The recent development of direct-acting antiviral agents (DAA’s) – Merck’s boceprevir (Victrelis) and telaprevir (Incivek) from Vertex has transformed the management of Hepatitis C viral infection (HCV).

In particular, the addition of these agents, just FDA approved in May 2011, can increase the likelihood of attaining a sustained virologic response (SVR) and even decrease the duration of treatment, compared to existing therapies.

Sponsored by pharmaceutical developers Vertex and Merck, the HCV Care & Guidance App was developed by Projects in Knowledge for the iPhone and iPad to assist clinicians, especially nurse practitioners and physician assistants, with the use of these exciting new medications in the clinic setting.

Projects in Knowledge, founded in 1980 and based in New Jersey, specializes in peer-reviewed continuing medical education and has developed a number of medically-themed iPhone & iPad apps, including ones pertaining to multiple sclerosis, rheumatoid arthritis, Parkinson’s disease, and diabetes.

Read below to learn more about how the HCV Care & Guidance App can offer assistance with the use of DAA therapy in HCV.

The use of the HCV Care & Guidance App requires registration with Projects in Knowledge, which is free and takes less than 1 minute.

The app’s table of contents features sections divided into six chapters, webcasts, video vignettes, and content from AASLD 2011, or the American Association for the Study of Liver Diseases.

The six chapters, which are designated as CME/CE activities, cover the following:

1. Getting ready for direct-acting antiviral (DAA) therapy
2. What you need to know about the new direct-acting antiviral (DAA) regimens
3. Hematologic adverse effects
4. Dermatologic adverse effects
5. Gastrointestinal adverse effects
6. Neuropsychiatric adverse effects

Each chapter offers CME/CE credit as shown above, and begins with a short pre-test before introducing the content.

The development of content is overseen by an editorial board that consists of nurse practitioners, physician assistants, and a clinical research director. One strength of this app is the inclusion of embedded links to multimedia, including articles, illustrations, and videos.

Each chapter includes the highlighted “take-away points,” and includes a series of tables among the text for well-organized education on DAA therapy.

References are included, though many are package inserts for medications.

The end of each chapter features a post-test for users to receive credit for completing the learning module.

The app also includes two 30-to-40-minute audio webcasts, which feature slides for visual correlation. The well-presented webcasts also utilize case studies to help educate listeners on new paradigms in the management of HCV as well as monitoring and managing patients on anti-HCV therapy.

Next, the app also features several shorter video vignettes presenting hypothetical cases that clinicians would be likely to encounter in the outpatient setting.

Finally, the app features a near-two-hour video from AASLD on Paradigm Shifts in HCV Standard of Care Treatment: DAAs. Like the rest of the app’s content, the videos can be viewed horizontally or vertically on the iPhone or iPad.

Pricing:

• The HCV Care & Guidance App is free at the iTunes store.

Likes:

• Loads of high-quality information pertaining to the use of DAA’s, including selecting candidates for therapy, dosing guides, managing adverse effects, follow-up scheduling, and monitoring for compliance and virologic response
• Education presented via text, tables, illustrations, webcasts, and videos
• Well-organized content and smooth user interface
• Free!

Concerns:

• Sponsored by pharmaceutical manufacturers Vertex (who developed telaprevir) and Merck (who developed boceprevir)
• Specific content useful mostly for clinicians who manage Hepatitis C

Conclusion:

• The HCV Care & Guidance App from Projects in Knowledge is a free resource sponsored by the pharmaceutical developers of the DAA’s that features well-presented, high-quality, and clinically useful information for clinicians who manage Hepatitis C infection.

iTunes Link

In the initial review of Surgical Intern Survival Guide , we concluded that the app was a simple starting point that could help the fresh surgical interns get their bearings.

In the few months since our review, the authors have given the app a facelift, in both appearance and content.

On that same plane, the app (which was only available for the iPhone a few months ago) is now also available for the iPad.

The app’s updates are apparent from the home screen. Along with some notable additions in categories, the organization of the app has also been improved. In the previous version the home screen was cluttered, and seemed thrown together.

The reorganization now includes more subcategories, but allows the app to flow in a more logical manner from the home screen. The tabs at the bottom of the screen remain the same, with improvements in some.

The new categories are geared more towards surgical interns; Sutures/Needles, Basic Instruments, Meshes. These categories along with the new OR Etiquette section are especially useful for those, such as medical students, who are new to the surgical realm.

There is also a new ability to create and save notes within the app.

The content of the app is now a bit more comprehensive, ranging from more topics in the “Common Floor Calls” and “Sample Dictations” to the previously mentioned new topics. (As a side-note, the Sample Dictation section can be used as a base to understand the step-by-step procedure that is to be performed. This is really a great way for any medical student to gain insight into surgical procedures.)

In the initial version, the formulas tab only contained 10 formulas. There is a mild improvement, with an attempted expansion in the number of surgically relevant formulas, criteria, and calculations presented. But the section remains purely a list of these formulas, with peculiar choices; from very broad (Cardiovascular with basic physiologic formulas) to very specific (MELD Score/Childs Classification).

The authors also addressed one of the main concerns in the previous version; the formatting. There is a notable improvement in the layout of the text portion, however the newly introduced instruments (images and captions) required some zooming and manipulating on the iPhone.

The iPad version is similar, but as expected, the larger screen helps with reading text, and the instrument images and captions seemed better suited to view on the iPad during the review.

Price:

• Currently $2.99 from the Appstore

Likes:

• Notable improvements in design and content
• New sections (Instruments, suture/needles, meshes) improve surgical relevance

Dislikes:

• While most of the formatting issues have been addressed, there still remain some issues
• Formulas, while increased in quantity, remain a work in progress

Inclusions that would improve the app:

• Getting greedy here, but the inclusion of other items (for example: vascular grafts and laparoscopic instruments)
• Suggested readings/resources for surgical topics

Conclusion:

• The improvements/new additions raise the stock of the app in our eyes. The app’s utility has broadened, and now can also be used by a range of people (medical students to surgical interns), and the app remains an affordable purchase for these populations.
• We look forward to seeing what other improvements the authors make in the future

iTunes Link

Its no secret that healthcare providers are adopting tablets at a rapid pace – one survey found that over 25% of physicians own a tablet and that was nearly nine months ago.

This trend, both with tablets and smartphones, has generally been bottom-up; physicians, PA’s, NP’s, nurses, and other healthcare providers are buying consumer devices and bringing them into the clinical world.

However, as Eric Yablonka, CIO of University of Chicago Hospitals put it, “This is not ‘nice to have stuff’ anymore, this is life saving stuff now.”

