Apple’s iPad Will Fall Short of Transforming Hospital Medical Care, But May Have Potential With Electronic Medical Records

by Satish Misra, MD
on Jan 29, 2010

IPad-02 Now that Apple’s bombshell has finally been dropped and the world has met the iPad, its finally time to begin separating fact from fiction. Will the iPad boast the same outstanding user interface as the iPhone and iPod Touch? Yes. Will the iPad solve world hunger? Probably not. Will the iPad be a useful tool in medicine, perhaps even transform the way healthcare is delivered or electronic medical records organized? The jury is still out on that one but, admittedly, I am skeptical. Here are a few of the reasons why.

1) For a healthcare provider’s day-to-day use, the iPad doesn’t do anything better than an iPhone or a laptop/desktop.

In considering whether to invest in an iPad, my question is simple – how does this device help me do my job better? The iPhone answered this question by enabling me to put a wealth of medical resources into a small mobile format. In certain health systems, I can even check on new labs or radiology reports from anywhere in the hospital via my iPhone. I’m less convinced the iPad offers similar benefits, at least beyond the iPhone or iPod Touch. Improved graphics or a higher resolution screen don’t really matter much for reading text or looking at numbers. And when it comes to looking at CT, MRI, Echo, or other kinds of imaging where resolution does matter, I’m going to use the 25’’ high-resolution monitors that are available in the hospital. While I agree that this would all be much “cooler” on the iPad (it’d be fun to scroll through a high resolution CT on a larger screen in the cafeteria), the fact is that specialists, such as radiologists, are the ones who really degree of resolution and their screens are already better than the iPad. The iPad certainly does it all, but I have yet to see how it’s a significant improvement over the iPhone in this type of day to day use.

2) Big hurdles face development of peripherals for more advanced healthcare functions

The mobility of the iPad certainly offers some opportunities for the more procedural tasks of hospital care. For example, there would certainly be value to a peripheral that measured blood pressure, heart rate, and other vital signs and then uploaded them to the inpatient electronic medical record. Or for a peripheral adapter that allowed connection to fiber optic cameras or ultrasounds, allowing me to view or record the images from my iPad to the electronic medical record. These are all intriguing possibilities. However, the big obstacle here are the entrenched powers currently in control. Medical devices are a big money game, and companies like Stryker, who make a number of such devices, including fiberoptic cameras, will likely not want to cede the user interface of their platforms to Apple, let alone standardize connectivity options with other device manufacturers.

3) Safety

I mean this in two ways. First, patient safety. Infection control is a paramount concern in hospitals today. You don’t want to know the number of protective layers I had to wear at the height of H1N1 (or the cost of this extra protection). If the iPad is going to do more than be an EMR portal for writing patients notes and reading their records, then it has to be strong enough to withstand disinfection procedures. Second, property safety. Desktops are hard to steal, laptops are easier, and an iPad would be a breeze. If patient information is stored or accessible on the iPad, the hospital’s lawyers will demand a pretty high level of security.

With that said, Apple has had discussions with with Epic, a major electronic medical record developer, on iPhone OS integration. I’m sure the parties involved in these discussions have thought about the potential the iPad has for EMR use. And I do think there is potential in healthcare, particularly in niches where tablets are already used (such as emergency medical services). There is a case to be made that this is the first tablet that’s easy and fun to use and it will succeed where prior tablets have failed. And while we at iMedicalApps have some differing opinions about the possibilities of the iPad, we’re excited to see what happens once developers start making medical apps for the iPad.

And by the way, while the iPad is certainly the coolest kid on the block, at least one competitor (Freescale) may offer customized tablets running open-source operating systems like Android for as little as $200.

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Comments:

  • As a busy emergency department physician, I have to say that ALL electronic medical records I have used to date are worthless (and even dangerous) to patient care in the ED setting. Here are some points I have observed:

    1. Every electronic record I have tried is excessively time consuming, time which could be spent tending to patients.
    2. Electronic records are frequently rigid, not allowing non-sequential data entry.
    3. Nurses using electronic records spend more time generating the record than they spend caring for patients.
    4. Emergency departments are fast-paced environments. Charting systems should be both fast and accurate.
    5. While generating electronic records is currently a total pain in the ass, viewing them after the fact is great.
    6. To date, I have found no more efficient system in the ER other than paper charts.

