AT&T announced recently that they currently support 13 million so-called “emerging devices” on their network, which are consumer electronics which have embedded connectivity or work in tandem with existing smartphones. AT&T Emerging Device Organization launched in 2008 with the mission of “introducing wireless capabilities into a wide variety of emerging wireless devices beyond the traditional handset.”

The company recently announced the appointment of its first chief medical information officer (CMIO), Dr Geeta Naggar. Additionally, AT&T has partnered with the Department of Health and Human Services Office of Minority Health and American Association of Diabetes Educators to launch a new mHealth initiative to test mobile devices for diabetes self-management.

Some examples of the companies developing the 13 million emerging devices include Zephyr Technologies which struck a deal to embed AT&T 3G/4G technology inside its body-worn sensors. BlueLibris is an “On Star for people”, allowing device owners to press a button to talk and transmit medical data such as heart rate and blood pressure. AT&T is providing Vitality GlowCaps wireless network connectivity for the intelligent pill caps designed to help patients take medicines regularly using phone call or text message reminders.

Separately, AT&T announced it will be redesigning its 2,200 stores to include a “wall” featuring these emerging devices, presumably including mobile health devices and wearable sensor technologies. This is a very big deal for start-ups in the mobile health sector, everybody should be trying to get their products on the “wall”, and its an even bigger deal for the consumer patient who can now access body computing devices at a relatively low cost.

This move will likely be considered a direct threat by Apple and I predict it won’t be long before we see a similar wall at Apple Stores featuring every connected health device available, a topic we addressed last week on iMedicalApps.

It’s also reasonable to presume Verizon, Sprint, T-Mobile and other competitors in the brick and mortar cellular business will follow AT&T’s lead and welcome developers of emerging devices to put their products on their shelves. They will also likely embed their proprietary 3G/4G technology into these consumer health products to create additional monthly revenue from existing subscribers.

While the Smartphone itself is a very powerful mobile computing device, if it can be bypassed in the transmission of critical patient data, this would remove a layer of complexity in the workflow of mHealth technologies and services. The companies with the best chance of emerging as best-in-breed mHealth providers may well be those thinking beyond the smartphone app today.

[Ed. On Thursday, we will publish an opposing viewpoint from another editor. Let us know what you think in the comments section.]

The rush of manufacturers to bring tablet computers to market was much in evidence at the 2011 Consumer Electronics Show (CES) and at the Mobile World Congress in Barcelona. The tablet market was essentially created by Apple with the introduction of the iPad in April 2010, who has gone on to sell an astonishing 15m of these devices in less than a year. The iPad 2, introduced last week, promises to extend these sales numbers.

There has also been tremendous enthusiasm in the medical world for the iPad, with most of the major medical apps now optimized for its larger screen and user interface. At the University of Chicago, internal medicine residents received iPads as part of a pilot study and are giving it “rave reviews“, relishing the ability to access patient records while on the move and to share information with patients at their bedside (see this news clip). Medical uses were even highlighted in the iPad video during the Apple March 2 press event.

With dozens of new manufacturers rushing into the tablet market in 2011, many of them running versions of Google’s Android operating system, the market dominance of the iPad will clearly diminish. Nevertheless, the iPad and other iOS devices will remain a massive market for app developers who will aggregate wherever there is a large customer pool for their products.

However, I believe the deployment of clinical apps specifically will follow different signals. In particular, I predict that tablets meant for real-time clinical use will run locked versions of Android, that allow interaction exclusively with clinical information systems, and be provided by hospitals and other institutions.

The reasons for this include:

• hospital information services and EHR vendors favor standardized application & hardware deployments for security and ease of maintanence
• vendors can customize the Android mobile operating system; Google exerts its control only when accessing the Android market, and thus this will be sacrificed
• paid app downloads will continue to diminish as a source of revenue, as real value shifts to connectivity with other apps and demonstrating cost savings

Recently, Palomar Pomerado Health, a large hospital system just north of San Diego, announced the development of a tablet application that will allow their physicians full access to patient health records. Already promised is connectivity with three major EHRs: Cerner, NextGen and the Veterans Administration’s VistA system. The application was previewed at the recent HIMSS meeting in Orlando. It was developed using the Android mobile operating system and was funded in part by Cisco, who is providing the wireless infrastructure for a planned new hospital by the health system.