And so we’ve seen institutions across the country move to implement mobile devices on an enterprise level – from the Johns Hopkins and University of Chicago Internal Medicine residency programs to the entire VA healthcare system. However, Kaiser Health News reports that less than 1% of hospitals have fully functional tablet systems and points out how one of our biggest investments in health IT, the HITECH act, may be part of the reason why.

When the iPhone was first released, it transformed the way people interact with mobile devices – they became something better than just mini-computers. However, as pointed out by Jenny Gold, staff writer at Kaiser Health News,

“The most popular systems don’t yet make apps that allow doctors to use electronic medical records on a tablet the way they would on a desktop or laptop. To use a mobile device effectively requires a complete redesign of the way information is presented, Jonathon Mack, director of clinical research and development at the West Wireless Health Institute, says.”

We would first point out that the assertion isn’t entirely accurate – Epic, Allscripts, and Centricity as well as many cloud based EMR vendors like MacPractice and Dr. Chrono do have iPad and in some cases Android apps. That being said, these apps are, in many cases, limited – some allow read-only viewing for example.

What is often true, though, is that for hospitals, accessing these apps requires substantial additional cost. For example, Epic and Allscripts both require a separate licensing agreement for their mobile platforms. As Mr. Mack points out, many hospitals and healthcare systems have just made major investments in their IT infrastructure, a trend which was accelerated by the HITECH act. As he puts it, “When you look at a health system that has bought into an EMR, they’re not ready to turn the boat around and start over.”

As a result, healthcare providers are very reliant on workarounds to shoehorn tablets into existing infrastructure. For example, apps like Citrix or VMWare enable access to virtual Windows environments on the iPad or Android tablets, allowing access to fully functional EMR’s, radiology viewers, and so on.

In my own experience, while this method works, it just turns these devices into laptops without the keyboard. Windows is designed for computers and laptops; Microsofts release of Windows Phone and abandonment of Windows Mobile is a testament to that.

Despite these obstacles, healthcare providers like Kate Franko, a physician assistant highlighted in the article, are still finding utility for tablets to improve efficiency, patient communication, and more. While there are many issues to be addressed – cost, security, infection control, and so on – tablets are likely to be an increasingly common feature on medical wards and it’s only a matter of time before the IT infrastructure is forced to catch up.

In the bygone years prior to the dawn of mobile devices, students and residents were sent into the intellectual battlefields that are the wards of the hospital, armed with little more than a stethoscope as their weapon, and a white coat as their armour.

While white coats don’t offer much protection against the sting of a preceptor’s difficult “pimp” questions or the weariness of frequent electrolyte abnormality pages, they do offer trainees a valuable commodity: pocket space.

Though we are now able to cram a virtually unlimited amount of information into our pockets via our mobile devices, just a few short years ago, pocket books and pocket cards were the weapons of choice. There were few weapons more efficient than a well-designed set of pocket cards; they were a potent combination of critical information presented in a compact package available for extremely quick reference.

But times change, and white coat real estate is increasingly occupied by mobile technology. I admittedly do find pocket cards to be quicker in terms of looking up critical information at times, but as one begins carrying multiple pocket cards, this speed advantage is lost. There is only a finite space available, and mobile devices are increasingly being tapped to fulfill this role.

In a bid to stay on top of trends, Borm Bruckmeier has translated their Wards 101 Essentials Pocketcard Set, which covers common emergency, internal medicine, and ICU topics, to the iPhone and iPad via a universal iOS app.

The Wards 101 i-pocketcards app is a straight digital conversion of the physical cards. There is a “classic view” available for users to view the cards in their original white coat form. The iPad is naturally better suited to displaying the cards in classic view, while the iPhone version will necessitate cumbersome zooming in and out to achieve a legible image size.

All 10 faces of the pocket card set are present in the app.

Luckily, the app doesn’t stop at just being a glorified pdf version of the original cards. The developers have broken down the information into categories that one can browse in the “table of contents” section. Selecting a section will display the information in a screen-optimized format that eliminates the need for cumbersome zooming, even on an iPhone screen.

While pocketcards are by nature largely not particularly interactive, the developers have tried to increase the functionality of the app by adding buttons to the SLUMS exam, so that one can administer the exam while inputting the scores while the app calculates a total score.

Overall, Wards 101 i-pocketcards is a good digital conversion of the physical set of reference cards. All the critical information found in the physical cards is present and accounted for.

However, the problems that plague the conversion of handbooks to electronic form still exist here. As addressed by us in previous reviews and commentary, these include issues about the relatively small amount of information in these apps compared to the amount of information that can possibly be packed into the digital format.

Other issues include the downward pressure on App Store prices and Apple’s 30% cut on every transaction, affecting every publisher’s bottom line. To the developers’ credit, they have priced the app at $5.99, which is cheaper than what I have seen in stores ($14.99).

The information presented in this app is nice and condensed; I could definitely imagine myself carrying it with me on an internal medicine, emergency or critical care rotation. The choice between the physical or digital version is solely up to personal preference, there are distinct advantages and disadvantages of both.

If in doubt, a visit to a medical bookstore allows one to skim over all the charts, formulae and content contained within the app, and also helps one to decide whether a physical or digital version is best suited to one’s individual needs.

Likes:

• Concise collection of important information needed on the wards
• Priced below that of the physical reference cards

Dislikes:

• While the presented content is very important, its scope is limited to that of the physical reference cards

Price:

• $5.99

Conclusion:

• Wards 101 i-pocketcards is a digital conversion of the physical reference cards; choice of a version will depend on individual preference.

iTunes Link

Orca Health has had quite a year. Launching their first app in in 2010, they now have a suite of ten apps with–we are promised–even more on the way. By combining stellar art work, three-dimensional interactive graphics and high-end native programming for the iPad, they have created and may well be en route to cornering the market for perioperative patient education apps.

Recent milestones for the company include winning the startup competition at Health 2.0 Europe, having two apps, EyeDecide & FootDecide, included in the iTunes App Store’s Apps for Healthcare Professionals. Until recently, Orca Health’s EyeDecide was ranked as the #1 downloaded free medical app on the App Store, and three other other apps (FaceDecide, BreastDecide & ENTDecide) are in the Top 25. To top it off, the iTunes App Store just included EyeDecide among the best the iPad / iPhone apps in its App Store Rewind 2011. It is interesting to think about the different places, and there are many, they could go from here.

Orca Health was among those selected for the StartUp Mobile Health Pavilion at the recent mHealth Summit (check out our fullcoverage), along with about two dozen other great mobile healthcare companies. There, I got to meet CEO & founder Matt Berry and publicist whiz Jake Lybbert (follow on Twitter). I talked with Matt about the (short) history and future of Orca Health, and his thoughts on the potential for tablets to improve the patient experience.

