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.

One member of the healthcare tablet family is Motion Computing and it’s tablet, the C5. The C5 has many things that a physician, nurse, pharmacist, and many other healthcare providers would want. First and foremost, its a rugged piece of equipment. It’s designed to be capable for taking a hit on the floor or being cleaned with disinfectants. If you’ve seen the sheer number of hand sanitizer dispensers in a hospital, you know how important that latter capability is. It also has a barcode scanner and RFID reader. This feature would be incredibly helpful for nurses who need to verify patient identity before dispensing a medication or confirm a medication they are about to administer is the correct one. In addition, it has built-in microphone and camera, the latter of which would be very helpful in areas such as wound management or patient identification. As for the microphone, if the Speak Anywhere technology is as good as Motion Computing claims, it would allow physicians to dictate patient notes without a peripheral microphone (though I suspect its not that good). Also, these machines are  Windows and stylus based. While this isn’t necessarily a functional strength, it does reduce some short-term barriers to adoption by increasing the likelihood of compatibility with established EMR’s. And if you’re going to be working with patient information in a HIPAA world, security is crucial. That’s why data security solutions for tablets like the C5, specifically those using Intel processors, are another crucial advantage that established vendors like Motion Computing have.

All of that being said, there is certainly a reason tablets like the C5 have not achieved widespread adoption already. For example, the C5 weighs in at over 3lbs, not that heavy, but more than twice as much as the 1.5lb iPad. In addition, it’s battery life is pretty weak in comparison with the iPad, 4 hours vs. 10 hours (per manufacturers reports).  To me – this means I’d have to lug the C5 around all day, stopping probably twice on the average day to charge up. And while the fact that it can run Windows 7 is key for compatibility and widespread adoption, there is a reason the iPhone has been so incredibly successful. Its user-interface and enormous developer community make it a far more versatile and easier to use medium than a Windows-based product can be. Finally, the $2,000+ price tag on the C5 makes it a large investment for even a suburban dermatology practice, let alone cash-strapped hospitals and private primary care practices.

So is the healthcare tablet market ripe for an iPad sweep or do the entrenched players already have the market cornered? Frankly, I can’t predict the future. On the one hand, the C5 has most of the features I’d want in a tablet. However, it also has a few things I don’t want, especially an eye-popping price-tag. And while the iPad really wallops the C5 on those weaknesses, it doesn’t come close to approaching its strengths. Honestly, I don’t think either tablet really fits the bill for what healthcare needs. But I’m excited Apple has entered this market, not because I think the iPad will become the dominant tablet, but because I want to see this fight. Apple’s record of innovation are likely to spur unprecedented competition in the healthcare tablet arena – and that kind of competition is almost always good for the consumer.

Related Posts:

1. Five Lessons Apple must learn from current Healthcare Tablets if the Apple Tablet (iPad) is to Succeed in the Medical Industry
2. How the Apple Tablet (iPad) Could Transform the Way Patients Experience Healthcare
3. New iPad Demographics Suggest the Medical iPad Could Be An Easier Sell to Healthcare Providers

With Apple’s soon to be released iPad re-energizing the tablet market, there has been much speculation on how the tablet will transform personal computing.  However, the tablet has been with us for quite some time. Almost a decade ago, I started testing and using Windows-based Tablet PCs for two cancer centers in Canada. They worked pretty well for what we were trying to do back then, but had definite limitations within the healthcare environment. If Apple’s iPad is to survive in healthcare, let alone transform it, then there are five key deficits Apple must address.

1) Input Method(s) and User Interface

This is the most crucial area and where the most problems arise.  For the tablet to be accepted by the healthcare community, versatility is the key. The basic input methods such as a touch screen (or pen based), keyboard (or lack of keyboard) and handwriting recognition accuracy need to be revamped and revolutionized. True, all of these features exist in today’s tablets, but they have yet to be implemented in the most effective and user friendly method.