This announcement is interesting in a few key respects:

• it neatly aligns with a prediction made by Research2Guidance and highlighted on this site that future medical applications will be provided by healthcare institutions, not App stores
• the app developers did not choose to develop on Apple’s iOS; their stated reason was that “they are not allowed to delve as deeply into the computer’s inner workings as they are [with Android]“
• the app’s real value is not in its presentation layer but rather in its integration with multiple EHRs

The latter point is highlighted in this quote regarding the app:

It sounds like it’s really cool and valuable …, but I suspect the real value is in the back office cooperation that needs to exist to access the data.

from Dr. Joseph Smith, chief medical and science officer at the nonprofit West Wireless Health Institute in neighboring La Jolla, in the San Diego Union-Tribune.

Integrating patient data across multiple clinical information systems and EHRs is difficult, unglamorous work. However, the relatively easy revenue from paid downloads will become a diminishing source of revenue in the future. Specifically, Research2Guidance predicts that, in the future, value will revert to device sales, monitoring & other medical services and advertising. This will further reinforce the model of apps distribution by health and IT providers, rather than being selected and downloaded by end users.

I would expect that the actual tablets will be provided by hospitals or EHR vendors, as free incentives, or at low cost. As above, the devices will have the apps preloaded and the operating system will have been modified so as not to allow any other user interactions or access to the Android market. This will greatly simplify provisioning and maintenance of the devices while the hardware will be kept to the bare minimum necessary to run the applications. Note also that we recently reported that Samsung is augmenting Android with new APIs to “make more secure and enterprise compatible apps” for Samsung phones and tablets.

Finally, for those keeping score on Apple vs. Google in the mobile space, what does this mean ? Apple is a hardware company and not terribly interested in commodity hardware and low-margin enterprise pricing. Thus, it may not loose too much. Google is an advertising company and uses Android to collect information on its customers and display ads. If these devices do not use Google’s own apps, it does not get customer data. However it benefits by getting more developer mind share, which increases the value of the platform as a whole.

In conclusion, Apple’s iPad is a highly refined and capable device which can rightfully be said to have revolutionized computing. It will, however, not be the device most likely used by physicians to access patient records in the future. Furthermore, since the value and power of future medical apps will depend on their ability to access patient records, the evolution of the medical app world will likely be influenced by the platform decisions made in the near future.

[Ed. The article below is simultaneously published today by iMedicalApps.com and the Journal of Surgical Radiology (http://www.SurgRad.com), a widely read, peer reviewed journal]

In just a few short years, smartphones with advanced operating systems have sparked a bright new era of mobile medical applications. Although the Blackberry smartphone had been the device of choice for physicians for most of the previous decade, the arrival of Apple’s iPhone in 2007 revolutionized mobile phones. The highly anticipated release of the iPhone software development kit (SDK) a year later immediately launched a wave of mobile software development and, almost immediately, interest in medical software.

As if to underscore this interest, a physician was on stage with Apple CEO Steve Jobs in 2009 demonstrating an early version of Air-Strip, an iPhone application that provided real-time monitoring of fetal heart rate tracings. This was nothing less than a thrilling peak at a possible future where physicians remained connected to their patients’ data, freed from the physical constraints of having to be at the hospital or office.

In the last two and half years, a new world of mobile medical applications has flourished. Currently, there are over 6,000 apps classified as health related across the various app stores, although only 30% are directed to clinicians. Still, with the numbers of physicians using smartphones climbing from an already high 72% to a projected 82% by 2012, the market for clinician oriented apps will only continue to increase.

Here at iMedicalApps we review and comment on mobile medical technology and apps from the perspective of physicians. In this column, we are going to explore the world of mobile apps and ask where medical professionals will be going to look for the medical apps of the future.

App Stores

After the iPhone in 2007, the next major revolution in mobile computing was the iTunes App Store, introduced a year later along with the iPhone SDK.
Suddenly, users could directly browse a huge array of applications directly on their phones and, with a single click, purchase and install software (“apps”) directly to the device. Along the way, the problems of software distribution – all publishers instantly had global reach – and security from viruses and rogue applications were mostly eliminated. By hiding the complexity of application installation from the user, Apple unleashed a commercial juggernaut and within 9 months, one billion apps were downloaded from the iTunes App Store.