First, I have to ask – why the name Orca ?

Yeah, the name. Well, I’m from Seattle and I was looking for something very unique and known and kind of respected globally and I just came up with Orca. I’ve always been fascinated with the ocean and the killer whale and what it represents across the globe. I thought from a marketing and branding standpoint, it could be pervasive and ubiquitous, and that people would really remember it because of the immediate visual the get upon mention.

How did the company start ?

So Orca was actually kind of an accident. My father is a spine surgeon and we were discussing some of the macro issues both US based and globally within healthcare, from information asymmetry to lack of patient education to lack of patient surgical retention and I kind of interrupted him and said “You know Dad, I really think smart phones and tablets are going to be a big deal within healthcare. Why don’t we create for you this app and we’ll put some really cool 3D anatomy that the patient can be entertained with and then we’ll break down ten to fourteen different conditions with some great visuals, great content … and we’ll see what happens.” So I just basically built it for his practice.

So we built it and we called it Spine Decide and it was a much poorer version of what’s in there right now. He started giving it to his patients while they were waiting and he started seeing that the patients were much more satisfied and entertained with the information the app was giving them. We then put it in the App Store and it went number one on the medical App Store for like 9 straight weeks.

We started getting emails from physicians in South Africa, Japan, Illinois saying, “Hey this is really great, really helpful.” “Can you do a shoulder?” “Can you do a knee ?” So we just started replicating these apps across the spectrum, and that was it really.

In that story, where did it go from a cool idea to a company ?

I was in the process of moving back from Palo Alto. I did a start up out there, got it to TechCrunch50. It was doing well but I love skiing and wanted to come back to Utah. The way that it became a company was really within that story, when we started getting these emails and seeing the actual benefit it was bringing to physicians’ lives, to professionals’ lives, to medical students’ lives and ultimately to consumers, to the patients’ lives.

And that’s when I was like “Why don’t we build upon this ? This is obviously a need, why don’t we make a company?” So we approached some other doctors, and basically built a company off of it. And there were about eight founding physicians that are part of it, and so each app has a physician that attends to it and is responsible for the content–basically responsible for best practice and scientific content in the app. So that’s really how it started.

What is your process for building these apps ?

We actually have ten apps and going on twelve by Christmas. These last two will be dental which we can talk about later. Basically, we’re a design oriented company. We want to re-design healthcare. We start with the design and get one-on-one with the physician, talk about the content and the anatomy. We redo everything, everything is original content. We don’t copy and paste or purchase anything. I want it to be all original content.

What’s fascinating about that is the doctor will be like, “Yes, you know, it kind of looks like this in Netter’s book but it’s actually really like this.” And that’s just a fascinating process to go through. So we start with the design and then we turn it over to the 3D riggers and they build that process and then it’s adding content from there, with illustrations in between.
Right now we are in the process of redoing all the applications in a much more robust, light weight way. Most of it will be server based. Everything, even the conditions, will be 3D, where you’ll be able to explore inside the condition, move it around, rather than have it just be a static image. So that’s kind of the process, and we have a pretty good expertise right now.

With the right resources, we can knock them out pretty quickly. And they’re not light apps, they’re not a little simple game app. We’re big on execution and that’s how I drive my team, everyday it’s execution, execution. It’s the velocity of what we can do at a high rate.

I’m just impressed that how you can do the quality of the content but at this rate

Yeah I mean basically within fourteen months, we’ve done twelve pretty heavy apps and I think you’ll love what our dental apps will do. It’s all about execution. The bigger companies that have ten times the resources we do but are like big aircraft carriers, they can’t really turn. We pride ourselves on being light and doing a lot of work. We’re able to do it very, very quickly and we have the process down pat now.

How much of the secret sauce is 3D ?

Pretty much everything. What we’re really waiting for is the hardware to catch up, to do what we really want with the processor. We have a heart and a brain app that we’re trying to parallel with the launch of the iPad 3. It’s going to have totally different specs and it’ll really push the limits and really wow people.
I think our apps are great right now. I think they’re OK. I think they’re some of the better stuff that’s out there. I don’t think they’re phenomenal yet. I think we’re getting to some phenomenal stuff, with some gamification, some utility and some augmented reality. That’s really going to kind of set a new bar. But we’re really kind of waiting for hardware to catch up, which is happening at a pretty amazing rate.

You’re not trying to wedge a website into a tablet. You’re actually developing something that’s entirely native.

That’s right. Although we do have a web strategy, my philosophy from day one is that we start mobile and work backwards into the web. Everybody knows that the world’s going mobile and our computing devices will be strictly mobile, whether that’s a smart phone or a tablet. That’s where we’re going. So about a year ago I told everyone on my team, we’re going to start mobile, everything starts native and then we work back in to web apps, we work back in to dot-coms and that type of thing. I feel like you start mobile and work backwards and you’ve got a pretty good recipe for success.

I think that’s a good business strategy because your native apps are a big barrier to entry.

That’s right. It’s not an easy thing. 

Who funded you at the beginning ?

We raised from those original participating physicians, eight of them. So they’re content contributors and they’re all investors, capital contributors as well as sweat equity contributors.

How are you marketing this ? The average doctor is not paying attention to Health 2.0

Yeah, that’s exactly right. You know, we haven’t done any marketing to date. We have a presence on Twitter. That’s really about it. This is kind of the first wave of what we’re doing. I want to tell people what we’re about. I wanted to get products out there and then get reception. We’re really starting the phase of doing some traditional marketing as well a social stuff, but we really haven’t done much to promote them yet. We’re going to go pretty heavy on the conferences next year and really get in front of the people. 

It’s hard to sell to doctors, how do you tackle that ?

The adaption of the iPad and iPhone within healthcare has been absolutely stunning. But you’re right, most of them are early doctors, younger guys who are just coming out of medical school and residency, and that’s fine. We’re happy that the physicians are using them but we really want to create a platform that’s kind of a next wave of patient education. Kind of a 21st century place that you go to interact with your health, and so it’s more patient based than it is physician.
 

Yes, I noticed you’re marketed as a professional app but in reality it’s consumer content.

The websites that are out there are kind of the old model. It’s content that was written by an attorney and you go there and you read this encyclopedic version while three Viagra ads are blaring in your face. It’s absurd and it needs to stop. It was cool in 1996, now it’s not. The next phase is really interacting with your condition whatever that may be and visualizing it and be entertained by it.

