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As medicine goes digital, Apple's iPad is top choice among doctors - Page 2

post #41 of 79
My doc's group practice made the change to Apple-based practice management software this year. Using more MacBook Airs than iPads, though.
post #42 of 79
Quote:
Originally Posted by MacBook Pro View Post


I will respectfully disagree with the statement "HiTECH Act's Meaningful Use requirements have only served to stifle innovation, consume vendor resources away from usability and towards govt requirements, and to strengthen large enterprise vendors in favor of smaller startups."
  • I have consulted on the design of clinical information systems for major medical device vendors. There is absolutely nothing in HIPAA or HITECH that we wouldn't or shouldn't have designed or developed in the product even without rules and regulations. In fact, the requirements of HIPAA and HITECH are laughable compared to our design constraints.
  • The consideration and effort dedicated to the user experience in clinical information systems is criminal with or without HIPAA and HITECH.
  • Although many healthcare enterprises still do not have electronic medical records, the market is fairly mature so startups have difficulty penetrating the already saturated market especially when "no one ever got fired for buying [major medical device vendor]."

FDA is a different story though.

The major issue is architecture. The major medical systems vendors developed systems more than a decade ago in many instances. In many instances these systems haven't withstood the test of time. The technology available to medical device vendors today is simply amazing compared to the absolute garbage that was rushed out the door in a race for market share a decade ago.

 

We are coming from different sides of the equation, so I can see how our view points differ.  I've directly asked vendors: 1) why no native mobile app, 2) why no mobile designed interface (via browser), 3) why not improve usability?  

 

The response I got from 3 different vendors (including practice fusion and McKesson) was that they have pulled too many resources to get MU/CCHIT certified, so the above issues have taken a back burner.

 

Could those companies be lazy and just shifting blame? Perhaps, but I'm not an IT or policy expert. I'm just a geek doctor that thinks almost all EHR products out there are garbage compared to software being used in non-medical fields. 

 

At the risk of getting too politcal, Judy Faulker has been a large campaign doner of the Obama adminstration and has sat in on high level goverment Health IT commitees. Her company has profited immensly from this.  

 

Part of the the ACA combined with HiTECH was the creation of the ACO (Accountable Care Organization). The foundation of this is that coordinated care (mainly through advanced health IT) would lead to shared savings and better outcomes. Because of this, hospitals are merging, buying up practices, and forming massive conglomerates.  These health systems strongly favor a universal Health IT/EHR vendor to supply all of the outpatient and inpatient services under their umbrella. Is this a ripe opportunity for large corporate EHR vendors like Epic or an opportunity for small startups like DrChrono? You be the guess.

 

Prior to the ACA and HiTECH, the private medical practice and private hospital was the norm, in which case a smaller vendor was looked at more favorably.  A hospital owned group, in contrast, has no option to pick their own EHR vendor, they are forced to use what their corporate entity uses. I should know, I work for a hospital owned group.

 

I like DrChrono, and I think as a startup they are flexible and innovative. But 30 to 40% of most medical data is on Epic, with the Dept of Defense eyeing them as well. All I see are entrenched players getting more entrenched. There is no clear opportunity for disruption, unless a significant number of practices break off (out of frustration for 3rd party payers) and form direct pay practices looking for a smaller, cheaper EHR for their needs.

 

<off my soapbox>


Edited by SiMBa37 - 5/31/13 at 2:19pm
post #43 of 79
Quote:
Originally Posted by SiMBa37 View Post

We are coming from different sides of the equation, so I can see how our view points differ.  I've directly asked vendors: 1) why no native mobile app, 2) why no mobile designed interface (via browser), 3) why not improve usability?  

The response I got from 3 different vendors (including practice fusion and McKesson) was that they have pulled too many resources to get MU/CCHIT certified, so the above issues have taken a back burner.

Could those companies be lazy and just shifting blame? Perhaps, but I'm not an IT or policy expert. I'm just a geek doctor that thinks almost all EHR products out there are garbage compared to software being used in non-medical fields. 

At the risk of getting too politcal, Judy Faulker has been a large campaign doner of the Obama adminstration and has sat in on high level goverment Health IT commitees. Her company has profited immensly from this.  