The power of simplicity was not lost on other platforms and within a few months, Google launched the Android Market for its then nascent platform. Since then, of course, sales of Android powered phones have skyrocketed and, in December 2010, a dedicated medical section of the Android marketplace was inaugurated. Each of the other major platforms now has its own market, including Nokia (Ovi store), RIM (Blackberry App World), Palm (WebOS App store) & Microsoft (Windows Phone 7 Marketplace).

Web 2.0

In the same period as the smartphone revolution, rapid advancement in web browsers and software technologies has occurred that could conceivably displace the central role of “apps” in the future.

In the first decade after the birth of the world wide web, usually marked by the launch of the first Mosaic “browser” in 1994, the web was essentially a publishing medium. A single entity could broadcast widely using the world wide web but the audience was limited simply to absorbing the content or, at most, purchasing online.

The first “Web 2.0″ conference in 2004, organized by O’Reilly Media, popularized this moniker. Although there is no canonical definition, Web 2.0 pertains to the web becoming a two way medium. The definition often given is “the internet as platform” or “the participatory Web”. By collecting data from users, brand new types of services and companies could be created. One example is Wikipedia, a user-generated encyclopedia. Another is Reddit, a highly successful news site founded in 2005 that relies on its thousands of readers to vote items of interest up or down. By “crowdsourcing” the editorial process, massive amounts of data could be sifted and the publishing process could profitably be automated.  In effect, the rise of a social, collaborative web meant that news, shopping, even software development became group efforts.

The evolution of Web 2.0 was in part facilitated by browser based technologies that allowed for more sophisticated interactions with the user. These were lumped into the memorable but loosely defined acronym “Ajax” (Asynchronous JavaScript and XML). Ajax allows for small portions of a web page to be modified in response to user input, instead of having to reload the entire page. This allows for more fluid interactivity. The original poster-child for Ajax is Google Maps, which can zoom, pan and display map overlays in a way that is still inspiring years after Google acquired and relaunched it in 2005.

Web Apps

While most people do not think of it as such, a website such as Google Maps is an application, only that it resides on a remote server and interacts with the user (executes) within the confines of a web browser. In contrast, an app such as Epocrates or Microsoft Excel resides within the device and directly manipulates the computer, via the intermediary of the operating system.

In fact, until recently all software applications were written exclusively to work within the environment presented by a computer operating system. For much of the last three decades, this usually meant the Microsoft Windows operating system. Until fairly recently, the kind of applications that worked within web browsers were just too simplistic to satisfy the wide variety of users’ needs.

However, the powerful browser based technologies mentioned above are starting to blur this distinction. Certainly, applications can be delivered through the browser much more cheaply and are far easier to distribute and maintain. Google, by giving away its barebones Chrome OS operating system is betting that web applications can deliver enough rich functionality to displace the role of device-specific operating systems such as Microsoft Windows and Macintosh OS X.

The end of Apps ?

While the demise of “native” app development and operating systems in favor of web applications has been regularly predicted for more than a decade, will the benefits of economical app distribution and maintenance finally be enough to overcome the shortcomings of browser based apps ?

The short and safe answer is no. The first reason was inimitably articulated by David Pogue in “The Lessons of 10 Years of Talking Tech” in the New York Times. As he put it:

TV was supposed to kill radio. The DVD was supposed to kill the Cineplex. Instant coffee was supposed to replace fresh-brewed.But here’s the thing: it never happens. You want to know what the future holds? O.K., here you go: there will be both iPhones and Android phones. There will be both satellite radio and AM/FM. There will be both printed books and e-books. Things don’t replace things; they just add on.

More arguments for the continued need for “native” medical apps were proposed by Albert Santalo, CEO of CareCloud – an EHR company, in his guest post on iMedicalApps. His arguments, paraphrased, were:

1. Offline Usability

Native apps can run in offline mode and then synchronize with the server when a signal becomes available. Dropped connections are a nuisance for the average consumer, but for health workers they can be “devastating”.

2. Full Functionality

Web apps cannot access device features and hardware such multi-tasking, Bluetooth, address books, the camera and microphone.

3. User Experience

Web apps lack a dedicated, device-optimized user interface and thus cannot be precisely catered to fit a particular device’s form factor, input methods and screen size. Thus, web apps typically deliver an “abridged” user interface.

Medical Apps Distribution

If “native” medical apps are going to be with us for the foreseeable future, how will physicians continue to find and deploy them ?

A recently published broad survey of the mobile industry by Research2Guidance predicts that the dominant mode of application distribution in the future will be from doctors, hospitals and other care providers, rather than via the current familiar App stores.