There are two learning curves that are going on while we’re building. Number one is smart phone adoption. My grandmother downloads apps and tells me about this Flipboard app that she uses all the time. It’s amazing. The second learning curve is healthcare apps. We’re under the assumption, and it’s obviously proven, that a doctor will prescribe you an app just like he does drugs or a medical device or something else or exercises or whatever. He will say download X app to get this information or to monitor your heart, etc.

So there’s two learning curves there, so I wasn’t over anxious to shift everybody’s paradigm but now we’re coming out of those two curves and the adaption of smart phones has been stunning and the success of everybody’s work within iTunes App Store that’s medically directed has been pretty cool.

So where do you want to go next ?

You’ve seen some of the augmented reality in the vision test that you can do with an Eye Decide. Seeing what actual macular degeneration looks like through your camera lens, ditto with floaters. It’s pretty cool stuff and possibly could be saving a trip to the optometrist or ophthalmologist and saving yourself a lot of money in the process.

The next phase that we’ll be doing is some utility based stuff that will communicate with various devices. The third one that I’m really, really excited about is our aging heart app. That will use some games where you can put various inputs into your heart. Let’s say that you smoke three packs a day or are 40 pounds overweight. Let’s see what that does to your heart over the next 20 years. Now let’s do the reverse.

Let’s say that you lose 40 pounds and you stop smoking and you go vegan, now let’s see what happens. Let’s see how that’s going to save your knees. That’s really kind of the next phase of where we’re going as far as implementing games and various inputs to hopefully influence behavior and get people healthier. If they can see what it’s going to do instead of having someone tell them, that could have a very profound impact on people

In a letter published in the Journal of Emergencies, Trauma, and Shock, physicians in Scotland described the use of a webcam, Skype, and an iPhone 4 to connect a provider in Calgary to an expert over 200 miles away in Aberdeen for assistance in performing a pulmonary ultrasound (full reference below).

As the authors point out, pulmonary ultrasound is becoming an increasingly valuable technique to look for a pneumothorax, evaluate the size of a pleural effusion, and more.

However, even for those that have some experience in this imaging technique, or for that matter, others like ECHO or abdominal ultrasound, its not always easy to tell what you are looking at or whether some finding is actually significant.

Even having put in plenty of central lines at this point in my training, there are still times where I seek a second set of eyes as I ultrasound the internal jugular vein for a suitable insertion site. For a physician in a remote location, whether a small Scottish town or a rural Indian village, a low-cost, simple way to get that kind of help could provide both welcome relief and improved care.

As described in their letter to the editor, system seems to have been relatively easy to set up,

A portable ultrasound (Sonosite 180, Sonosite, Bothell, WA) in Calgary was interfaced to a laptop computer (Aspire 5741, Acer, Kuala Lumpur, Malaysia) via an analogue-to-digital converter (VC-211V, ActionStar LinXcel, Taiwan) [Figure on-line supplement]. Xsplit Broadcaster (SplitMediaLabs ltd, Hong Kong) allowed video-streaming of both an inexpensive head-mounted webcam (LifeCam VX-2000, Microsoft, Washington) and ultrasound over Skype (Skype, Luxembourg), easily viewed on any smartphone.

The pessimist in me notes that HIPAA lawyers would probably be all over this in the United States, as viewing radiology images in Skype falls a little short of FDA approval.

That being said, those are solvable problems in the USA and somewhat irrelevant in the developing world, where the benefits could be substantial.

Image and quotation text from Crawford et al, “Telementorable “just-in-time” lung ultrasound on an iPhone.” J Emerg Trauma Shock. 2011 Oct;4(4):526-7.

New York City has announced a new app challenge aimed at finding innovative ways to use the hundreds of public datasets that it maintains.

The app challenge is entitled BigApps 3.0 and is challenging software developers to create apps that use city data to make NYC better.

The city collects data on everything from the location of WiFi hotspots to a directory of basketball courts. Much in the same way that retrospective analysis of the Women’s Health Initiative data or Framingham data goes well beyond the original intent and has yielded surprising results, NYC hopes that opening its datasets to all the creative minds out there will yield a result that improves the lives of its residents.

A chunk of prize money is also set aside specifically for health apps.

Among the datasets available are: 911 Receiving Hospitals, Health and Nutrition Examination Survey Results (NYC HANES), Community Health Survey (GIS data) 2003-2008, and the Community and Health Survey (SAS data). All of these were found after a cursory review of 250 of the 800+ datasets available. The only requirement is that the app at least use one NYC dataset. What it does beyond that is only limited by the imagination of the app developer.

Entries can be mobile apps, SMS based systems, computer software, or “any software platform broadly available to the public.

The App challenge will give away a total of $50,000 in prize money, divided in several smaller prizes. This includes $4,000 for an “app that best encourages healthy behavior, aids health education and understanding of health trends, and/or improves access to healthcare resources.” Other prizes include

• Best Overall Application: $10,000
• Investors Choice Application: $5,000
• Popular Choice Award: $4,000

The submission deadline in 1/25/12 and winners will be announced at the end of March. Last year’s biggest winners were apps that helped people monitor traffic conditions in realtime, organize pickup sports, and find parking – all of which make sense in NYC. There was no health category last year, so it will be interesting to see the entries that take aim at this category in particular.

Mobisante made its first big waves a little over a year ago with their ultrasound peripheral for smartphones as MobiUS began to accumulate awards all over the country.

After receiving FDA approval earlier this year, the device launched commercially with a reported cost of just under $8,000, comparable to other mobile ultrasound devices but with the additional benefit of wireless connectivity.

We caught up with Mobisante Chief Engineer Nikhil George at the mHealth Summit for a live demonstration of the latest version of the MobiUS device. There are now several different probes available with varying frequencies and also a pairing configuration available with a tablet.

In addition to the demo, we also got an update on their move to support Android devices.

We reported the possibility of Android integration a few weeks ago after reports that Android 4.0 (Ice Cream Sandwich) would enable USB 2.0 host support. As Sailesh Chutani, CEO of Mobisante, told us in an interview then,

“iMedicalApps: What do you think about Android 4.0 and it’s robust support for USB 2.0 hosting?

Sailesh Chutani: The new release of Android does support USB 2.0 host, which makes it suitable for connecting peripherals such as ours. Essentially, Android starts to become a real computing platform a la Windows, which is great for mHealth companies.

iMedicalApps: Are you planning on bringing your Ultrasound Peripheral to Android phones?

Sailesh Chutani: Yes”

Mr. George echoed the sentiment that Mr. Chutani shared with us though that this move will take a lot of work. As Mr. George put it, they broke pretty much every component of the Toshiba device on the road to developing MobiUS, and he expects to do the same with whichever Android device they start with from a wide range of expected and unexpected engineering challenges.