Part of the the ACA combined with HiTECH was the creation of the ACO (Accountable Care Organization). The foundation of this is that coordinated care (mainly through advanced health IT) would lead to shared savings and better outcomes. Because of this, hospitals are merging, buying up practices, and forming massive conglomerates.  These health systems strongly favor a universal Health IT/EHR vendor to supply all of the outpatient and inpatient services under their umbrella. Is this a ripe opportunity for large corporate EHR vendors like Epic or an opportunity for small startups like DrChrono? You be the guess.

Prior to the ACA and HiTECH, the private medical practice and private hospital was the norm, in which case a smaller vendor was looked at more favorably.  A hospital owned group, in contrast, has no option to pick their own EHR vendor, they are forced to use what their corporate entity uses. I should know, I work for a hospital owned group.

I like DrChrono, and I think as a startup they are flexible and innovative. But 30 to 40% of most medical data is on Epic, with the Dept of Defense eyeing them as well. All I see are entrenched players getting more entrenched. There is no clear opportunity for disruption, unless a significant number of practices break off (out of frustration for 3rd party payers) and form direct pay practices looking for a smaller, cheaper EHR for their needs.


I have difficulty believing that Epic has 40% market share of the EMR market. I have seen no data to support this conclusion. I have seen data that suggests that (as of October 2011):
  • AllScripts has 15,8% market share
  • Epic has 14.93% market share
  • eClinicalWorks has 11% market share
  • GE has 9.19% market share
  • Cerner has 7.39% market share

Epic began as a startup and has thrived without any outside investors. This is the very essence of entrepreneurialism.


  • Do you believe we need to constrain healthcare costs?
  • Do you believe that electronic data interchange can improve patient care and constrain costs?
  • Do you believe there should be public funding for implementing electronic data interchange?
  • Do you believe there should be requirements to receive public funding for implementing electronic data interchange?
  • Do you believe the economy would be "better" if healthcare costs weren't constrained and public funding not used as a catalyst to constrain healthcare costs?

Edited by MacBook Pro - 5/31/13 at 2:51pm
post #44 of 79
Quote:
Originally Posted by MacBook Pro View Post


I have difficulty believing that Epic has 40% market share of the EMR market. I have seen no data to support this conclusion. I have seen data that suggests that (as of October 2011):
  • AllScripts has 15,8% market share
  • Epic has 14.93% market share
  • eClinicalWorks has 11% market share
  • GE has 9.19% market share
  • Cerner has 7.39% market share

Epic began as a startup and has thrived without any outside investors. This is the very essence of entrepreneurialism.

Ask and you shall recieve:

 

http://www.forbes.com/forbes/2012/0507/global-2000-12-judith-faulkner-epic-system.html

 

http://medicaleconomics.modernmedicine.com/medical-economics/news/why-epics-market-dominance-could-stifle-ehr-and-health-it-innovation#

 

This not about market share, its about who has the data. I did not use the term market share. 

post #45 of 79
Quote:
Originally Posted by SiMBa37 View Post

Ask and you shall recieve:

http://www.forbes.com/forbes/2012/0507/global-2000-12-judith-faulkner-epic-system.html

http://medicaleconomics.modernmedicine.com/medical-economics/news/why-epics-market-dominance-could-stifle-ehr-and-health-it-innovation#

This not about market share, its about who has the data. I did not use the term market share. 

Is there any supporting data? There is no link to the source of the data.

Suggesting that "30 to 40% of most medical data is on Epic" is highly questionable considering that the vast majority of medical data is medical imaging data. Epic does not manage or store medical images.

Based on my own experience I understand that someone could conclude that Epic has 30% - 40% of patient data contained within EMR systems in the United States though. This is based on my own observation that Epic is very popular amongst larger healthcare enterprises.
Edited by MacBook Pro - 5/31/13 at 3:11pm
post #46 of 79
Quote:
Originally Posted by christopher126 View Post

Dude, I crossed Ford off my list as far as car choices b/c of MS Sync....and tesla b/c of android. Shame.

Me too (in fact, I steered my daughter towards a Hyundai Elantra GT rather than a Ford Focus that she was initially keen on!).Tesla is a tad overrated, imho. And no Samsung products. Ever.