While App stores have been a revolution for consumers, this distribution mode is not adequate for health information technology, where isolated data stores are dead-ends. In particular, the ability to reference clinical evidence, prescribe medications, or communicate with other providers is of greatly diminished value unless all parties have simultaneous access to the same patient record.

The current generation of medical apps still emphasizes information retrieval – think Epocrates & Medscape. Although AirStrip Ob and Critical Care stand as a shining example of mobile devices acting as extensions of the doctors’ hands and eyes, the main mode of usage for smartphones remains information retrieval.

Therefore, it makes sense that hospitals and other provider networks will be the ones to develop and distribute intrinsically networked apps for their providers in the future. These future apps will be powerful extensions of physicians’ clinical tools, seamlessly extending their reach from hospitals and offices onto their mobile devices.

The Future of Medical Apps

The future for medical apps is bright. There will coexist both native and web based apps. App stores will continue to thrive and the market for consumer directed health apps will thrive. However, apps directed at physicians will become increasingly better connected to patients’ clinical records and will more likely be distributed by hospitals and other provider institutions.

Finally, a couple of other potential developments to look out for in the future. First is Practice Fusion, a free web-based EHR, which is seeing rapid adoption. If the enthusiastic developer response to the first, limited deployment of its API at the Health 2.0 meeting in July is any indication, there may yet be a flourishing App store within this EHR in the future. Also, look out for the Accelerator Apps Network , a sort of “meta-platform” for health care applications which aims to provide an environment where multiple health care apps can communicate with each other. From their description:

The Health 2.0 Accelerator Apps Network is a growing ecosystem of web applications and services that work together – collaborating 2, 3, 4 and more at a time, serving as platforms for other apps and as interoperable bridges between apps – all to connect and support patients, caregivers and providers

In future columns, we will investigate these items in further detail.

Lost in all the buzz of the recently announced Verizon and Google Net Neutrality “partnership” was that both companies were thinking of mobile health care as part of net neutrality. The reaction to the net neutrality proposal has gotten significant criticism by the tech world, mainly because Google and Verizon feel wireless carriers should be exempt from net neutrality rules. But in a joint and long winded statement, there was the following noteworthy note about mobile medicine:

Fifth, we want the broadband infrastructure to be a platform for innovation. Therefore, our proposal would allow broadband providers to offer additional, differentiated online services, in addition to the Internet access and video services (such as Verizon’s FIOS TV) offered today. This means that broadband providers can work with other players to develop new services. It is too soon to predict how these new services will develop, but examples might include health care monitoring, the smart grid, advanced educational services, or new entertainment and gaming options. Our proposal also includes safeguards to ensure that such online services must be distinguishable from traditional broadband internet access services and are not designed to circumvent the rules. The FCC would also monitor the development of these services to make sure they don’t interfere with the continued development of Internet access services.

Google recently showed how mobile health care apps can sync with their personal record – Google Health – and with their clear interest in collecting “observations of daily living” data, the proposed net neutrality standards make one think Google wouldn’t be opposed to providing a platform for health care monitoring in the future.

We’re giving away 5 promo codes for one of the most popular PDF readers in the App Store via the comments section of this post.  We’ve reviewed it on this site before and now the app is boasting some significant upgrades.

There were fireworks at the recent Google developer conference (“Google I/O”). Some of this was well deserved excitement around features found in the newest version of the Android mobile operating system (version 2.2, “Froyo”). Much of the fireworks, however, were due to loud, public taunting of the iPhone and Steve Jobs by senior Google executives.

Since everybody loves a contest, these statements by Google speakers were widely covered in the tech press and predictably stirred up heated comment threads throughout the blogosphere.

In truth, the schoolyard level of the rhetoric (see Kara Swisher) probably does not serve Google’s interests in the long run. This is because Google’s business relationships are symbiotic: Google needs its partners’ trust to continue delivering to Google, via their devices and services, massive amounts of user data for its primary business, which is selling advertising.

As a result of the mentioned spectacle, people seem to forget an important fact: that business-wise, Android is competing against Microsoft not Apple. Microsoft is a software vendor, like Google, but it makes billions by licensing its OS cheaply to multiple hardware vendors. Unfortunately, it seems Google has destroyed that marketplace by giving away its OS for free. John Gruber’s recent insightful post on the Google I/O conference provides more insight on this.