So in short, you will eventually be able to run a Mobisante ultrasound probe on an Android tablet or smartphone, but not in the immediate future.

We also learned that Mobisante is anticipating other diagnostic peripherals moving to smartphones and has built their software in such a way to allow for easier integration of future peripherals. They currently include a feature to take pictures using the smartphone’s camera, images which can be transferred in precisely the same way as the ultrasound images themselves.

While this may not sound like much, its important to remember that this feature not only includes some useful tools like labeling lesions with the diagnosis in question, but it would also be HIPAA compliant.

Check out our live demo below!

Our healthcare system is, in many ways, designed to deal with acute medical issues.

So when a patient facing an exacerbation of a chronic condition – acute volume overload in heart failure or DKA in diabetes – shows up at the hospital, we are well equipped to get that extra fluid off or fix the blood glucose.

We are, however, far less adept at understanding why the exacerbation occurred in the first place and even starting interventions that will keep it from happening again.

So what does this have to do with Ford? Well, one crux off mHealth is making care delivery to patients a continuous rather than episodic endeavor, reaching people in their homes, workplaces, and wherever else they spend time. As Gary Strumolo, Global Manager for Health & Wellness Research, pointed out to us, people spend an incredible amount of time in their cars and Ford is pioneering efforts to bring our cars into the mHealth fold.

Perhaps one of the most interesting insights that Mr. Strumolo shared with us is how Ford got involved in healthcare in the first place. Several years ago, a member of the Ford family, who’s child had diabetes, developed an interest in the continuous blood glucose monitor being developed by Medtronic at the time. At the same time, Ford was at the beginnings of bringing mobile connectivity to its vehicles. From those fortuitously timed developments, the opportunities for Ford in healthcare became apparent.

Ford has thus far partnered with three healthcare groups – Medtronic, Welldoc, and SDI Health. As Mr. Strumolo made clear to us though, Ford is not, nor does it intend to be a healthcare company,

“Ford’s approach to health and wellness in the vehicle is not about trying to take on the role of a healthcare or medical provider, we’re a car company. Our goal is not to interpret the data offered by the experts, but to work with them to develop intelligent ways for Ford vehicles using the power of SYNC. In essence, creating a secondary alert system and alternate outlet for real-time patient coaching services if you will.”

When we asked about his thoughts on pending regulation from the FDA, Mr. Strumolo made it clear that it was not Ford’s intention to have their vehicles become medical devices. Specifically, interpretation of data, alarms, and other similar functions will remain on smartphones and other patient devices. So the alarm for the low blood sugar from the Medtronic continuous blood glucose monitor will still be generated by the device, which will still have an alternative outlet for generating an alarm.

However, the vehicle will now also be able to alert the driver and act as a portal through which the driver can interact with the device. Similar applications for cardiac, pulmonary, neurologic, or really any other sort of monitoring device aren’t difficult to imagine.

According to Mr. Strumolo, Ford intends to keep SYNC device agnostic and thus allow anyone with a useful device to integrate with SYNC. They plan on adopting an Apple-style approach however of carefully screening any proposed device, ensuring that it not only works with SYNC but generates a user experience consistent with their overall vision for the system. As Mr. Strumolo put it, the goal of a driver is to drive from point A to point B, and its important to make sure a SYNC-enabled device doesn’t get in the way.

It does seem that Ford intends to walk a very fine line to avoid making the car a medical device, much like many other manufacturers of consumer products. Functioning as another portal though by which a person can manage their health still has extraordinary value in making chronic disease management a continuous, rather than episodic, endeavor.

Its not hard to imagine someday a heart failure patient’s TV generating a pop-up alert that their weight has been trending up or even a hypertension patient’s refrigerator reminding them how much salt they have had that day. The future looks bright.

According to the CDC, 133 million Americans have at least one chronic disease, and that number was from 2005.

The cost of that disease burden, both in terms of direct medical costs and indirect costs to society, is immense. In a health system that is largely set up to deal with acute illness, we are not only unable to deliver what we know to be the best care, but we also face substantial costs due to system inefficiency.

As Don Casey, CEO of the West Wireless Health Institute, told us in an interview with iMedicalApps,

“…the way to manage chronic disease in our opinion is moving away from infrastructure, expert driven, location-centric care to infrastructure independent care”

Nicole Boramand, VP of Clinical Systems Innovation at West Wireless Health Institute, led a panel of innovators and leaders in remote monitoring who shared their insights into the practical challenges of implementing the remote monitoring systems to deliver this “infrastructure independent care.” Here are some highlights.

The panelists were quick to point out that remote monitoring can only be effective when implemented in the right environment. Dr. Randy Williams, CEO of Pharos Innovations (whose Tel-Assurance system for remote management of a range of chronic disease has been widely adopted), pointed out that remote monitoring is really a way to generate more data – the critical element for efficacy is having the right feedback loops in place to react to the data collected.

Dr. Brett Stauffer, Director of Clinical Decision Support (CDS) for Baylor Health System, additionally noted that implementation of appropriate incentives for everyone – the patients, physicians, nurses, etc – was critical to drive important behaviors, whether its the reducing the incentive to send someone to the hospital at every alarm or encouraging patients to simply participate in the system.

Both Dr. Williams and Dr. Stauffer highlighted the value of having high-volume centers, which allows the care team to build the necessary experience and insights to make the system work at its best. Dr. Williams noted his belief that the presence of a highly experience care coordinator at the successful VA remote monitoring programs was a critical feature.

The other necessity for success will be a culture change among physicians, according to all three panelists. In order to effectively scale these systems up, there will be some requirement for standardization and protocol-driven care, which is often anathema to physicians.

Mr. Claudio Saccavani noted his own experience in trying to determine alarm triggers for weights and blood pressure required him to simply make each physician individually determine alarms for each patient.

Perhaps taking a page out of the Apple and Google playbooks, all three panelists also commented on the need for simplicity and ease of use. For patients, Dr. Williams points out this requires giving patient’s choices that let them decide how to integrate the system into their day to day lives. For physicians, according to Dr. Stauffer, this means making information easy to act on.

The United Kingdom’s National Health Service (NHS) provides a free 24-hour health advice and information service for UK residents and visitors, called NHS Direct which was established in 1997.

By asking patients about their complaints and/or symptoms, NHS Direct seeks to address the concerns of users with the assistance of nurses and cut down on the number of unnecessary emergency room visits. NHS Direct is available through a telephone contact, a website, and since this summer, apps for the iPhone as well as Android smartphones.

The mobile version has been quite popular — the first week after being launched, the NHS Direct App reached the #1 spot on the free app section of the iTunes store.