In order to be transformative, the iPad will need to include inputs that consider the workflows and usages in healthcare. For example, consider input methods such as voice recognition and audio input (think transcription and also patient voice recording), photo/video capabilities (think user recognition, but also photos for wound care or tracking skin infections), and even the option for additional “medical stuff”, presumably through accessory hardware such as measurement of temperature or blood pressure. Such considerations would allow the iPad to be integrated in the clinical field in ways previous tablets were not.  A further discussion of the robust user interface the Apple Tablet operating system could bring was discussed in a previous post.

2) Look and Feel

For the most part, tablets used in the medical world have been too heavy and are often not built with enough toughness.  It might seem frivolous, but there are good reasons why a tablet has to look and feel right in a healthcare setting. Prior to computers, patients had the undivided attention of their physicians.  Now, with the advent of mobile computing and tablets,  a consistent complaint from patients is the lack of eye contact physicians make because of the computer screen they are staring at.  This is why the weight, look, and feel of a tablet is so key in the health care setting.  The more comfortable a physician is with their tablet, the less time they spend dividing their attention between the patient and the computer, allowing for a more seamless patient-physician interaction.

3) Battery Capacity

The battery on a typical tablet used in the health care setting needs to last long enough to get through an entire shift, which can be anywhere from 8 to 12 hours. Currently there are health care tablets available that can get close to 12 hours, but with repeated use this number significantly declines.

The battery issue might be the most interesting issue the health care community might have to consider with the Apple Tablet.  Apple is notorious for having non-removable batteries in their products.  The iPhone, iPod Touch, and even the newest MacBooks do not have removable batteries.  Apple claims they use high end batteries that lose capacity much slower than their competitors, this was their reasoning when they took out removable batteries from the latest Macbook.  If Apple decides not to include a removable battery in their tablet, it could be a huge blow in their efforts to be embraced by the healthcare community.

4) Privacy and Security

One of the great features healthcare tablets offer is their portability, but this same portability makes them targets for theft.  General physical security needs to be built into the device.  Also, software and hardware based privacy and security measures need to be options in healthcare tablets as well. Currently no manufacturer has yet to master these in full. Without getting overly technical, some examples include user recognition (e.g. finger print, retina, face, voice), patient verification, data encryption over wireless connections, remote data storage, and auto-log off features. In a HIPAA-dominated healthcare world, these features will be critical to widespread adoption.

5) Cost

Cost is always a central issue in health care.  But today’s healthcare tablet’s are generally priced greater than most high end notebooks, which works in Apple’s favor.  Current projections have the Apple tablet hitting the $1,000 price point.  If this is true, the healthcare industry might actually find using the Apple Tablet is a cost saving proposition, which usually isn’t the case when Apple products are in play. However, it will also be important to consider emerging competitors who may price lower than Apple, with some reports suggesting prices as low as $200.

If some of these issues are addressed on Wednesday, Apple might actually be a legitimate player in the healthcare tablet arena.  I’ll report back later this week to let you know.

Iltifat Husain and Satish Misra contributed to this post

Related Posts:

1. Apple iPad: Promising Features For Healthcare Use and Medical Education
2. Apple Tablet Will Succeed in the Medical Community Because of Operating System, Not on Form Factor Alone
3. How the iPhone has paved the way for a quicker transition by the Healthcare industry to an Apple OS Tablet

As the debut of the iPad fast approaches, speculation about it is reaching a fevered pitch. Scanning the thousands of articles written about the iPad’s potential, one may walk away thinking that Steve Jobs has just cured cancer, ended global warming, and established peace in the Middle East. Some people are even calling Apple’s latest creation the “Jesus tablet.” While the iPad probably falls somewhere short of some of those lofty projections, it has already done what Apple seems to do best – transformed the way we look at an existing market, in this case mobile computing and the tablet. We’ve talked previously about how the iPhone paved the way for the iPad in healthcare. Again, Apple’s entry into this market has signaled a huge shift in the way users will interact with the tablet and, through it, their environment.  This new user interface has a great deal of potential to change the way physicians deliver care. But perhaps more importantly, it could also have profound impacts on the way patients experience healthcare.