Apple, in contrast to Microsoft and Google, is more of a hardware vendor. Its business model depends on producing consistently great products and charging customers a premium for them. Apple makes a lot of money doing this and, as Gruber suggested, does not need more 20-25% of the marketplace to be wildly successful (it currently has 19%). Apple is only interested in the top portion of the market and already has an astonishing 90% of the market share for PCs costing more than $1000. But, if Apple stops making great products, its business model disappears.

Android promise is near-complete freedom for developers & handset makers and rapid iteration. This freedom will necessarily mean that Android will be fragmented, with multiple software and hardware versions (see Engadget) being sold at any given time. Thus, one can predict that handset and software incompatibilities will negatively impact application development, enterprise adoption and user experience. But, these impediments are not going to stop wide-spread adoption of Android since it only has to be “good-enough” to be accepted at low prices in the mass marketplace.

In the long run, as many have said, there will be more Android than iPhone devices – a lot more (see previous post). But, despite the heated rhetoric from Google, Apple will continue to thrive by continuing to deliver a highly polished user experience with a deep bench of applications deployed on a consistent platform. Nor will the iPhone vanquish Android with its permissive ecosystem, free licensing and large market share.

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.

1. There will be more Android devices in the future than iPhone OS devices. Lots more.

Android is based on the Linux kernel, which already powers an unimaginable range of computers and devices. Google’s contribution of a rich communication and user interface layer will mean that we will not only see Android in phones and tablet computers but also cars, thermostats, refrigerators and who-knows-what else. This is going to be great for consumers. But, it’s not clear that the future ubiquity of Android means it will also be the de facto platform for smart phones. Many commentators have already made the arguments that Android phones will not be a unified platform, but rather splintered by a wide variety of hardware configurations, and that separately building the operating system and the devices will lead to unintended compromises.

What I want to emphasize, however, is that developing software for mobile devices is fundamentally different from developing desktop and enterprise applications. Specifically, mobile applications are much smaller and simpler to build. Most only take a few weeks of programmers’ time. The numerous developers rapidly publishing Android versions of their iPhone apps have already proven this and it means mobile computing is not going to be a winner-takes-all platform race. There are currently five major platforms: Symbian (Nokia), Blackberry (RIM), iPhone OS, Android and Windows Mobile. Maybe not all will survive into the next decade, but it’s difficult to imagine only one remaining.

2. The profitability and competition in the device market will help Apple too

If there was any doubt about this, just look at Apple’s most recent quarterly blow-out earnings. The number to look at is not the revenue of $15.7 billion (more than double Google’s, by the way) but rather the gross margin of 40%. This is incredible. Commodity hardware and open-source software means there will always be competitors entering with lower-priced devices. But do not forget that Apple also benefits from these same downward price pressures. In fact, Apple’s market power gets it lower prices on flash memory than its competitors, while it leverages open-source software development in its operating system kernel and web browser.

As proof of this principle, just look at the iPad’s starting price of $499. By designing its own CPU, Apple has further eliminated another supply cost. By being profitable at this low price, Apple just might have knocked out the legs from the consumer netbook market. Also, while Google can enter the device business, Apple can also enter the advertising business. Apple’s purchase of the mobile advertising company Quattro and its plans to integrate innovative advertisement displays directly into its mobile operating system suggest the latter isn’t far off either.

3. Mobile computing is most powerful when it interfaces to web data, but both ends are important

Tim O’Reilly, one of the most perceptive technology observers, recently reviewed the Google Nexus One and effectively suggested that it is not Apple vs Google but rather Apple vs the web. In an information age, controlling the data (i.e. Google) is more important than controlling the device (i.e. Apple).

Prognosticating in information technology is murky as web-based services are evolving very rapidly. Google will clearly remain a dominant storehouse of data into the foreseeable future. But new companies will continue to arise with compelling data in their sectors, such as Yelp for local restaurant and vendor reviews, IMDb for movies, and Twitter for social networking.  And then of course there are the medical databases such as Cochrane, PubMed, and EMR-based patient data. But, even if cloud-based computing is the “killer app” for mobile computing, its means of consumption is very relevant. In fact, there will always be room to innovate on the user interface -  witness the iPhone. If we use the car analogy and consider cloud data to be roads and highways, who wouldn’t want a nicer car(device – user interface) to drive?