Moreover, earlier this month, the NHS Direct App reached 1 million patients. The incredible pace of adoption of this service highlights the potential of delivering care, particularly the kind of care that can reduce costs, through consumer platforms. Here we look at the app in detail and learn about why it is has been so successful.

Ronnette Lucraft, the Chief Operating Officer of NHS Direct, celebrated the success of their app.

“This is a significant milestone for NHS Direct and highlights the popularity of accessing healthcare remotely. More people now access NHS Direct’s services online than they do over the phone and it is our aim to continue to provide our services in places that patients and the public will find useful and convenient.

The mobile app is a more discreet and less embarrassing way of seeking health advice for sensitive issues in public or crowded places. We know that people also value the ability to request a call-back from a nurse if it is required, which is why the app is fully integrated with our phone service.”

The NHS Direct App home screen opens with links to Emergency Calls, the Service Finder, NHS Direct, Personal Info, and First Aid Tips.

The “PRESS ICE: In Case of Emergency” functions as an emergency call function for those in the UK.

The Service Finder helps users locate nearby healthcare facilities, including emergency rooms, walk-in centers/urgent care centers, hospitals, general practitioners, dentists, pharmacists, and 4YP sexual health service centers.

For example, for users attempting to locate a nearby walk-in center, the app describes appropriate indications for visits to walk-in centers. Then, the app uses the iPhone’s location services to help locate nearby facilities.

The NHS Direct link from the home screen opens the mobile browser version of the NHS Direct website within the app. This website allows for a myriad of functions, including checking symptoms, obtaining a general health assessment, getting cold and flu advice, inquiring about health topics, and much more.

Here, we demonstrate the symptom checker by exploring information for a hypothetical non-traumatic nosebleed that has resolved.

The NHS Direct website guides users through a series of questions. The questions start with location, age, and gender, before becoming more specific.  The questions, though, still remain user-friendly (did the nosebleed start after an injury to the face, is the skin on your arm warm or cold when you touch it, is there a foreign body stuck inside your nose, is your nose bleeding now, do you have any conditions or take any medicines that you have been told may make any episode of bleeding worse, etc.).

In this example, the answers given led the symptom checker to recommend that the user speak to their primary care physician the next day (within 36 hours). However, if the user has any further concerns or their symptoms worsen before speaking to their physician, the app recommends calling the 24-hour NHS Direct phone number.

Moreover, NHS Direct also provides a short synopsis of patient information for the symptom of interest. In other examples, including contact information can allow for a callback from an NHS nurse.

The Personal Info tab from the home screen features links to ICE Settings, Reminders, and Notes.

ICE Settings allow users to store information for emergencies, including blood type, allergies, medications, existing information, and next of kin.

Reminders can serve to help users remember their appointments or even medications, as well as to set reminders a certain time before such events.

First Aid Tips offer audio presentations to assist users with commonly encountered accidents and emergencies, ranging from burns and wounds to convulsions and CPR. There are no audio playback controls (pause, rewind, etc.) for these tip presentations.

Pricing:

• The NHS Direct App is free for both iPhone and Android users.

Likes:

• App is linked to NHS Direct’s telephone service, so nurses can call users back
• Health and symptom checkers cover a wide range of complaints and symptoms
• Variety of terrific resources, including locating nearby healthcare facilities, checking symptoms, and dealing with first aid emergencies
• Free!

Dislikes:

• Navigation through the NHS Direct website and symptom checker can be somewhat unwieldy on the iPhone in-app browser compared to on a laptop/desktop (as expected)
• The First Aid Tips do not offer audio playback controls (pause, rewind, etc.)

Conclusion:

• We consider the NHS Direct App part of an outstanding service provided by the UK’s National Health Service, and agree that it represents a must-have for UK residents and visitors.
• We especially applaud the symptom checker, healthcare facility locator, and first aid tip functions. 

iTunes:
Android Market:

Acute coronary syndromes (ACS), encompassing ST-elevation myocardial infarction (STEMI), non-ST-elevation myocardial infarction (NSTEMI), and unstable angina (UA) represent commonly encountered events, and often require prompt diagnosis and management strategies to prevent associated morbidity and mortality.

Fortunately for physicians and patients, an abundance of outstanding, well-conducted clinical trials have guided appropriate, evidence-based recommendations to aid the management of patients with ACS.

However, this abundance of clinical trials can also make it difficult for healthcare providers to keep the conclusions and caveats of each trial straight.

This interesting challenge is well-known to pretty much every physician and medical student.  As a result, a few entrepreneurial people at Washington University in Saint Louis/Barnes-Jewish Hospital decided to do something about it.

Dr. Jason Meyers, a first-year cardiology fellow, and Drs. Michael Nassif, Prashant Atri, and David Suk, third-year internal medicine residents, developed the ACS Trials App.

Here we talk to them to learn how a group of physicians recognized a need and came up with a solution.

AP: What served as your inspiration for the ACS Trials App?

MN: In this age of evidence-based medicine, it seems to happen all too often, especially as a trainee, that you know there is evidence for one therapy over another, but you can’t remember where that evidence came from, the dose studied, and so on. This app is designed so that when you’re at the bedside or on rounds, you can quickly and easily access that information.

AP: What’s a quick description of what the ACS Trials app offers?

MN: ACS Trials brings you thorough, focused, MD-written summaries of the seminal trials of acute coronary syndromes (ACS) that have given rise to current practice. Its easy-to-use interface and layout provide quick, accessible, one-line ‘soundbites’, as well as deeper analysis and historical context of landmark trials in cardiology.

Trials are sortable by name, date of publication, and subject; can be filtered by ACS subtype (NSTEMI or STEMI); and are discoverable via a convenient search feature which indexes keywords, generic drug names, brand names, and more. Each trial includes a take-home message, summary, design, baseline characteristics, and results, as well as the relevant ACC/AHA guidelines.

AP: For what target audience did you design the app?

JM: ACS Trials has a broad target audience. A pharmacist needing to know the bivalirudin dosing regimen in the ACUITY trial, a medical student whose attending is asking “What’s the evidence for aspirin?”, a nurse practitioner wondering why they should continue the eptifibatide drip when the stent is already in place, a resident wondering how long after ACS was atorvastatin started in PROVE IT-TIMI 22, a cardiology fellow who can’t remember the loading dose of ticagrelor, or a cath fellow making sure they’re right about bivalirudin before the interventionalist yells at them.

AP: How did you choose which trials to include in the app?

