[ Introduction and Background ]
Tablet computing has grown at an incredible rate over the past year. Surprisingly, even physicians and hospitals have adopted this technology in relatively large numbers, considering that many hospitals and clinics continue to rely on paper-based charts, fax machines, and ledger-style appointment tracking. Some hospitals transmit blood draw orders by having them placed in a computer by a physician, printed out by a nurse, and dropped in a paper slot for a phlebotomist to collect. In spite of this archaic backdrop, the iPad in particular has blazed a trail to the bedside of the patient. A number of medical schools and residency programs are actually buying iPads for their students and residents, sometimes with and at other times without a clear idea as to how the tablets would be used. One thing is certain: that tablet computing has made its inroads into the medical community, and it is here to stay.
While tablet computers have a variety of uses for consumption by medical trainees such as reading textbooks (whether through the Kindle or iBook stores, individual apps developed by big publishers, or through interactive textbooks that are being developed) and watching instructional videos (e.g. how to perform an arterial blood gas), production of new content has major barriers. In particular, most people do not find the glass keyboard of the iPad comfortable enough to type anything longer than a short e-mail. Even for me, someone who has used computers since an early age with good manual dexterity, I find that even the iPad 2 with its faster processing speeds and reduced typing-key-to-screen delay is too cumbersome and can be a hindrance to efficiency, an achievement so rarely acquired in health care delivery settings. I have tried using text expansion and templates to speed up the process, but writing an admission or consultation note remains a chore.
[ Hypothesis ]
Accordingly, I was very excited to discover the ClamCase, a keyboard case for the iPad and iPad 2. Unlike other keyboard cases, it has a hard shell and seamless method of connecting the Bluetooth device to the iPad. I suspected that this device might succeed where others might not: in facilitating a rapid means of text input in the medical setting into a device that is built for speed and convenience.
[ Results ]
The ClamCase, as one might expect from the name, has two halves like the shell of a clam. The iPad snaps into place in the top half: two lips hold the iPad tightly into place. The top half has indentations to allow for head phones and the charger to be plugged in; recesses for the power, orientation, and volume buttons to be accessed; and a cutout for the rear camera to take pictures and video. Unlike with some other cases, the alignment is perfect. The bottom half houses the recessed keyboard, two indicator lights, and rubber bumpers on the top and on the bottom to protect the iPad screen and provide friction on the bottom to prevent sliding. The bottom half has a small USB port for charging with the cable provided (which can be plugged into the same AC adaptor as that used by the iPad). The two halves are connected by a tight hinge which feels very sturdy.
The case itself has a spectrum of orientations. When completely closed, it provides full back, front, and edge protection for the iPad as though it were a laptop. It can then be pulled opened and angled in the same way (90 to 120 degrees) as a laptop. However, it doesn’t stop there: the hinge rotates a full 180 degrees, allowing you to use the keyboard face of the bottom half as the support/stand for the device, allowing for easy access to the screen when reading at a table or watching a video. Finally, the case can be fully folded back and used as a tablet held in one hand and directed with the other.
The case does have some weight and nearly doubles the weight of the iPad. Of note, much of the weight is in the top half of the case, meaning that tilting the screen too far back while it rests on a slanted surface that the rubber grips can’t hold as well (like a lap) can cause it to topple over if one isn’t careful.
The case comes in three colors: white, black, and a limited edition aluminum/brushed metal finish.
Typing on the keyboard is surprisingly pleasing. The keyboard is notably smaller than a full-sized keyboard, but this is the same trade off one would find with a netbook of a similar size. After a few minutes, I found that I could easily touch-type the way I would with a full-sized keyboard.
The Bluetooth connection between the keyboard and iPad is one of the best features. After the initial setup, the keyboard connects to the iPad 2 automatically. Like other magnet cases, the iPad 2 activates the lock screen or turns on when the case is opened. After clicking any key on the keyboard, the keyboard emerges from its “sleep” or “suspend” mode and immediately connects to the iPad as indicated by the flashing Bluetooth symbol at the top right of the iPad screen. After a couple of seconds, the synchronization is complete, and one can start typing. As expected, the keyboard returns to a sleep mode when it has not been used for some period of time. It is possible to turn on and off the keyboard as well when one does not want to accidentally press the keys (for example, when using the case in tablet mode wherein the keys would be resting against a surface such as one’s forearm).
Lastly, the keyboard offers a number of features that would be missing from a non-keyboard case: keyboard commands (such as copying, pasting, cutting), arrow keys, easy access to numbers and letters and punctuation on the same spread, and finally special characters (such as accents).
[ Discussion and Conclusions ]
While all keyboard cases would add much needed ease of use and additional functionality to the iPad, the ClamCase appears to stand ahead of the crowd. After inserting the iPad into the case, the device and case truly feel unified. One does not need to keep plugging and unplugging the iPad from the keyboard. Many other cases have a “pasted-on” feel to the keyboard which might add extra bulk but very little form factor or protection, but the ClamCase makes one forget that this isn’t actually a traditional laptop. The landscape orientation feels much more natural for word processing than does the portrait orientation used by some other keyboards, an orientation that is better suited for stylus writing on the screen.
The convenience, utility, and form factor do come at a price, though: $150 for the iPad and iPad 2 versions. Most keyboard cases come at a price ranging in the $50 to $150 range. Nonetheless, while some balk at the idea of spending more money on an already expensive device, the money could be very well spent if the added functionality is worth it. For me, my impression thus far is that the added value of a solid keyboard for generating medical notes (in the setting of a medical record system that lacks text expansion, a medical team structure that suffers from long rounding times and frequent activities that removes one from the ward computers, and a service that has a high admission and consultation rate) is well worth this price.