Conclusion

We know history does not quite repeat itself, but does echo. So rather than reciting the story of Microsoft vs Apple with new characters, I suggest that we look beyond that simple analogy and consider it may not be Apple or Google in the mobile world, but rather it will be both. I expect both companies will flourish and we, the consumers, will be the beneficiaries.

Google’s launch of it’s newest phone, the Nexus One, has been met with praise and skepticism.  There are many who love the speedy SnapDragon processor and the 5 megapixel camera, while others rail against its lack of differentiation from other Android OS platforms.  Through all the debate, I’ve found the built in capability of Voice to Text not getting much attention.  From what I’ve read of the phone so far, the voice to text appears to be surprisingly accurate, opening up the possibilities for this feature to be used for Medical Transcription services.  The only problem is Google has offered Voice to Text in other platforms, and we haven’t seen similar results.

Google’s most recent history of voice to text is often highlighted by their Google Voice service.  Through google voice you can get your own unique number, and use it in conjunction with your current number with added features.  One of the features touted by Google Voice is the voicemail transcription service.  This transcription service hasn’t faired well so far, as evident by this CNET review of the service.  Hopefully this current iteration of their voice to text on their phone is a leap above their Google Voice service, and to be fair, Google Voice is still in its infancy stage and not yet “official”.

Dictation services are nothing new to the App Store.  There are already plenty of applications in the App Store that have various forms of Dictation offerings.  Almost all are subscription based and in the future we hope to review some of them for our readers.  However, the iPhone doesn’t have built in voice to text software.  My assumption is this feature will not have the capability to understand complicated medical language/terminology, as other dictation services can, but sometimes jotting down a few notes about a patient is all one needs before doing a full dictation.

This built in capability of voice to text could enable short and simple dictations and its only a matter of time before an application is released that helps enhance this feature so medical professionals can utilize it even further.

By: Matthew DeAugustinis, MD/MPH student, MS4

The Google behemoth has brought us many life-simplifying applications in the last decade (gMail, Google Calendar, etc…). Health professional have found these applications priceless in many aspects of our busy lives. Whether keeping that Grand Rounds top on the agenda or making your kids recital, having access to the data of our lives wherever we have internet is something we cherish. In December 2008 Google released another web based app to organize our lives, Google Tasks.

Google Tasks functions as a simple to-do list, with the ability to create multiple lists, provide due dates (and sort by due dates), add notes and access these lists through gMail, Google Calendar or on a standalone web app. This enables individuals with busy lives, i.e. medical professionals, to keep tabs on what’s most important, when it’s important and if we’ve yet done it. Unfortunately, like many Google applications, Google Tasks is solely web-based requiring the use of a browser and internet connection to access your tasks (both on a PC and Mobile Device). This issue has been remedied in the past for gMail and Google Calendar by the native Apple applications “Calendar” and “Mail” which sync with Google but retain information for offline viewing. Apple has no such native app for tasks. In comes GeeTasks to solve this issue.

There already exists a plethora of to-do lists in the App Store. Many offer syncing with online subscription services (some free, some pricey), but none sync with Google Tasks straight from your iPhone/iTouch. Most applications cite Google’s withholding of the Google Tasks API (Application Programming Interface; what allows programs to interact with other programs) as the reason syncing isn’t yet provided. Developer Memengo, Inc decided this wasn’t an insurmountable obstacle and went ahead and figured out the API protocols on their own. This has been done only by one other developer, who currently has the Google Tasks app out for the Android OS. The biggest issue with the app rests in the fact that the API has not been officially released. If Google makes any changes to the API, GeeTasks won’t be able to sync and Memengo, Inc will be forced to rewrite the protocols to restore it, a process that could take up to 3 weeks. In the meantime, GeeTasks would still function as a capable, native “to-do” app.

GeeTasks ends up providing the user with a simple native “to-do” application for their device, with the functionality of the Google Tasks application and the unique ability to sync directly with Google Tasks. This provides the busy Health Provider or Medical Student with a handy place to organize their day, week, month etc. with those tasks best suited to a “to-do” list rather than a calendar. The ability to check things off as they’re finished is also quite satisfying, and may even increase the likelihood you’ll get those tasks done (RCT pending). GeeTasks could also be recommended to patients who need additional help with task planning and reminders (patients with ADHD, dementias, etc.). Unlike the USPSTF, we here at imedicalapps.com are allowed to consider cost-effectiveness, and at $2.99, GeeTasks is cheaper than any notepad I could find at Staples (pen not included).