JM: We utilized Dr. Richard Bach, who is an interventional cardiologist and director of the Cardiac Intensive Care Unit (CCU) at Washington University in Saint Louis. He has a unique knowledge of, and affinity for, evidenced-based medicine. Our goal was to include both the landmark trials that built the foundation for ACS management, as well as modern trials that will likely be shaping future therapies.

As such, we included everything from the aspirin studies of the early 1980s, to the studies of rivaroxaban after ACS released in last week’s New England Journal of Medicine (NEJM). Because ACS trials was created by a cardiology fellow and three internal medicine residents at Washington University in St. Louis who are passionate about cardiology and evidence-based medicine, our customers can expect frequent updates as more landmark trials become available and as guidelines change to encompass these seminal trials.

AP: How did you build the content that’s contained in the app?

MN: With the help of our partners Prashant Atri and David Suk, we took the information directly from trial manuscripts. We meticulously reviewed them for accuracy, and included a summary to give some context as to why the trial was pertinent to the way ACS is treated.

AP: What features make the ACS Trials app unique?

JM: I think our search function will really facilitate finding evidence quickly. For instance, if you are curious why someone is on prasugrel you can simply enter the search term “prasugrel.” It will then bring up the TRITON study which compared prasugrel and clopidogrel, and the user can decide which is the ideal treatment.

AP: How do you plan to price the ACS Trials App?

JM: ACS Trials will be available through the Medical category of the App Store for $2.99. A free lite version, with a limited number of trials but the full complement of medical calculators, will also be available.

We thank Drs. Nassif and Meyers for their time and look forward to the debut of the ACS Trials App. We will bring our readers a full app review soon.

The mHealth Summit is the largest annual gathering dedicated to mHealth in the world and convenes a global group of researchers, health professionals & industry. As a media partner for the Summit, iMedicalApps will be presenting an exclusive series of interviews with keynote and prominent speakers between now and the December meeting titled “mHealth Leaders speak to iMedicalApps”.

Joseph Kvedar, MD, is the Founder and Director of the Center for Connected Health, which was established in 1995 by Partners HealthCare.

Partners was founded by Massachusetts General Hospital and Brigham and Women’s Hospital, and is a principal teaching affiliate of Harvard Medical School.

The Center’s mission is to “develop new strategies to move health care from the hospital and doctor’s office into the day-to-day lives of patients.” Dr. Kvedar will be speaking in the Super Sessions at the Summit on “Mobile Health in the Clinical Enterprise”.

Read below to learn more about the fascinating work being done at the Center for Connected Health and his thoughts on the mHealth Summit.

Why are you participating in the mHealth Summit?

The growth in this sector has been extraordinary in the last that two or three years. From a patient perspective, the power of having mobile technology always on, always networked, in the palm of your hand and very personal just really does open up a whole new opportunity for the delivery of health care that we just have never thought about.

What do you hope to get out of it?

I think safe to say in this space the mHealth Summit is one of the biggest meetings, so there is going to be great content, and there are going to be great networking opportunities. I hope to get insights into the field, to take the pulse of what’s happening and to with colleagues working in the same area to inspire new concepts and business relationships.

Could you please share a few thoughts on the potential of mHealth to improve health?

I have been at it seventeen years and we just couldn’t conceive of the opportunity that today’s smart phones, as an example, give us in terms of just-in-time care delivery and just-in-time messaging and the opportunity to educate people when they needed the most and on and on. So I do think there is something here, I do think it’s a — it’s really profound and it is going to have an enormous effect on not just the health care industry, but all industries.

Mobile technology is with you and we are always connected so that we can use it as a tool to sense all kinds of things about you and collect them and aggregate them and then give you insight into your lifestyle which will be important for health care.

Tell me about the Center for Connected Health

We changed our name in 2006 from Partners Telemedicine because we evolved from the concept of traditional telemedicine and got into some of these other areas, so we thought we need to really have a different term for what we do. We would say that mHealth and connected health aren’t exactly the same. But mobile enables us to push our vision so much faster, in such a more compelling way that it’s incredibly exciting. Now what we do here is we are very focused on opportunities for really two things.

One is self care and insights into lifestyle change and behavior change and all those sort of things that will take your population that’s headed for chronic illness and reverse that trend. And then the second is just-in-time care or the ability of a health care provider to manage a population of patients and then reach into the moment and find you and say, “hey, look it’s me, I am just looking over your data, and it looks to me like — you know, I see this trend over the last three days of your blood glucose reading, let’s have a chat about what’s going on” and do that teaching in the moment that you just can almost never do during office visits. You’ve got an appointment at 3 pm on Friday afternoon and that’s when you show up and if you are not sick then it’s a quick visit, but if you go home in the next week you get sick, tough luck.

It seems the Center works both on the provider and the consumer side

So we are definitely a hybrid organization, that’s part of what is fun about it. We do have an academic side, true, but as a division of Information Systems at Partners Healthcare, one of our missions is to keep the organization three to five — more like five to seven – years ahead of the curve on these technologies. So, as we move into a world of accountable care and capitation, all of a sudden it’s become very, very plausible that we use a lot of these programs to extend ourselves across greater population of patients and take care of them effectively outside of the office. It’s really about creating innovative programs that get us into the care coordination world as opposed to the office visit world.

Then we have what I call our external facing side. We do some research grants, we do some cutting edge research, we have four or five things going on right now that are fairly large scale implementation trials of either an interesting technology or a care model. We are doing something with social networking and Facebook in asthma for instance.

We are doing something with an ingestible biosensor that measures certain things, and whether that’s effective for changing behavior. We are doing some things with a medication adherence device that scans pills and tells you whether you took the right pill or if you filled the bin wrong, its a very, very smart device. So we do that work and it is either funded by research grants or by the companies themselves.

And then we have a consulting practice, particularly for early stage firms. But a variety of organizations hire us to help them to either get their products sorted out and determine how they fit in the marketplace or possibly to do a feasibility trial or a clinical trial. We sometimes help people with their business plan, we connect them with funders.

We aren’t an official incubator in that sense but we do a lot of those things. We also have a close associate who can help people sort out their investment strategies. So we do bleed over into the start up world. I tell people our mission is to accelerate the adoption of connected health and that can be by moving things forward in the commercial sector or it can be right here in our own delivery system.

How can connected medical devices reduce health care costs ? Have you seen some examples?

Well, I alluded to this in the very beginning, we have this hypothesis that our patients and consumers – people don’t have to be already sick to be part of this phenomenon – they are our biggest untapped resource. And the way that we believe that we’re going to fundamentally lower the cost of care or decrease the demand in an already overtaxed system is by offloading more and more of the responsibility on to individuals. And they will be happy to do it because who cares more about your health than you do?