 

No shame there.

post #47 of 79
Quote:
Originally Posted by MacBook Pro View Post


I have difficulty believing that Epic has 40% market share of the EMR market. I have seen no data to support this conclusion. I have seen data that suggests that (as of October 2011):
  • AllScripts has 15,8% market share
  • Epic has 14.93% market share
  • eClinicalWorks has 11% market share
  • GE has 9.19% market share
  • Cerner has 7.39% market share

Epic began as a startup and has thrived without any outside investors. This is the very essence of entrepreneurialism.


  • Do you believe we need to constrain healthcare costs?
  • Do you believe that electronic data interchange can improve patient care and constrain costs?
  • Do you believe there should be public funding for implementing electronic data interchange?
  • Do you believe there should be requirements to receive public funding for implementing electronic data interchange?
  • Do you believe the economy would be "better" if healthcare costs weren't constrained and public funding not used as a catalyst to constrain healthcare costs?

Since you edited your post after I replied, I will answer your questions:

 

  • Do you believe we need to constrain healthcare costs? YES
  • Do you believe that electronic data interchange can improve patient care and constrain costs? YES
  • Do you believe there should be public funding for implementing electronic data interchange? YES
  • Do you believe there should be requirements to receive public funding for implementing electronic data interchange? YES
  • Do you believe the economy would be "better" if healthcare costs weren't constrained and public funding not used as a catalyst to constrain healthcare costs? Silly rhetorical question, but I will entertain. NO

 

All of the above I agree with (you would be suprised that you and I are on the same side). I disagree with the implementation of meaningful use (cars before roads), and the ACO concept (which I think will go down in flames). 

 

You're the IT guy, so here's the analogy:

I can use any brand of USB cable for my printer. I can use any brand of HDMI cable for my Apple TV. I can use any browswer to view this website. Can I use any EHR to access anyone's medical data (if that patient authorized it)?

 

No, because no data communication standards have been set. 

 

Meaningful use said to go out and get a system based on certain criteria (many of which are logical), but not foundation was set ahead of time. Its like partially subsidizing the cost of a car for you before the road is even built. All my patients want is cross communication of data between me (a subspecialist) and their other physicians. You know how we do that now? The fax machine. 

 

I am echoing this that nearly all the physicians I meet and work with complain of. I'm not sure how many practicing doctors you speak to, but none of us are happy.  All we want is to care for our patients without the meddeling of 3rd party payers (private or govt insurance), have same high  quality of software that other industries do, and utilized 21st century data and technology to better our care and field (not the fax machine).

post #48 of 79
Quote:
Originally Posted by dwbernergirl View Post

The iPad mini fits into standard lab coat pockets. I work in hospital medicine and it comes with me on my rounds. I have purchased antimicrobial back skins and keep it covered in a DodoCase. I use a glass screen protector which can withstand cleaning with alcohol swabs or the chlorhexadine wipes found on the floors. There are some medical grade protectors, but right now they are too bulky.

 

Thanks for that.  I was wondering if medical professionals used tablet protectors.

 

The trouble with touch devices is they're a great way to spread germs.

 

Before the iPad came along, there were a lot of Windows PC/CE based custom tablets that were specifically designed for medical usage... drop and moisture resistant... capable of constant sterilization / cleaning.

post #49 of 79
Quote:
Originally Posted by SiMBa37 View Post

Since you edited your post after I replied, I will answer your questions:
  • Do you believe we need to constrain healthcare costs? YES
  • Do you believe that electronic data interchange can improve patient care and constrain costs? YES
  • Do you believe there should be public funding for implementing electronic data interchange? YES
  • Do you believe there should be requirements to receive public funding for implementing electronic data interchange? YES
  • Do you believe the economy would be "better" if healthcare costs weren't constrained and public funding not used as a catalyst to constrain healthcare costs? Silly rhetorical question, but I will entertain. NO

All of the above I agree with (you would be suprised that you and I are on the same side). I disagree with the implementation of meaningful use (cars before roads), and the ACO concept (which I think will go down in flames). 

You're the IT guy, so here's the analogy:
I can use any brand of USB cable for my printer. I can use any brand of HDMI cable for my Apple TV. I can use any browswer to view this website. Can I use any EHR to access anyone's medical data (if that patient authorized it)?

No, because no data communication standards have been set. 

Meaningful use said to go out and get a system based on certain criteria (many of which are logical), but not foundation was set ahead of time. Its like partially subsidizing the cost of a car for you before the road is even built. All my patients want is cross communication of data between me (a subspecialist) and their other physicians. You know how we do that now? The fax machine. 

