Storm clouds continue to gather in the Apple-Adobe feud over Flash and recent reports suggest it could get even worse. Reports are surfacing that they Department of Justice and Federal Trade Commission are in discussions over opening an inquiry into the recent changes to the iPhone OS developer license agreement. As we discussed previously, these changes basically kill Flash on the iPhone OS, thus including both the iPhone and iPad. We’ve talked previously about our excitement over the numerous emerging web-based electronic health records such as CareCloud and Practice Fusion. With news from Adobe of plans to include a “Packager for iPhone” in the latest development kit, we were definitely excited that these electronic health records would be ready to go on the iPad. But it looks like those dreams have ended.
As the folks over at PC World are quick to point out, we are right now in the “rumor” stage that an inquiry – not a full scale investigation – may occur. Even so, Apple’s legal team is certainly revving up for a fight. But, at least when it comes to medicine, this is a fight they may be better of losing.
As Steve Jobs continues to rage against the Adobe machine, Google and the associated Android are very publicly embracing Flash and will be including Flash support in Android 2.2. This will allow access to everything from news content to the most inane of internet games, which some may argue is also important to medical professionals who are also regular people outside of the clinic and hospital. What is indisputable though is that many low-cost or even free web-baesd electronic health records will now be accessible via Android devices. Meanwhile, iPhone and iPad users will have to wait for healthcare IT vendors, whose EHR’s are generally either Windows or Flash-based, to develop apps specifically for them. And as the race for electronic health record adoption continues in light of the stimulus funds available for it, time is not on Apple’s side.
As physicians, especially those in smaller practices, look to adopt EHR’s, they will also look to adopt new devices on which to run them. Android devices will have an obvious advantage with web-based electronic health records thanks to Apple’s scuffle over Flash. What’s also interesting to note is the numerous emerging tablets that will also run Android. Glancing at the CES 2010 review of 10 tablets worth noting, by PC World, the majority will run Android. And with prices as low as $200 (if Freescale does in fact deliver on this promise), there will be a lot of choice in terms of cost as well. So for the physician looking to adopt a tablet, there will be a variety of choices to fit his or her needs.
Web-based EHR’s certainly carry a smaller market share than major players like Epic, Allscripts, and so on. They are, however, a dynamic platform with a lot of potential especially, from a cost and simplicity perspective, for the smaller physician practices. And as physicians deploy these systems and look for devices on which to run them, Android-devices are, for the most part, now the only game in town.
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Can you give an example of an application that is dependent on Flash that physicians need? I routinely block Flash in my web browser and can’t think of anything that I’m missing.
Scott – The applications I was referring to are the web-based EHR’s referenced in the article. For smaller practices, I think these systems offer a low-cost way to adopt EHR that further offers opportunities for population health. And many of them, at least the ones we have explored, are largely Flash-based. While this could certainly change, the fact is that the rush to adopt is now (to get the stimulus funds and avoid penalties), hence the argument I make in the post that physicians, specifically those for whom these web-based platforms are attractive, would now have to turn to another OS and Android is a growing option. Thanks for allowing me to clarify that point.
Satish, interesting post. I think it’s important to mention that, at least in CareCloud’s case, just our Practice Management Suite which is intended to run on the desktop is based in Flash. We are currently extending our system to run natively on the iPad, iPhone as well as a myriad of other devices.
This has always been our strategy as we feel that different devices and screens are optimal for different types of uses. Flash/Flex is great for delivering a consistent user experience across multiple desktop platforms, but we’re equally enthusiastic about some of the iPhone-specific features we’re building into some of our mobile ‘extenders’.
Ah well there is the answer even faster than I can ask for it.
Mike-
great to hear that the no flash won’t have a negative effect on CareCloud! do you think the no flash support has required you to put more time into the mobile iteration of your platform, or do you think it causes a more stable experience? (flash’s current iteration being system resource heavy and sometimes buggy).
It’s definitely led to a more stable and superb user experience – there’s no doubt. Apple’s SDK is an amazing toolset and we’re very happy to be using it to bring a unique EMR experience into the hands of physicians.
Thanks for the insights Mike! I was curious about the time frame on the iPhone OS platform?
We are shooting for an iPad release in early Fall. The mobile versions should be released shortly after that.
Hope that helps!
It’s probably just a setback, not a broken dream. In the case of CloudCare your article points out that they separated the core of the app from the display/UI so I’m guessing they’ll spend the time rewriting their Flash widgets to HTML5 or native code for the iPhone/iPad. It’s a pain but they’re apparently well-funded and can absorb that extra expense.
Since you interviewed the CEO at HIMSS I think a followup on precisely this topic would be very interesting to read!
Thanks for the thoughts! I agree, its a setback but my sense at HIMSS for example was that the race is on now. So what I wonder is whether this will turn into a setback at a critical time in terms of EHR adopters. And regarding your suggestion, we’re definitely pursuing that and look forward to posting more on this topic. Honestly, I do hope I’m wrong – I’m a big fan of competition (including in OS) and having Apple in the game on web-based EHR is, I think, critical.
I don’t think it’ll have an impact for the following reason:
It takes a lot of work to make a desktop-sized app work on the tiny screens of the iPhone. One can not just recompile the code into a iPhone-native format and expect the app to be usable. The entire layout and flow of the app has to be different on the iPhone than on the desktop. On top of that, iPhones and iPads are touch devices. Any interaction on the desktop version that depends on a “mouse-over” type action needs to be rethought, redesigned, and recoded for the touchscreen. My point is that the EHR devs probably planned on a lot of work going into the iPad/iPhone versions and whether that work is done on adobe’s CS5 tool or another will not amount to a huge difference.
Besides, CS5 is shipping just now. If the race is on and the devs were waiting for this tool to get started on their iPad/iPhone apps they were probably going to be too late anyways.
Interesting, I think at the end of the day the no flash rule is actually
going to be a good thing. it will be interesting to see how the android
platform will perform with flash based medical apps via the web – from what
you’re saying – that experience would be compromised unless the app has been
customized for mobile form. Although adobe said its newer iterations of
flash are going to be significantly better – jury is still out on that one.
I agree that mobile platforms can’t simply be the desktop version on a different screen. But it seems to me that when it comes ot that mobile platform, it would be easier to build in Flash if you are working with a Flash-based EHR than having to use HTML5 or some other language. What I’m suggesting is that it just raises the amount of work necessary to deploy an iPhone/iPad platform for these EHR’s.
But you do raise a good point that if developers commit to building the platforms, even if delayed past an Android platform, would mean that physicians looking to adopt now could be satisfied. That definitely tempers my concerns.
Anyways, thanks for this discussion!
A perfect example is how Gmail enhanced their UI specifically for the iPad to really utilize the touchscreen. Different screens/input devices need different interfaces to make sure the user is abstracted from any complexities or difficulties.
CareCloud’s aim has always been to deliver a great user experience and that simply isn’t going to happen by slapping our desktop experience onto a small touch screen.
I use Practice Fusion for both my office and the inpatient. I feel that the service is great buy somewhat power hungry. It runs very well on my desktop but slows down and even stops working on the older computers in the office on long days. I feel that mobile hardware may not be ready for full flash yet. Remains to be seen is the Android take on this. Hopefully I will be able to play with a device sometime this year.
Thanks for sharing your experience with Practice Fusion – its interesting to hear that user perspective. Hopefully, we will soon get to give some of these Flash-based systems a trial on an Android device soon. If you happen to have that opportunity sometime, please do share with us either via a comment or email us directly – we’d love to hear about it.