The statistics that I like to throw out here are that 56% of the health care expenses in this country are labor. In the last, I want to say, ten years the economy in general has increased labor productivity by 1.8% whereas health care has fallen by 0.8% creating an almost three percentage point difference in the overall productivity of workers in our economy and what’s going on in health care.

So we really have an enormous opportunity to use our healthcare labor across more individuals and keep more individuals healthy, lowering the demand and lowering the cost. We think mobile health, and of course “connected health” our brand of mobile health, has that opportunity. It has to do with feedback loops, it has to do with just in time care. We are seeing it happen, and have great data in our own patient populations that’s showing this can happen and that’s the direction we are pushing everything we are doing.

Do you think capitated and global payment structures will help or hinder adoption of these technologies?

I would say it will be a boost because providers, when they really are capitated, will very quickly realize that their most precious resource is their brick and mortar and they simply don’t need to have everybody come in for every sore throat, flu shot, blood pressure check. We did all those things for years partly because we couldn’t think any differently but also probably because the cash register rings every time you go – that’s the only way the cash register rings. So you know if you get us out of that, where you are going to get paid a flat rate to take care of this population and the goal then is to sign up more people because the more people you sign up the more you get paid and yet be more efficient, this stuff will take off like a rocket.

It seems there is an mHealth conference somewhere every other week. What do you believe sets the mHealth Summit apart?

I think the that has to do really with the fact that there’s such a heavy emphasis on the NIH side. And that brings a different crowd to the table,. You have Health 2.0, which I know is not mobile meeting but there certainly is plenty of mobile technology present there. Health 2.0 is mostly about startup land. There is also the Wireless Life Science Alliance which is really more traditional pharma and device companies and how they are moving into wireless.

We run a meeting here, the Connected Health Symposium which is really about policy and psychology around growing the connected health market. I think the reason the mHealth Summit can attract thousands of people is because it attracts people from the foundation side, it attracts people from the public health side, and it attracts people from the various institutes at NIH. So it’s a different crowd and they are thinking about the problems differently. I am a big huge believer in the whole ecosystem and I am an equal opportunity networker. There are people here that I wouldn’t necessarily get to see at other meetings.

[Ed. In addition to his role at the Center for Connected Health, Dr. Kvedar is a past President and Board member of the American Telemedicine Association (ATA) and a Past Chair of the American Academy of Dermatology (AAD) Task Force on Telemedicine. In 2009, Dr. Kvedar was honored by the ATA with its Individual Leadership Award, recognizing his significant contributions to connected health and telemedicine. Mass High Tech, The Journal of New England Technology named Dr. Kvedar an All-Star in the field of healthcare. ]

[Ed. Note: This post will be part of an ongoing series on the efforts of the Johns Hopkins Internal Medicine program to go mobile. Given that Dr. Misra (iMedicalApps senior editor) is part of this effort, we will be able to share an honest, insider perspective that can help others learn from the Hopkins experience. Not only was this permitted by the Hopkins program leadership, it was embraced, and for that we are grateful. ]

Medical training is currently undergoing a dramatic change. Duty hour reforms, increasing financial and regulatory demands, and a healthcare system at the center of a political battle are among the extraordinary pressures being exerted on the traditional training model.

These pressures require that training programs at all levels – from medical school to the most sub-specialized fellowships – rethink how we do pretty much everything.

Recently, the Johns Hopkins Internal Medicine residency program distributed iPads to its housestaff as part of an effort to do just that. The aims of the program are quite broad – to increase the efficiency of in-hospital care, enhance clinical training of residents, improve patient-physician communication, and more.

The mobile platform is relatively young in terms of its utilization in healthcare and many of the potential applications, benefits, and pitfalls remain to be discovered. As this program continues to grow and evolve, iMedicalApps will continue to share the the insider perspective on the Hopkins experience as part of our shared desire to drive this process forward. In this first installment, we’ll start by addressing the question – why the iPad?

Why the iPad

There are many tablet’s out there that are similar, and in some ways, better than the iPad. In fact, Apple is in a legal dispute with Samsung because they claim the Galaxy tab is a repackaged iPad. And the question certainly came up – why not go with another tablet? Android is arguably a more malleable platform than iOS, many of the tablets are cheaper, and there are many more options.  We’ve had great debates on iMedicalApps in the past about this subject.

Here are a few reasons why we went with the iPad.

The iPad has a head start

When looking to launch a mobile platform, you have to consider your audience. And in any clinical practice, that will include a range of familiarity with consumer technologies, specifically in this case tablets. Among those that were already using tablets, all of them were using iPads. That simple detail confers a number of advantages.

First, with the iPad, we have a group of individuals who are already “embedded” within the our audience. So not only had their use of the device already piqued the interest of others, they also were engaged in this program from the beginning. After launch, these individuals can provide both formal and informal help to colleagues who are less familiar with the device and platform.

Second, in terms of program planning and development, we already had a wealth of experience due to using the iPad in our own institution. These early adopters had already problem-solved a number of issues, found some of the potential efficiencies to be gained, and even identified potential new applications and enhancements.

Third, the launch of the iPad program at the University of Chicago was certainly helpful as their program leadership was quite forthcoming with their own experiences.

The choice Android offers wasn’t all that helpful

Choice is a great thing for the average consumer, but not necessarily for an enterprise. In considering Android as an option, several issues arose that led us to conclude that the iPad was the best choice.  One of the main issues — choosing an Android device involves several extra steps.

First, we would likely order a few different devices, test them out, and then, for practical reasons, probably pick one device. Picking more than one would complicate everything from picking accessories to device management by the IT folks. And if were going to choose a single device in the end, then the value of choice for individual housestaff is ultimately lost anyways.

Another argument could be made that Android potentially offers cost-savings in comparison to the iPad. However, we determined early on that we didn’t need the 3G connectivity nor did we need the 32gb memory. Our application of the device is primarily for in-hospital use where WiFi connectivity is available – this makes the 16gb WiFi iPad the natural choice and very competitive in terms of pricing, roughly $500.00.

What about apps?

Apps are a big part of success of any mobile platform. We’ve talked before about how their absence in the Blackberry and Windows environments are an Achille’s heel for those platforms. However, the difference between iPad and Android apps did not end up being a significant factor in the selection of the iPad as our platform of choice.

Perhaps it was the sense of parity between iPad and Android, given that most major apps are available on both. Additionally, the issue of app compatibility across different Android devices was less of a concern since we would most likely only be dealing with one Android device anyways.

These reasons, among others, were major drivers in our selection of the iPad as the platform of choice in our efforts to go mobile. Please share your thoughts and experiences below as we’d love to hear and learn from other efforts.