    Given the above experiences, I am very optimistic about the iPad. It's mobile like a clipboard and will facilitate bedside charting; data entry should be easy - like paper; and, it has great connectivity for obtaining labs, xrays, old records, and hopefully for printing. I am hopeful that I will be able to transpose my quick, easy, and accurate paper template into a workable iPad format. It will combine all the advantages of paper charts with the advantages of viewing electronic records after the fact.
  • MCMD
    A mobile tool for in office exam room report generation that can bypass wasteful data duplication between EMR and report with lightening speed, possibly including hands free dictation insertion capability might actually succeed in eliminating paper, which thus far has been done in very few offices, could be huge. I could even foresee patient participation to ensure accuracy of the report. I have found palmtops with styli too cumbersome. Ipad might just get around this. Certainly the need is enormous, as is the need for software standardization, especially in imaging. The downtime is punishing. Though I haven't seen one yet, if the resolution on the iPad is as good as the iPhone/Pod, at it it's size I doubt it would be any worse than what were getting on laptops and just imagine being able to blowup images the same way you can on iPhone, eliminating clumsy eyeglass button.. Lawdymama.
  • Satish Misra
    Thanks for your comments Jared, and your article was a great read. The lack of expansion ports and multitasking were particularly disappointing to me as well. I do think tablets have potential in healthcare, iPad included, but for now in more specialized functions that would benefit from the user interface and software potentials (patient education for example). And regarding the point you make about the ubiquity of Windows, I read that Citrix software enables Windows 7 to be remotely run on the iPad. I bet Apple loves that one.
  • forex robot
    Keep posting stuff like this i really like it
  • Jared Houck
    There is a large gap between what many HOPE the iPad will do and what it actually CAN do. Tablet PCs have been on the market for many years and promised many of the same things. The limiting factor has been (and most likely will continue to be) software. In the US, CCHIT/Drummond certification (via the ARRA stimulus) will be the badge that differentiates what healthcare facilities will actually support and purchase.I've listed another 10 reasons the current iPad will not be significantly deployed in healthcare if you have the time.
  • Iltifat Husain
    StatCoder, I actually agree with your comment, and compared to my peers on the site, I think the tablet will be a huge splash in the health care community because of its form factor and the fact that its a "blank slate", as you mentioned. I'll actually have a post up soon countering some of the points made by Satish, who definitely does bring up some great points
  • Satish Misra
    Thanks for your thoughts. I certainly agree that the iPad has a lot of potential, precisely for the reasons you shared. But as for the thought of physicians, nursing, etc each carrying around an iPad, I'm more skeptical. Perhaps a few iPads on the floor available for rounding on patients, education, etc. But in my experience, the only thing I carried with me all the time was what could fit in my pockets. Even the clipboard generally only got taken for new admissions or rounding on patients. So if I'm running to the cafeteria for lunch, up two floors to put in a central line, or doing the other various daily tasks that pull me away from a computer, the only thing I'm taking with me is my stethoscope and whatever is in my pockets. In that sense, I found the iPhone to be transformational because suddenly there was a lot more in my pocket. The iPad I think will be a very useful, innovative tool. But I do not think it will change things like the iPhone did.
  • StatCoder.com
    I think the iPad will be more important to health care IT than you might imagine. When the iPhone was launched a couple of years ago, there was really very little to indicate that it would have much if any use in the healthcare setting. Even Apple had no initial intention of targeting such vertical uses. More so for the iPod Touch which was basically introduced as a game device. Now we have medical schools deploying them and neurosurgery conventions using them in place of program binders.

    The potential isn't apparent in any of the software that was displayed. It's in the hardware, the platform, and the price. The hardware: Large screen, 1.5 pounds, thinner than most paper charts, 10 hours of battery life, wifi/3G, bluetooth keyboard, microphone. The platform: all current and future iPhone apps, media delivery. Finally, a starting price of $499 maxing out at less than $900.

    The iPad is blank slate. While the initial target is a wide range of lifestyle users, the potential for niche vertical applications is right there out-of-the-box. The Dragon voice recognition app seems accurate enough to allow eventual transcription via bluetooth microphone onto the iPad. Ever try to show something to a patient or a colleague on your iPhone? It's not ideal. What if I pull out my iPad?

    Every time view data on my iPhone in a clinical setting, I sacrifice size for mobility. Every time I sit down and open my laptop in a clinical setting, I sacrifice mobility for functionality. It's quite possible that the most useful clinical data device is the one that resembles the form factor of the original clinical data device - the clipboard.
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