Updated! This post has been updated below to include comments from the folks at Epocrates

The excitement and hype surrounding the announcement of Apple’s iPad have subsided for the time being, perhaps just a lull prior to the actual release in a few months. Here at iMedicalApps, we were certainly among the many believers and expected that the iPad could make significant contributions to healthcare, such as potentially replacing the physician’s clipboard or medical textbooks.

However, we did disagree at times on the extent to which the iPad could penetrate the healthcare market, for a variety of reasons. The folks over at Software Advice decided to try to get a feel for what the community at large was thinking through an interesting survey they performed. And for Apple, the results of this survey aren’t encouraging – if you believe the results.

Having spent nearly four years learning how to read medical literature, I decided to try to get a better sense of just how valid these results are especially considering the seemingly conflicting results of the Epocrates survey. Chris Thorman, who authored the article on the survey, was kind enough to correspond with me on details of the survey methodology. Here’s a look at the results and our take on what they really mean.

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The first app I downloaded on my iPhone was Epocrates. I didn’t think twice about it, and in a way I assumed it was my obligation to do so before I saw patients in the hospital.  Such high regard for this medical app elicits thoughts of a deep history, but it really burst onto the scene in the late 90s on the classic palm PDA platform.  Epocrates quickly gained market share because it offered key functions for free, unlike its competitors.  This tactic of offering some functionality for free has not changed over the years.

Unlike its arrival to the Palm PDA platform, Epocrates is considered the first medical application for the iPhone and iPod Touch platforms.  The free version of the application is one of the most heavily downloaded medical apps in the App Store.

There are four different versions of Epocrates you can have on your iPhone or iPod Touch.  Each version offers different features and subscription fees.  The default application in the App Store is free, but in order to get the premium versions you can upgrade either online or through the app.

• Epocrates Rx (Free)
• Epocrates Rx Pro ($99 per year)
• Epocrates Essentials ($159 per year)
• Epocrates Essentials Deluxe ($199 per year)

In this article, I’ll review Epocrates – Essentials, the second premium level offered, and also go through the key features offered in each level of subscription.  This is the largest medical app we’ve reviewed to date, content wise – so there will be lots of pictures!

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When I was handed my first pager, I was stunned. It looked like the beeper that Will Smith used to flash on the Fresh Prince of Bel Air (and not even the later seasons, I’m talking about the early, crazy outfit seasons!). So I asked why I couldn’t simply use my phone or, for that matter, why we didn’t all use phones. The answer was simple – reliability. The paging system, of which this rather archaic looking item was part, was very reliable. But was that enough? No. The hospital also maintains it overhead paging system just in case. And if that goes down – yep, there’s a back up there too. In health information technology, reliability is everything. And for the iPad, that could prove to be a major barrier to adoption in the medical community as it faces off with other medical tablets, at least if the FCC’s recently voiced concerns prove to be true.

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When I first entered the clinical world, physician order entry and electronic medical records were just concepts to me. As I learned how to navigate the hospital, diagnose everything from the mundane to the incredibly rare (my first patient was a baby with an idiopathic subdural venous thrombosis), and figure out how to treat the sick, I also had to learn how to use those two systems as a prerequisite to doing everything else. The four hours of class didn’t seem to cut it, so I probably spent at least a month trying to get my bearings on how to manage these IT systems. So for anyone who is already familiar with some form of healthcare technology, in this case a tablet, I suspect the adoption cost is far higher than just the price tag. You may be surprised how highly some medical students and residents weigh the notion of learning a new system in their career decisions. And because of what seems to be a particularly high barrier to adopting new information technology in healthcare, anyone interested in whether the iPad will succeed in healthcare should first ask who the competition is.

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Having had the opportunity to visit nearly a dozen academic medical centers in the past few weeks, I saw quite the spectrum of IT systems – from simple order entry to fully-integrated decision support systems. And for programs with the former, that revelation was quickly followed by the timeline for the coming upgrade. But what’s next for the most IT-savvy institutions? Well, Steve Jobs thinks he has an answer. Rumors abound that Apple is already pitching the iPad in LA-area hospitals as the replacement for the old physician clipboard. For outpatient practices already running a Mac-based EMR, MacPractice has already announced development plans for an iPad interface. According to their press release, they plan to develop apps that will allow patients to fill out registration, medical history, and other forms on the iPad. For physicians, it will integrate with the MacPractice EMR to manage schedules, view patient records, and even enter clinical notes. So could the iPad become the new best friend of healthcare providers? Well, there are a few challenges that need to be overcome first but the opportunities are exciting.

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