In previous articles in Dentistry Today (August, 2002, and November, 2002), I examined the advantages of having computers in the treatment rooms and specifically looked at Internet access and its applications in the operatory. While there are certainly many reasons for placing computers in a clinical setting, for many offices, space limitations have prevented some doctors from making this decision. Desktop computer systems are bulky and take up a considerable amount of space. The average computer system is about 18” high and deep, and about 6” wide. Many treatment rooms have cabinets and delivery systems that take up much of the free space available. Computer manufacturers have realized that space is often at a premium, and they have created “small form factor” computers to deal with this. Unfortunately, these computers do not permit standard size add-on cards to be installed in the computers, so dentists will not be able to use these systems with capture cards that are needed for intraoral cameras and digital radiography, for example.

One solution used in the past for the space problem dilemma was laptop computers. I have never been a big proponent of laptop computers in a clinical treatment room. They are often very expensive compared to desktop computers. They are often underpowered and the screen resolution is poor compared to a CRT monitor of flat screen monitor. As a medium to show patients digital images, they are difficult to move from one room to another and the need for a network cable and power cord often defeated the idea of a “portable” computer. Recently, however, a new concept in computers was introduced. This new computer is called a Tablet PC and it has certain advantages that require us to re-think the idea of laptops in the operatories. In this article, I will explain the pros and cons of Tablet PCs, compare these to Smart Displays (another new technology), and explore some of the ways that Tablet PCs can find a home in the dental office.

What is a Tablet PC?

While there have been attempts at pen-based computing in the past, the Tablet PC is a relatively new idea. In essence, the Tablet PC is a portable laptop that has a touchscreen and uses a special digital pen for data input. The main reason that many experts believe that the tablet will become popular is due to Microsoft’s backing. Microsoft has created software designed specifically for tablets, known as Windows XP Tablet PC Edition. This software is a full-featured version of Windows with a few extras. The main extra feature is digital ink. Digital ink allows you to write on the screen as if it were a pad of paper. The other main feature is handwriting recognition. You can be in a program like Word, use your own handwriting or printing, and see the writing converted to text as it’s entered into the document.

There are two basic forms to the Tablet PC: slate, and convertible. The slate form is the design that was originally recommended for the Tablet PC. The slate is a true tablet; there is no imbedded keyboard or mouse, and data is designed to be entered by the digital pen. All Tablet PCs have at least one USB slot, so you can easily connect a keyboard, mouse, or touchpad if you want. The slates tend to be lighter and less bulky than the convertibles, and have screens that range in size from 10.4” to 12.1”. Examples of the slates are the Compaq TC1000, Electrovaya Scribbler, Fujitsu Stylistic ST4000, and Viewsonic V1100.

Convertible tablets are a more traditional laptop with a literal “twist”. The screen has the ability to swivel around 180 degrees, and then the screen folds back over the keyboard, converting the laptop into a slate design. Simultaneously, when the screen swivels, you can setup the orientation to switch from landscape (the width is greater than the height) to portrait, where the screen more resembles a notepad. Examples of the convertible design are the Acer TravelMate C100 and the Toshiba Portege 3500.

The choice of a convertible or slate is really one of personal preference; there is no “best” tablet PC out there. The slate designs tend to be thinner, less bulky, and easier to carry from room to room. However, only one currently on the market has the larger 12.1” screen. There have also been issues of heat generation in a couple of the slate systems. Convertibles are a good choice for users who have trouble giving up the concept of a keyboard. This design is best for people who really aren’t sure how or when they’ll use the digital pen.

When is a Tablet a Tablet?

Thanks to Microsoft’s input, any tablet that wants to use the Windows XP for Tablet PC Edition software must meet 6 basic criteria:

1. Precise pens. Tablet PCs use a pen, but it’s not the same as the pens or stylus that you would use with a Palm or Pocket PC. Microsoft requires that vendors use a digitizer, which is a thin piece of metal that sits behind the LCD screen and communicates via radio signals with the pen. The screen can actually detect the pen when it’s about ¾ of an inch above the screen surface. The downside? Don’t lose the pen! The screen won’t detect a finger or stylus. The benefits of this are that you can rest your hand or wrist on the screen without fear that you’ll create random marks of digital ink.
2. Fast Wake-up. As many owners of laptops are aware, the sleep mode in a laptop can be variable at best. Microsoft knew the importance of this for a portable device like a tablet, so specifications require that tablets wake up in less than 5 seconds and that batteries must be powerful enough to keep the tablet in sleep mode for at least 72 hours.
3. Rotating display. Since some software works better in portrait mode than landscape mode, tablets must be able to display both formats, either through the use of a menu selection, button, or automatically.
4. Grab and Go. Many of the tablet PCs are sold with docking stations that allow you to use the tablet as a monitor. Unlike many laptops, tablets must be able to be docked and undocked without the need to turn off the power.
5. Legacy Free. In order to keep tablets thin and light, tablet PC manufacturers are not required to include legacy devices, such as parallel and serial ports (and most don’t). On the plus side, they are free to add slots and ports not normally seen in laptops, such as USB 2.0, Firewire, Compact Flash and SD memory slots. All of them have at least one PC Card slot.
6. The reboot function that is normally invoked by hitting Control, Alt, and Delete at the same time is combined into a single button on a tablet, thus making it difficult for a hacker to take control of the system by bringing up the onscreen keyboard.

While it’s not mandatory, almost all of the Tablet PCs have built-in wireless networking. This is crucial for using the tablet as part of your office network. In some cases, tablets also have an Ethernet port in either the tablet or the docking station, allowing you a choice of wired or wireless connections. The wireless connection is the 802.11b standard, which can transfer data at up to 11 MB/s.

Another newer technology that should not be confused with tablet PCs is Smart Displays. Unlike Tablet PCs, which are designed for the business environment, Smart Displays are meant more for home use, although they have found a market in hospital settings. Their goal is to extend the use of an existing Windows XP desktop by using a pen-enabled monitor. The monitors look and feel like the slate Tablet PC design, but they do not run Windows XP. Instead, they run a version of Windows CE, similar to Pocket PCs, and they communicate with the server through a wireless network. In essence, programs do not run on the Smart Display. Instead, the Smart Display allows you to run the software that resides on the server, and you will see on the Smart Display the image that would have shown up on the server’s screen. From the user’s standpoint, it’s hard to differentiate between the Smart Display and a Tablet, since you can control and run software from a Smart Display that will seem like the software is residing in the Smart Display. In dentistry, the only company currently marketing a Smart Display is Video Dental Concepts; their D.O.T. has been available for a few months. Other companies will release Smart Displays in early 2003.

One of the main differences will be cost. Tablet PCs, being a new technology, are selling in the $1800 to $2500 range; expect these prices to come down in the next 6-9 months. With Smart Displays, because they are significantly less powerful, expect prices to be around $700 to $1000 for the first models.

Dental Applications

Of course, the question remains, how can tablets be used in dental offices? I see a few scenarios where the tablets will make sense:

1. The single tablet for personal use. I see a good use for a tablet in a fully computerized office where the dentist will have one tablet that he or she uses for personal use. Since the tablet has a wireless connection to the network, it is easy to run the practice management software from the tablet. Since many practice management programs allow for electronic chart notes, the dentist can make these notes between patients or during a few minutes of downtime in the operatory. The doctor can also use the tablet to check his schedule, go online, write emails, etc.
2. The patient monitor. Although their resolution is not as good as a conventional monitor, the higher resolution of tablets compared to older laptops makes them a nice alternative for viewing digital radiography or digital camera images. The USB and memory card slots make it easy to incorporate a digital camera memory card or USB capture card. The patient can hold the tablet and view the images as they are downloaded. Also, by using the digital ink features of the tablet, the dentist can annotate, highlight, or make notes on areas of the digital images, and then print out the images with these notes intact. This scenario would be ideal for the dental office with very small operatories and where it would be impossible to place a monitor for patient viewing.
3. The desktop replacement. I do feel that in certain circumstances, offices that do not have computers in the operatories might consider using tablets exclusively, with a few caveats. First and foremost, many digital technologies require a desktop computer. For example, most digital radiography systems use SCSI or proprietary PCI cards for data capture; these could not be used with tablet PCs. Secondly, dentists should look at tablets that come with docking stations so that they can use external monitors, floppy and CDROM drives. Docking stations will also allow the tablet to be mounted in a position where it can be viewed like a regular monitor.

The Tablet PC presents a new option for dentists who are looking to add technology to their practices. By giving dentists a truly mobile platform, Tablet PCs may have a place in many offices. The choices in design and features give practitioners many options for finding the right solutions for their office. Dentists who have resisted placing computers in the treatment rooms should look at Tablet PCs as a viable alternative.