abbreviated surface. It can make bad handwriting must work. form. Pen-based tablets are an efficient worse. Examine your signature the next Microsoft is promoting the concept of form for this mode of data capture. time you sign an electronic pad, if you digital ink as a complement to Adding speech recognition software to need further evidence of this. Pens are handwriting recognition. In what the the tablet computer may add an better for drawing and direct company is calling “Ink as Ink,” the tablet additional convenience for data capture. manipulation, but tend to be inferior for computer will capture notes as written in Many consider speech recognition to be textual communication. an image format for storage and possible the Holy Grail of data capture. But, it is Keyboard preference. Even if interpretation by handwriting recognition clearly not appropriate for all situations handwriting-recognition technology were software. Users will be able to mix digital and must be complemented by other in a mature, stable state—which it is ink with traditional electronic documents. modes of data capture. Like handwriting not—handwriting, for many workers, is Imagine making true, handwritten recognition software, speech recognition no longer the preferred mode of margin notes on your eCRF. software is much improved, but not yet a capturing text. People who entered the Digital ink and handwriting completely robust solution. workforce using a computer often find recognition will support international they type faster and more legibly than character sets. Interestingly, Chinese Challenges facing the Tablet PC they scrawl longhand. Consider the characters are better for handwriting Skepticism for starters. Pen-based recent success of Research in Motion’s recognition than English characters, computing has come and gone, leaving (Waterloo, ON, Canada) Blackberry because they require specific stroke many early adopters wary of the wireless handheld. Why is it such a order and design. In English, unique excitement generated by this new breed tremendous hit? It is wireless, but two- writing styles make handwriting of tablet computing. The Tablet PC must way wireless messaging has been around recognition much more challenging. convince clinical users of undeniable for years with numerous failures. The With the continued acceptance of improvements over previous generations. Blackberry supports exceedingly basic eCRFs and EMR (electronic medical Let’s face it, it’s not paper. The tablet PC integration, works poorly with record) systems for capturing data, much form is notoriously difficult to get right. documents, and certainly lacks the less handwriting recognition is A paper pad is thin, flexible, has great benefit of a wealth of third-party July 2001 APPLIED CLINICAL TRIALS 33 I NSIDE IT applications.