When Apple’s retail stores reopened yesterday at 5pm, they had a shiny new item sitting on their shelves – the iPad 3G.  At iMedicalApps, we’ve certainly been excited about the iPad, not only because its a great device that could work for clinicians, but also because it is hopefully just the leading edge of a new generation of tablets that will finally free healthcare providers from paper charts and computer stations.

For the most part, the 3G iPad is no different than the non-3G iPad in terms of hardware. So the question is, is the 3G premium worth it? With going rates of $630 for the 16GB device, up to $830GB for the 64GB device, it definitely carries a substantial premium over its non-3G sibling. In addition, the unlimited data plan from AT&T will run another $30/month. My first impression – not yet, but it will be. Here’s why.

Reason 1: Electronic Health Records

The greatest promise of the iPad and the coming generation of healthcare tablets is putting the electronic health record – patient records, decision support tools, safety stops, billing, etc – in the hands of healthcare providers at all times. As healthcare evolves to respond to our current challenges, the flexibility to put tools into the hands of clinicians will be crucial. At Johns Hopkins, my home institution, the Elder House Call Program is an excellent example of an innovative response to a patient-care challenge that would benefit from a 3G enabled device like the iPad. The gist of this program is that a team of physicians, nurses, and other professionals provide in-home care to elderly patients who lack the mobility to get such care on their own. A similar program exists in Pediatrics here.

From some of my peers who have participated this program, it is an incredible experience, an opportunity to provide care for the person rather than the disease. A 3G iPad here could enrich the encounter in so many ways – videos uploaded by PT to the EHR to document mobility one week, reviewed by the physician who visits the next week ; access to online patient education modules for teaching patients about whatever topic comes up ;  the ability to actually review radiology and labs face-to-face ;  and so much more. There are similar opportunities in many other areas – rural/remote care, care of indigent populations, and so on. In addition, if healthcare peripherals are developed for the iPad (blood pressure cuffs, weight scales, maybe even portable ultrasound), the opportunities to provide care anywhere/anytime get bigger.

So why not yet? The reason is simple – electronic health record platforms out there are still maturing and building the capabilities that would allow them to take advantage of truly mobile healthcare. Some of the more rigid, cumbersome systems will take some time. More flexible systems with a “plug-in” based infrastructure, as Dr. Wodajo described previously, may be ready sooner. But the fact is that current EHR’s are designed for hospitals and clinics with workstations. But they are certainly on their way to embracing mobile healthcare.

Reason 2: High-Powered Apps

Apps are another cornerstone of mobile healthcare, as evidenced by the success of the iPhone in healthcare. The ability for developers and clinicians to fill niche requirements quickly with a targeted app has turned the iPhone into the “peripheral brain” of many clinicians, putting incredible amounts of information at their fingertips. And many developers are embracing the mission of evidence-based healthcare, trying to put decision-support tools and practice guidelines into the hands of clinicians. Take the app CORE – Clinical ORthopedic Exam – from Clinically Relevant Technologies. This app provides instruction on common physical exam techniques, including sensitivity/specificity and follow-up testing information. Videos of the techniques are linked in the app but stored on YouTube.

Any comprehensive resource that includes lots of videos compromises device memory if stored locally, so many developers opt to store on a platform like YouTube. This also allows them to readily add to that database of video as needs arise. As cloud storage of content in these high-powered apps is likely to grow, having a 3G-enabled tablet lowers the oft-cited disadvantage of such storage. Take a patient education app that includes lots of videos, like Blausen Human Atlas (above). In our home-visit scenario, I can now access high-resolution video that helps me explain a cholecystectomy to the elderly woman who I think has gall stones. And as the needs arises, developers can augment these resources without worry about compromising device memory.

So why not yet? Frankly, the iPad app store isn’t there yet. Many apps which we think would be perfect for the iPad are not yet available in iPad optimized forms, and therefore resolution is poor when trying to use the iPad. But they are coming.

So in the end, 3G will be a big plus for the iPad some day soon. But its not quite there yet.