Why the iPad is a revolution in healthcare: It’s the first proper screen Doctors took to work

FierceHealthIT Editor Ken Terry reports on how the “Rise in physician tablet use means less than meets the eye” dampening enthusiasm over reports from Sara Jackson at FierceMobileHealthcare that 62% of physicians are using tablet computers – an increase of 100% over last year – and claims from Monique Levy, Director of Research for Manhattan Research, to eWeek that “all physicians will eventually adopt these gadgets”.

That would certainly affect healthcare, but perhaps not as much as one might expect… …For one thing, only half of the current tablet owners have ever used them at the point of care. That’s still a lot of physicians, but they’re mostly using their iPads to read medical news, access drug information and e-prescribe. In other words, they’re doing the same stuff they used to do on PDAs and smartphones, only on a larger screen

To me this is nonsense. It’s much like saying I’m doing the same stuff in a car that I used to do on a train. While I suppose you could argue that it’s all just travelling it’s quite clear that the experience is very different and the end user focus is a magnitude higher when a tool is so much more personal.

Referring to mobile devices as a “gadget” (something often regarded as a novelty) is a mistake and is not appreciating that for most clinicians this device is now much more important than a stethoscope (something that I suppose was also thought of as little more than a gadget albeit back in the early 1800’s). Even the rise of something simple like digital books should make this obvious (the worlds best Doctors and Medical Schools are already buying their textbooks in digital format for their tablets and smartphones).

A smaller number of physicians are using tablets to view the information in electronic health records. The relative lack of uptake in this area reflects the fact that most EHRs are not designed for use on mobile devices. Of the major EHR vendors, only Allscripts has so far released an iPad-native application, although eClinicalWorks is expected to come out with one this summer. Epic is also said to be working on an iPad-native version but has not made any announcements

Isn’t this how adoption always works? By chance I met with Epic staff at eHealth Week in Copenhagen only last week and let me assure you it might not be launched publicly but they already have an iPad native version of their software.

The EHR incompatibility problem is compounded when physicians want to enter patient data. First, it is difficult to type on the iPad’s onscreen keyboard. Second, some hospitals connect iPads to their systems via Citrix. Since that thin client application is designed for Windows, Citrix makes it hard for Apple OS users to navigate EHRs

I wonder if Ken is aware that most Microsoft applications are already available on the App Store for iPad? That a large chunk Apple MacBook and iMac customers are using Microsoft software on their devices?

A December, 2011 Kaiser Health News and NPR article examines the situation at the University of California San Diego Health System (UCSD), which has received a HIMSS Analytics Stage 7 award for its advanced use of health IT. IPad use is widespread at UCSD, but only about 10 percent of the medical staff utilizes iPads in patient care

ONLY 10% of medical staff? The iPad ONLY launched in April 2010! Is there something else that got 10% adoption levels by medical professionals for patient care within 2 years of it’s announcement as a consumer product and availability to the public?

Besides encountering the problems described above, UCSD physicians find it difficult to carry iPads around with them, since they don’t fit in lab coat pockets

There’s already a solution (the Airstrap Med case from Griffin Technology) to this that’s being used by medical staff in several major hospital iPad deployments:

Also, they point out, wireless communication in the hospital is spotty, according to the Kaiser story

In-building network issues aren’t unique to hospitals. If your IT director can’t get a reliable WiFi network up in your hospital get a new IT Director.

“Are you ever more than four feet away from a computer in the hospital? Nope. So how is the tablet useful?” one hospitalist said

I take it the hospitalist being quoted here isn’t doing much bedside work, but really isn’t the obvious question why has your hospital got such blanket (every 8ft) computer coverage? Is it still necessary? Is there a better/cheaper/more effective and reliable way to meet your computing needs?

Of course, physicians’ attitudes toward using tablets in patient care could change if a technological breakthrough makes it easier to enter data. Such a breakthrough might come in the field of natural language processing (NLP)

OR patient entered data? Touch screen devices are now so user friendly they’re opening up huge new opportunities for patients to interact with Healthcare IT systems.

More and more vendors are already imbedding NLP in their EHRs for various purposes. If these applications ever get good enough to parse dictation and put medical terms in the correct EHR fields automatically, tablets might become indispensable to physicians

Change “If” to “when” and “might” to “will” and this makes perfect sense to me.

In the meantime, however, physicians are likely to remain skeptical about the clinical potential of tablets

Let me show that physician my 7in Galaxy Tablet containing a comprehensive up to date medical library and I imagine she’ll change her mind quite quicker than it would take to walk to the library.

In a recent Spyglass survey, 80 percent of doctors said they thought iPads had an “exciting future” in healthcare, but most doubted they were ready for clinical use

Our response to the new and unfamiliar is unchanged. Most people shown the iPad in 2010 doubted the need for it. A major analyst firm was forecasting that the enterprise netbook market was hot.

So what does the big rise in physician tablet use mean? It indicates that these devices are very popular, especially among highly educated professionals such as doctors. It does not mean that their healthcare potential will be realized anytime soon

Ken has been writing about health information technology for more than 15 years which makes it almost inconceivable that he hasn’t noticed the incredible expense, loss of productivity and wasted resources that Healthcare businesses have encountered as a result of the need to train clinicians on the use of IT.

Fast forward to 2012 and Doctors are bringing their OWN screens to work. They already know how to use them, they pay for them out of their own pocket, learn to use them in their own time and they’re now expecting to find at least the same standards of usability, design and effectiveness in the systems they use at work.

I’ve trained to use NLP (I’m writing this post using it) and even I can see that unfortunately it’s not going to be through training days that we get the majority of Doctors using it. It will because they’re using it first on their mobiles, initially doing boring things like finding locations (via Google Maps) or replying to a text message while driving the car to work.

Revolution? Call it what you like but it’s a step change from the past and many of the worlds leading care providers (eg Ottawa Hospitals which has already deployed more than 3000 devices) already know this.

About David Doherty

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2 Responses to Why the iPad is a revolution in healthcare: It’s the first proper screen Doctors took to work

  1. Pingback: ICMCC News Page » Why the iPad is a revolution in healthcare: It’s the first proper screen Doctors took to work

  2. Vinod says:

    As the number of moineortd sensors increase, I envision some sort of PHR dashboard that selects and presents the data in the most understandable form. Accelerometers will measure activity and sleep patterns. Home environmental sensors will monitor when doors (refrigerator, shower, front door) open. Wearables will track pulse, temp and other vitals. Standards will be needed to allow for interoperability. Eventually (10-15 years), we may see real time recording of everything you see and hear with the ability to recall and project it on heads-up displays, like Google’s new ski visors. But it’s more about understanding market needs, because this vision was described at least 10 years ago and still is not here.An important driver/enabler is the health gateway, which sits between sensor devices and remote services. It’s likely to be a smartphone or tablet, with the smartphone offering greater mobility.

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