I am echoing this that nearly all the physicians I meet and work with complain of. I'm not sure how many practicing doctors you speak to, but none of us are happy.  All we want is to care for our patients without the meddeling of 3rd party payers (private or govt insurance), have same high  quality of software that other industries do, and utilized 21st century data and technology to better our care and field (not the fax machine).

I am not surprised that we agree. We might disagree how to achieve certain patient care goals but I have never met any clinician who [like me] didn't want to improve patient care and reduce costs.

Interesting that you assume I am an "IT guy."

There are data communication standards. DICOM and HL7 are very robust communications standards. While the HITECH Act may not prescribe a specific communication standard it is safe to safe that DICOM and HL7 are overwhelming used and should be assumed to be the prescription for EDI in healthcare. Unfortunately, budget constraints as well as technology constraints and the interests of the medical device vendors have conspired to ensure that the data communication standards are followed only in as much as absolutely required.

I understand what you are saying. You are stating that there is no national (let alone global) electronic data interchange infrastructure in healthcare. There is no (to borrow from banking) Cirrus, Plus or STAR network (interbank network) or interhealthcare enterprise network.
Edited by MacBook Pro - 5/31/13 at 4:09pm
post #50 of 79
Quote:
Originally Posted by KDarling View Post

The trouble with touch devices is they're a great way to spread germs.

Keyboards are (probably) worse.

 

I would not go near a computer keyboard in a hospital. But if had something (like my sweater sleeve) to wipe clean an iPad screen, there's a slightly greater chance I might consider using it.

post #51 of 79
Quote:
Originally Posted by MacBook Pro View Post


I am not surprised that we agree. We might disagree how to achieve certain patient care goals but I have never met any clinician who [like me] didn't want to improve patient care and reduce costs.

Interesting that you assume I am an "IT guy."

There are data communication standards. DICOM and HL7 are very robust communications standards. Unfortunately, budget constraints as well as technology constraints and the interests of the medical device vendors have conspired to ensure that the data communication standards are followed only in as much as absolutely required.

The source of the 127 million patients on Epic data is the New York Times:

http://www.nytimes.com/2012/01/15/business/epic-systems-digitizing-health-records-before-it-was-cool.html?pagewanted=all&_r=0

 

They also do not list their source. Not sure how trusty the times is nowadays.

post #52 of 79
Quote:
Originally Posted by anantksundaram View Post

Keyboards are (probably) worse.

 

Oh yeah, for sure.  They capture crumbs :)

 

OTOH, a person can use gloves on a keyboard or a resistive touchscreen.

 

Hmm.  Never tried it:  do fingers in medical gloves work on an iPad touchscreen?

post #53 of 79
Quote:
Originally Posted by KDarling View Post

OTOH, a person can use gloves on a keyboard or a resistive touchscreen.

http://www.apple.com/accessibility/resources/iphone.html

 

..... where, of course, you hold the iPad with gloves on.

 

1smile.gif

post #54 of 79
Quote:
Originally Posted by mstone View Post

I would have to disagree because an iPad does not have multiple users. In the case of the treatment area, each user has a different permission level. The Windows machines are using IE browser as the computer interface.

 

Unless the iPad is accessing data remotely, that is.

 

Such as all the stuff entered by a nurse on a PC in the corner, which is a haven for dust and germs btw.

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post #55 of 79
Quote:
Originally Posted by KDarling View Post

OTOH, a person can use gloves on a keyboard or a resistive touchscreen.

 

Typical latex examination gloves work just fine on iPad. Not quite as sensitive as bare fingertips but totally usable. The thicker gloves used in surgery do not work very well on iPad.

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post #56 of 79
Quote:
Originally Posted by SiMBa37 View Post

The source of the 127 million patients on Epic data is the New York Times:
http://www.nytimes.com/2012/01/15/business/epic-systems-digitizing-health-records-before-it-was-cool.html?pagewanted=all&_r=0

They also do not list their source. Not sure how trusty the times is nowadays.

The primary issue affecting clinicians is that the clinical information systems are not designed to readily accommodate reliable and secure electronic data interchange amongst healthcare facilities without a robust capital investment.

The use case to which you refer is really almost an ad hoc connection (despite that fact that you most likely have a business relationship with the other clinician). Most medical device vendors are more than happy to sell you and him a solution that provides essentially a permanent connection. In fact, this is the focus of most medical device vendors.

