When I was handed my first pager, I was stunned. It looked like the beeper that Will Smith used to flash on the Fresh Prince of Bel Air (and not even the later seasons, I’m talking about the early, crazy outfit seasons!). So I asked why I couldn’t simply use my phone or, for that matter, why we didn’t all use phones. The answer was simple – reliability. The paging system, of which this rather archaic looking item was part, was very reliable. But was that enough? No. The hospital also maintains it overhead paging system just in case. And if that goes down – yep, there’s a back up there too. In health information technology, reliability is everything. And for the iPad, that could prove to be a major barrier to adoption in the medical community as it faces off with other medical tablets, at least if the FCC’s recently voiced concerns prove to be true.
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When I first entered the clinical world, physician order entry and electronic medical records were just concepts to me. As I learned how to navigate the hospital, diagnose everything from the mundane to the incredibly rare (my first patient was a baby with an idiopathic subdural venous thrombosis), and figure out how to treat the sick, I also had to learn how to use those two systems as a prerequisite to doing everything else. The four hours of class didn’t seem to cut it, so I probably spent at least a month trying to get my bearings on how to manage these IT systems. So for anyone who is already familiar with some form of healthcare technology, in this case a tablet, I suspect the adoption cost is far higher than just the price tag. You may be surprised how highly some medical students and residents weigh the notion of learning a new system in their career decisions. And because of what seems to be a particularly high barrier to adopting new information technology in healthcare, anyone interested in whether the iPad will succeed in healthcare should first ask who the competition is.
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Over the last few months, a great deal of time has been expended on the “hot competition” between Apple and Google in relation to smart phones. Much of this interest probably had to do with a partially imagined story of a once close friendship between Apple and Google, founded on their mutual enmity of Microsoft, now fractured on the rocks of competition and greed. While the truth probably isn’t as dramatic, whatever conflict exists is much less interesting than where they may overlap – especially when imagining where medical technology could go and how it would affect medical professionals. As most readers are undoubtedly aware, much of the recent discussion in the blogosphere on this topic (at least before January 27) was about the rapid ascent of the Android platform. The emergent themes were that the open and mutable nature of the Android operating system, the entry of multiple handset makers, and the absence of any restriction on software publishing will inevitably make Android the dominant smart phone platform of the future. The historical analogy given was desktop computing, where commodity hardware and a minimally restrictive operating system made Microsoft Windows the de facto standard, despite many obvious flaws. But, it seems this analogy is flawed and here’s why.

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Having had the opportunity to visit nearly a dozen academic medical centers in the past few weeks, I saw quite the spectrum of IT systems – from simple order entry to fully-integrated decision support systems. And for programs with the former, that revelation was quickly followed by the timeline for the coming upgrade. But what’s next for the most IT-savvy institutions? Well, Steve Jobs thinks he has an answer. Rumors abound that Apple is already pitching the iPad in LA-area hospitals as the replacement for the old physician clipboard. For outpatient practices already running a Mac-based EMR, MacPractice has already announced development plans for an iPad interface. According to their press release, they plan to develop apps that will allow patients to fill out registration, medical history, and other forms on the iPad. For physicians, it will integrate with the MacPractice EMR to manage schedules, view patient records, and even enter clinical notes. So could the iPad become the new best friend of healthcare providers? Well, there are a few challenges that need to be overcome first but the opportunities are exciting.
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By now many have heard the amazing story of how Dan Woolley, a Colorado man in Haiti, used the Pocket First Aid & CPR app to help survive severe injuries he sustained in the earthquake.  We highlighted this story last week when it broke, and we’ve always thought Pocket First Aid & CPR was a great app when it was first introduced in the summer of last year, and we even wrote about it back then.

At that time we put it in our “Apps for Patients” category not only because of the useful information it provides, but because it’s backed by the American Heart Association, the organization that sets the standard of care on first aid procedures. This app review will focus on the features of the app that helped Dan Woolley survive the injuries he sustained during the earthquake.
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It was only a matter of time before partnerships between medical textbook publishers and the iPad development community emerged. One key partnership the Wall Street Journal just announced is between ScrollMotion (app developer) and McGraw-Hill’s Education division, with the purpose of developing e-books for the iPad.  And why does this matter? Because if you’re a medical professional, you most certainly have read or own a medical text from McGraw-Hill.

McGraw-Hill is the publisher of Harrison’s Internal Medicine, Schwartz’s Principles of Surgery, the Case-File series and many more medical texts.  They acquired Apple and Lange Inc in 2007, further expanding their vast medical library.  Many of us know of McGraw-Hill via Access Medicine, the online portal to their large collection of medical texts that is available in almost every academic institution in the country.

Many pundits feel the iPad’s use of an LED screen verse E-ink (think Kindle) will dissuade readers from purchasing the iPad for reading purposes.  The principle argument is the LED screen will cause more eye strain after prolonged use, but the medical community should embrace e-books on the iPad because we read textbooks in a different way than traditional readers.
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This is the second part in a series we’re doing on iMedicalApps. On a daily basis, there are plenty of free medical applications released for the iPhone and iPod Touch and most of them aren’t useful, hence the “free” tag.  Some of these free medical apps actually do provide key functionality.  This app review will cover four apps that meet the above criteria.  Remember, some of these apps are only free for a limited time.
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