Innovative therapies

Over the past decade, there have been a number of examples of novel technologies being used either therapeutically for sick patients or in preventative care. For example, there have been numerous trials, with more success in the pediatric population, that use text messaging to remind patients to take their medications. When the iPhone transformed the user interface for the smartphone, therapies centered on that platform also emerged – autism and major depression are two conditions with iPhone apps that are therapeutic in nature. Enter the iPad. With a more advanced touchscreen, a high-quality webcam, and perhaps even 3d graphics, the possibilities become far more rich.

Take children with cancer – these kids can be hospitalized for weeks at a time and, due to the chemotherapy, stuck largely in isolation for most of that time. An app that utilizes the webcam to connect kids while playing a fun and interactive game together would provide a far richer interaction than a networked gaming console. Or consider the numerous elderly patients who succumb to delirium while in the hospital largely because, on top of being sick, life in the hospital, void of sunlight and normal sleep-wake patterns, gets so disorienting. Consider an app that, much like the mentally challenging games on the Nintendo DS, helps older patients stay a little more active during the day and perhaps ward of delirium. Will the iPad cure cancer or, for that matter, anything? No. But what it will do is provide some interesting and creative adjuncts to standard therapy that could make the patient’s quality of life a little better.

Improved patient-provider communication

In the ever growing iPhone app store, educational apps are among the most numerous. One of the biggest reasons why is because the interface allows user to interact with the material in a number of different ways. Take the Blausen Human Atlas or Pocket Heart – both of these apps allow the user to interact with anatomy in an incredibly rich way. With much more powerful graphics capabilities, these kinds of apps can certainly be taken to another level.

Consider a patient going into surgery. Today, explanation of the surgery is restricted to some form of charades by the surgeon and 2d radiology images. An app that allows 3d reconstructions of a patient’s scans to be pulled onto the iPad and manipulated would allow for a far better explanation, improving patient-physician communication. Or how about the diabetic patients or the heart failure patients? These poor folks are often subjected to hours of mind-numbing “educational” videos in the hospital – iPad apps could bring an element of interactivity that allows patients to engage with material that is critical to their health. Finally, consider the stroke patient. There are rumors that the iPad’s camera will be sufficiently sensitive to allow facial recognition. Perhaps then it could also be used to detect facial, or for that matter limb and trunk, motion with apps designed for post-stroke rehabilitation therapy. In a “game” format, individual goals outside of professional physical therapy could help empower the patient as they fight to recover.

The key opportunity that the iPad offers here is not just another platform to convey information, but a way to make it fun and engaging. While the iPad won’t replace a good physician taking the time to talk to a patient, it could certainly augment the patient-provider relationship in a fun and engaging way.

These are just a few ways that the iPad could transform the way a patient understands their illness and interacts with their healthcare providers. Among the most elusive goals in medicine is helping patients understand complex diseases and empower them to manage these conditions. Nothing will ever replace a strong patient-provider relationship, a personal support network, and evidence-based therapies based on a thorough scientific foundation. But the iPad could herald the introduction of innovative adjuncts that help patients take control of their own health and improve their quality of life.

No related posts.

The rumor mill keeps on churning with the soon to be released Apple Tablet, and now the medical community is supposedly involved.  According to an article by VentureBeat, Apple Reps have been talking to the Los Angeles Cedars – Sinai Medical Center about the potential of an Apple Tablet for medical professionals.

The article goes on to mention one of the reasons why tablets haven’t been universally embraced by medical professionals:

We’ve been told for years that medical professionals were the guaranteed-to-succeed market for tablets. Bill Gates raved about his in 2006. But tablets like the Dell Latitude XT2 XFR, pictured above, have stiffed again and again, in part because of their ungainly laptop-with-a-backwards-facing-display design.

I’ve mentioned in a previous post why the Apple Table could be a huge success in the medical industry, and it’s not because of form factor.  I can’t emphasize this enough.  There is this idea in the tech community that bulky tablets are why you don’t see medical providers using tablets for electronic medical records.  This couldn’t be further from the truth.  In my previous post I talk about how the User Interface of potential Electronic Medical Records in a native Operating System made by Apple would be one of the keys to success.