You want an HL7 interface? $10,000. You want 17? Fantastic! $170,000. I can provide you with a 10% discount. How long? Three days if your integration engineer is available but more likely six months.

What you seem to want is to be able to exchange data on demand without any prior technological arrangement (perhaps just exchange IP Addresses)? Sadly, only the vendors are preventing you from exchanging data. I believe the most recent version of the HL7 communication standard assumes use of the TCP/IP protocol suite as the Lower Level Protocol. If so, then typical security protocols (certificate-based authentication and symmetric encryption keys) can be used to ensure the confidentiality, integrity and accuracy of the data.

Keep in mind that a lot of healthcare enterprises have until recently used clinical information systems designed, developed and deployed thirty years ago. The communication standards have evolved significantly in the interim.
Edited by MacBook Pro - 5/31/13 at 4:20pm
post #57 of 79
Quote:
Originally Posted by hill60 View Post

Quote:
Originally Posted by mstone View Post

I would have to disagree because an iPad does not have multiple users. In the case of the treatment area, each user has a different permission level. The Windows machines are using IE browser as the computer interface.

 

Unless the iPad is accessing data remotely, that is.

 

Such as all the stuff entered by a nurse on a PC in the corner, which is a haven for dust and germs btw.

The cross contamination is their problem. Whenever they need to work with you they should be using fresh gloves. The thing about multiple users is that a regular computer is completely logged out at the OS level when the staff member leaves the room. If you were to implement the same thing on an iOS device you would have to have a common user/password at the OS level which is a major security risk plus, in order to grant individual permissions you would need to use a specific app. That is fine but theoretically there would be several apps needed and the browser which would need to use a proxy server so that security could be enforced. Way too complicated.

 

The only solution I see is everyone has their own iPad or Apple allows multiple users. But even that would still need to be implemented along side a secure LADP server.


Edited by mstone - 5/31/13 at 4:13pm

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post #58 of 79
Quote:
Originally Posted by SiMBa37 View Post

Since you edited your post after I replied, I will answer your questions:
  • Do you believe we need to constrain healthcare costs? YES
  • Do you believe that electronic data interchange can improve patient care and constrain costs? YES
  • Do you believe there should be public funding for implementing electronic data interchange? YES
  • Do you believe there should be requirements to receive public funding for implementing electronic data interchange? YES
  • Do you believe the economy would be "better" if healthcare costs weren't constrained and public funding not used as a catalyst to constrain healthcare costs? Silly rhetorical question, but I will entertain. NO

All of the above I agree with (you would be suprised that you and I are on the same side). I disagree with the implementation of meaningful use (cars before roads), and the ACO concept (which I think will go down in flames). 

You're the IT guy, so here's the analogy:
I can use any brand of USB cable for my printer. I can use any brand of HDMI cable for my Apple TV. I can use any browswer to view this website. Can I use any EHR to access anyone's medical data (if that patient authorized it)?

No, because no data communication standards have been set. 

Meaningful use said to go out and get a system based on certain criteria (many of which are logical), but not foundation was set ahead of time. Its like partially subsidizing the cost of a car for you before the road is even built. All my patients want is cross communication of data between me (a subspecialist) and their other physicians. You know how we do that now? The fax machine. 

I am echoing this that nearly all the physicians I meet and work with complain of. I'm not sure how many practicing doctors you speak to, but none of us are happy.  All we want is to care for our patients without the meddeling of 3rd party payers (private or govt insurance), have same high  quality of software that other industries do, and utilized 21st century data and technology to better our care and field (not the fax machine).

I should add that I am not convinced that the results of the HITECH Act or any other aspect of the American Recovery and Reinvestment Act will, in fact, constrain costs and improve patient care only that that is the publicly stated purpose.
post #59 of 79
Quote:
Originally Posted by anantksundaram View Post

Me too (in fact, I steered my daughter towards a Hyundai Elantra GT rather than a Ford Focus that she was initially keen on!).Tesla is a tad overrated, imho. And no Samsung products. Ever.

 

No shame there.