Features:

The features of this application are basically those offered by Google Tasks. These include:

• Ability to add new tasks
• Apply a due date to the task
• Apply notes to the task
• Sort tasks by due date
• Access tasks on multiple lists

Additional features include the ability to sync to Google and still run natively when sync isn’t available (with new tasks syncing when you are back online), color coding to keep you informed of a tasks sync status (red check or check box means it has not yet been synced) and reminders on the GeeTasks icon of your home screen (the little red number in the top-right corner of the app icon). In the native Apple “Settings” app you can adjust the GeeTasks reminder number to display any of the following:

• Non-completed tasks
• Tasks with due dates
• Tasks due tomorrow or earlier
• Tasks due today or earlier
• Nothing (disables reminders)

As tasks are completed, they are grayed out and the reminders for those tasks disappear. You can also set GeeTasks to sync either Immediately, Immediately (with no warning when you’re offline) or Manually.

Security:

GeeTasks took into account privacy quite adequately. After initially entering your Google ID and password, it is stored in the iPhone’s/iTouch’s secure keychain (the same way that the iPhone/iTouch saves your gMail password for mail). After this initial step, you never have to enter your login information again, and the only people who see your password are your iPhone/iTouch and Google (as it’s transferred for login purposes).

Drawbacks/Future Developer Plans:

The application needs to be opened in order to sync tasks. It would be nice to have scheduled updates done without user involvement (the way mail and calendar work), but the developer informs me this isn’t possible.

The app doesn’t yet support indenting tasks to visually group them (as the web app on the PC does). The developer has planned to use the ‘swipe’ gesture in the future to enable this indenting functionality.

Recurring tasks are not supported by the Google web app yet, and are therefore not yet available on the GeeTasks native application. Additionally, while supporting “due date” Google doesn’t support “due time.” It would be nice to see this added to the native application, even if it’s not data that can be synced to Google.

Currently, you also cannot create new task lists on the application. This function is available on the Google iPhone/iTouch web app, so I would expect to see it added to GeeTasks soon.

You can’t manually sort the tasks in your list, but I’ve been informed that this is already being addressed and will appear in a future update.

Although you can delete tasks, you can’t delete them directly from the main list display screen. The developer informed me that he has submitted to Apple an update that includes a “purge” button to delete completed tasks in addition to a function that allows you to delete individual tasks in the main list display screen.

What I liked about this app:

• it syncs with Google, providing the ability to access my task list on any PC and see it updated on my iPhone/iTouch
• clean user interface that makes it easy to use
• simple program that mimics a paper to-do list with a few handy additional features
• development team provides excellent customer service, with prompt response to questions and suggestions
• no subscription fees
• opens and loads MUCH faster than the web app, and without the need to open Safari

What I did not like about this app:

• uncertainty of changes to Google API that could leave me without the syncing function for 2-3 weeks
• still missing some functionality available in the web app
• the developer has limited features to those supported by Google

What I would like to see in future versions:

• add the functionality available in the web app
• stable API (currently under Google’s control)
• add simple features not available in Google’s web app, like “due time,” even if those features don’t sync to Google

Conclusion:

GeeTasks fits a unique niche of providing a native “to-do” application on the iPhone/iTouch that syncs to Google tasks. This allows those of us with Google accounts (I assume very few of you haven’t used gMail or Google Calendar) to keep using Google for mail, calendar and now tasks while offline, without opening Safari or needing to enter our login information repeatedly. There are plenty of more complex “to-do” apps out there for those that don’t use Google and have more complex functionality (the developer suggested Remember-the-Milk), but most of us don’t require that level of functionality nor do we want to create yet another user account or pay a subscription fee. For those who already have a Google account and want a simple “to-do” list, GeeTasks provides this for less than the price of a pad of paper at Staples. So keep it in mind for yourself or your patients, and keep checking the App Store for future updates.

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Note: If you use Google custom domains (“Google Apps” for business users) keep in mind that you’ll need to buy the slightly more expensive ($5.99) GeeTasksPro. This probably applies to very few of you.

Along with traditional Medical Applications, we will be looking at “Productivity Applications” that are useful to medical professionals.  This is the first part in that series of reviews.

Matthew DeAugustinis is a currently a 4th year MD/MPH student with an interest in medical technology, among other things.  He currently plans on going into emergency medicine for residency.  He is currently one of the guest writers for iMedicalApps.com