A nice looking tablet PC for medical professionals is already available.  The Motion C5 is viewed as a great Tablet for medical professionals, it’s a clipboard like computer that has an RFID reader, photo capability, and other nice features.  Basically, its a slim tablet with a nice form factor.

One of the largest barriers holding back medical tablet PC’s are the hundreds of iterations of Electronic Medical Records(EMR) that are too complicated and not easy to use.  The User Interface and workflow on the EMR software is certainly functional, but not fun to use.  One would think an EMR program that has the Apple touch would be significantly more aesthetically pleasing, easy to use, and functional at the same time.  All qualities Apple is famous for.

I doubt Apple is going to be designing these EMR programs, but at the same time, we’ve seen how controlling Apple is about software running on its devices (think App Store).  I wouldn’t be surprised if Apple leveraged their hardware to force EMR companies to design better software in tune with Apple’s core principals. Surprisingly, Apple’s desire for control might actually help with the progression of electronic medical records. In the upcoming weeks this is a topic we’ll discuss in detail to a greater length.

Related Posts:

1. Five Lessons Apple must learn from current Healthcare Tablets if the Apple Tablet (iPad) is to Succeed in the Medical Industry
2. How the iPhone has paved the way for a quicker transition by the Healthcare industry to an Apple OS Tablet
3. Apple iPad: Promising Features For Healthcare Use and Medical Education

Rumors of an Apple tablet have been all over the place during the past few weeks. Although Apple is notorious for pulling off clandestine product launches, the consensus appears to be that Apple will launch a tablet early next year. With the $19 billion dollars from the stimulus package set aside exclusively for electronic medical records, it would make business sense for Apple to venture into making tablets that can be used for electronic medical records. So then hypothetically, if we get an Apple tablet in 2010, will it really be used by the healthcare world? Everyone seems to be talking about how great an Apple tablet would be for the medical community, but few are talking about if it would actually be used.

In almost every keynote related to the iPhone, Apple has embraced the medical community and set aside time to show how its platform can be used in healthcare. The same can’t be said for other mobile technologies, such as Windows Mobile and the current reincarnation of Palm. Palm was a leader in portable medical technology and their old PDA’s continue to be used by healthcare providers. Their fall in the medical tech world can largely be attributed to their history of lackluster phones. The current Palm-Pre, a beautiful device, leaves much to be desired from when it comes to medical technology. There was a recent study stating six out of ten doctors prefer iPhones. Although this wasn’t a super-scientific survey, we’ve all seen a huge increase in the doctors and providers using the iPhone in the clinic.

This preference for the iPhone is largely due to it’s beautiful UI and ease of use. I’ve had plenty of colleagues pick up my iPhone and intuitively use the medical applications I have. Quite literally, the iPhone makes the medical technology experience fun again. This experience isn’t exclusive to the iPhone, but also with the iPod Touch. Both devices are great to hold and look at, but it’s not the hardware that makes the device exciting, it’s the software. This experience gives the iPhone a great brand name in the medical community, even to those who don’t use the phone.

I think the brand name and the fun experience the current iPhone operating system provides will be the key to the tablet’s success. Using electronic medical records definitely saves me time, but the different platforms I’ve used can be cumbersome and sometimes I feel like I’m using a program developed for Windows 3.0. Overall, it’s an efficient experience, but not a fun one. Can you imagine selling a electronic medical record to a physician who has exclusively used Windows operating systems? If they don’t like change, as many physicians are notorious for, this would be a difficult task. In the medical community the iPhone is associated with fun and innovation, two things that will get physicians like the one I mentioned excited about change. The iPhone’s Operating System has bridged the gap between PC and Apple, and it’s going to be interesting to see how the tablet will be used once the stimulus money really gets rolling in 2010. I’ll venture to guess the tablet will actually help with the implementation of electronic medical records because of the excitement it’ll bring.

Related Posts:

1. Five Lessons Apple must learn from current Healthcare Tablets if the Apple Tablet (iPad) is to Succeed in the Medical Industry
2. Apple Tablet Will Succeed in the Medical Community Because of Operating System, Not on Form Factor Alone
3. Windows Phone 7 could challenge iPhone in medical arena and offer unique streamline functionality in healthcare