Good for you...I think the Elantra was Motor Trends car of the year 2012. I rented one and was impressed with the gas mileage, handling and performance. A bit cheap on the inside, but today they all are! :)

 

Good choice. :)

post #60 of 79
Quote:
Originally Posted by christopher126 View Post

Good for you...I think the Elantra was Motor Trends car of the year 2012. I rented one and was impressed with the gas mileage, handling and performance. A bit cheap on the inside, but today they all are! 1smile.gif

Good choice. 1smile.gif

I bought a 2013 just last month. For the money the inside is pretty nice. It was either an Elantra Limited or the base Sonata for the money I was willing to spend on an ever lowering investment. Since I didn't need the larger sedan I decided the leather interior and additional electronics in the Elantra Limited was a better buy for me.

I momentarily considered the Hyundai Equus and then the Hyundai Genesis but I really can't stomach putting that much money into a car. Well, most cars. If I saw a good deal on an Ariel Atom or 1967 Pontiac GTO I'd likely go for it (but a part of me hopes that never happens).

When I consider how much time I spend in a car compared to how much time I spend in front of a computer I would much rather buy a better computer. I know cars help when attracting the ladies but two things keep this from being a factor for me: trying not to date superficial women and having a personality (of sorts). 1wink.gif
Edited by SolipsismX - 5/31/13 at 6:50pm

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post #61 of 79
Quote:
Originally Posted by SolipsismX View Post

I bought a 2013 just last month. For the money the inside is pretty nice. It was either an Elantra Limited or the base Sonata.....

 

Quote:

Originally Posted by christopher126 View Post

 

I think the Elantra was Motor Trends car of the year 2012. I rented one and was impressed with the gas mileage, handling and performance. A bit cheap on the inside, but today they all are! :)

(Off-topic).

 

She got the GT, which is quite a bit different. It has been in Europe for a couple of years now, but was intro'ed in the US only a few months ago.

 

With its panoramic sunroof, and leather, it's really quite impressive. And the interior is surprisingly spiffy and cool: http://www.caranddriver.com/reviews/2013-hyundai-elantra-gt-manual-test-review

post #62 of 79
Quote:
Originally Posted by anantksundaram View Post

(Off-topic).

She got the GT, which is quite a bit different. It has been in Europe for a couple of years now, but was intro'ed in the US only a few months ago.

With its panoramic sunroof, and leather, it's really quite impressive. And the interior is surprisingly spiffy and cool: http://www.caranddriver.com/reviews/2013-hyundai-elantra-gt-manual-test-review

Ur right... I do remember sitting in a GT at a dealership. My GF was considering the reg. elantra! 1smile.gif GT was a lot better inside! 1smile.gif
post #63 of 79
We use Epic at our place. Their strategy has been to service whales and kids (the story is that Faulker's husband, a pediatrician, had a kid die because information from another encounter was not available). Since they go after larger institutions, they get a disproportionately larger share of patients from a smaller share of facilities/practices. Reportedly their 'sales' department consists of a small number of individuals whose main job appears to be turning clients away.

Having been involved in a minor way in the implementation of our system (content for Radiology) I can say the system is clunky at best largely due to the incredibly complex interfaces. This is probably going to be the case with any system. Interfacing with other systems will be even more complex. Finally, ideally the interchange will be a two way communication that will allow data to be pushed to the remote site rather than just queried. This doesn't even work now between sites using the same vendor, so expect a universal system to be a ways off.

On the iPad issue, I typically use the Citrix client on an iPad mini, so I get the full package (including image display) rather than the very limited iOS native app. It's a little clunky but the Citrix folks have provided some decent options. There are design elements that work reasonably well on an iPad even though functionally you're running windows on the remote machine.

Finally a minor correction: the Tesla touchscreen runs a customized Linux OS (specifically NOT Android).
post #64 of 79
Quote:
Originally Posted by Apple ][ View Post

Just face it. The iPad is the standard in just about every imaginable industry and business that deploys tablets, from medicine, to airlines, to restaurants, to clothing stores, to warehouses, in real estate, you name it. I would think twice about doing business with any business that deploys Android tablets, for a number of obvious reasons.
eri

Many banks and stock exchanges use Android tablets because their trading software can be easily converted from Java to Dalvik. Multi user support is also an absolute must when it's imperative to keep a traders profile separate from each other. PnL sheets are found on remote servers which can only be accessed with a system that can mount a Samba drive and be accessed from the local filesystem. Our trading software for instance uses a standard called FIX Protocol, it's basicly a XML file however these files are updated in real time and can't simply be copied over to the device to manipulate but must be accessed on the server.

There is no doubt that a iPad is a very useful tool in business but it's also missing some functionality that certain industries need. As a Unix user I like that I can use most of my scripts on the tablet itself, Python, PHP and Ruby are easily installed and like I said before can access multiple servers.
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post #65 of 79
Quote:
Originally Posted by Lord Amhran View Post

No surprise here. iPad is the standard and nobody even comes close. The also-rans need to just face facts and give up. Outside of perhaps a Kindle, nobody wants or has use for their junk.

The real weak point with the iPad, and I am an iPad user, is the lack of handwriting capability. They need to support proper writing which means the need for active digitizer equivalent capabilities. Capacitive screens are just terrible for writing. Now you can say that writing no longer matter but it still does in the scientific world, and I would hope that doctors are still living there.

I have owned every iPad but Apple's reluctance to support writing led me to a Samsung Note 8.0, and from a very Apple supportive person point of view I must tell you that Apple has to add more than just poking at a screen to its lineup. I for one will probably never buy another iPad until they do.

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post #66 of 79
Quote:
Originally Posted by pmcd View Post

The real weak point with the iPad, and I am an iPad user, is the lack of handwriting capability. They need to support proper writing which means the need for active digitizer equivalent capabilities. Capacitive screens are just terrible for writing. Now you can say that writing no longer matter but it still does in the scientific world, and I would hope that doctors are still living there.

I have owned every iPad but Apple's reluctance to support writing led me to a Samsung Note 8.0, and from a very Apple supportive person point of view I must tell you that Apple has to add more than just poking at a screen to its lineup. I for one will probably never buy another iPad until they do.

Philip

The iPad has some of the best music creation apps that I have ever used so until they become available on other platforms I will always have one. However for work related uses I still prefer Windows 8 or Android on my tablet. The handwriting tech on my Lenovo Thinkpad Tablet 2 is pretty awesome. I no longer use a journal when in meetings or when writing down any notes for that matter. I to really wish that the iPad Mini had support for a active digitizer, the size is perfect for note taking. However the Samsung Note 8 is a good alternative, Samsung's dedicated pen apps are very intuitive and useful.
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post #67 of 79
We use iPad minis in the clinic. For viewing images on our PACS, it is far better than paper or a desktop CPU. Our next EMR will work on the mini as well - and they fit perfectly inside a white coat pocket.

We are also transitioning to an EMR (Modernized Medicine) that utilizes an iPad-based UI for direct patient interaction, and has a web background as well for more detailed data processing/entry.

I find it appalling that many current EMR systems require medical staff to be behind a computer screen, rather than dealing directly with the patient. It is impersonal for both, and i have never met anyone that actually likes it.


In terms of number of devices, we have 4 doctors and 8 other medical staff. But 17 examination rooms. If everyone gets their own tablet, and is responsible for it, we only need 12 devices versus 17. I would say that the majority of my hospital's clinics work the same way - far more exam rooms than staff, so outfitting each exam room is the least efficient way of doing things.
post #68 of 79
Quote:
Originally Posted by mstone View Post

 but it does require larger lab coat pockets and also carrying around a tablet all day, but on the plus side it does offer better security for the patient data. Even though the iPads aren't that heavy, it is an additional bulky item to tote around all day.

 

Not that big, not that heavy. Especially if you get a Mini. 

 

Also, if you are using a system that connects to a server based record system then you can still have the receptionist enter this bit, the nurse that, and the doctor that. And all can see what each has done. 

 

Some states are looking at state wide adoption of the same software or at least software that uses protocols that will take to various software so that everything is online such that if, for example, I get rushed to the hospital cause I am puking my guts up they can access the records for my GP and find out what drugs I'm on and have been on, my allergies and oh yeah, I had a mild stomach ulcer 2 years ago due to a drug reaction and I still have my appendix. And on such a system my vitals, diagnosis and treatment for my case of food poisoning are available to my GP. 

 

Apple themselves have a system in line that works in this kind of way for tech appointments. Their iPads have various apps that allow for particular views of information as needed by parties of different authority and it all goes into a system that is accessible as needed by various stores, Apple Care etc. Watch sometime if you are there for any appointment and you'll see it in action. 

 

And an advantage to everyone having their own means that they are logged in with an individual id that allows folks to see which nurse etc entered what data and even to review alerts for new information without being in the room. It can be pushed by various parties to all the devices with that patient currently 'in progress'. 

A non tech's thoughts on Apple stuff 

(She's family so I'm a little biased)

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A non tech's thoughts on Apple stuff 

(She's family so I'm a little biased)

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post #69 of 79
Quote:
Originally Posted by sessamoid View Post

 

You're delusional, or you've been watching too many cheesy SciFi movies.

 

He's neither. Such hardware that could report data directly to an app or server avoids input errors. And yes one day those paper surveys could be replaced by an iPad as well and yes it might be with audio prompts. 

A non tech's thoughts on Apple stuff 

(She's family so I'm a little biased)

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A non tech's thoughts on Apple stuff 

(She's family so I'm a little biased)

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post #70 of 79
Quote:
Originally Posted by christopher126 View Post

Dude, I crossed Ford off my list as far as car choices b/c of MS Sync....and tesla b/c of android. Shame.

I'm betting Microsoft paid Ford to get into their vehicles, something I assume Apple would never do.

Proud AAPL stock owner.

 

GOA

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Proud AAPL stock owner.

 

GOA

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post #71 of 79
Quote:
Originally Posted by oliverochs View Post

We use Epic at our place. Their strategy has been to service whales and kids (the story is that Faulker's husband, a pediatrician, had a kid die because information from another encounter was not available). Since they go after larger institutions, they get a disproportionately larger share of patients from a smaller share of facilities/practices. Reportedly their 'sales' department consists of a small number of individuals whose main job appears to be turning clients away.

Having been involved in a minor way in the implementation of our system (content for Radiology) I can say the system is clunky at best largely due to the incredibly complex interfaces. This is probably going to be the case with any system. Interfacing with other systems will be even more complex. Finally, ideally the interchange will be a two way communication that will allow data to be pushed to the remote site rather than just queried. This doesn't even work now between sites using the same vendor, so expect a universal system to be a ways off.

On the iPad issue, I typically use the Citrix client on an iPad mini, so I get the full package (including image display) rather than the very limited iOS native app. It's a little clunky but the Citrix folks have provided some decent options. There are design elements that work reasonably well on an iPad even though functionally you're running windows on the remote machine.

Finally a minor correction: the Tesla touchscreen runs a customized Linux OS (specifically NOT Android).

Which PACS are you using?
post #72 of 79
Quote:
Originally Posted by sandor View Post

We use iPad minis in the clinic. For viewing images on our PACS, it is far better than paper or a desktop CPU. Our next EMR will work on the mini as well - and they fit perfectly inside a white coat pocket.

We are also transitioning to an EMR (Modernized Medicine) that utilizes an iPad-based UI for direct patient interaction, and has a web background as well for more detailed data processing/entry.

I find it appalling that many current EMR systems require medical staff to be behind a computer screen, rather than dealing directly with the patient. It is impersonal for both, and i have never met anyone that actually likes it.


In terms of number of devices, we have 4 doctors and 8 other medical staff. But 17 examination rooms. If everyone gets their own tablet, and is responsible for it, we only need 12 devices versus 17. I would say that the majority of my hospital's clinics work the same way - far more exam rooms than staff, so outfitting each exam room is the least efficient way of doing things.

Which PACS are you using?
post #73 of 79
Quote:
Originally Posted by Relic View Post

The iPad has some of the best music creation apps that I have ever used so until they become available on other platforms I will always have one. However for work related uses I still prefer Windows 8 or Android on my tablet. The handwriting tech on my Lenovo Thinkpad Tablet 2 is pretty awesome. I no longer use a journal when in meetings or when writing down any notes for that matter. I to really wish that the iPad Mini had support for a active digitizer, the size is perfect for note taking. However the Samsung Note 8 is a good alternative, Samsung's dedicated pen apps are very intuitive and useful.

The iPad mini would be ideal with an active digitizer or equivalent. I far prefer the 4:3 aspect ratio to say the 16:9 ratio of the MS Surface. The Samsung Note 8.0 is 16:10 which is not bad. There are some excellent writing programs for the Note 8. For the life of me I just don't understand why Apple is disregarding this issue. Mind you, on the basis of the responses here it is clear that handwriting just isn't an important need for most users. I wonder if signatures will have to be disregarded since it appears as though people no longer handwrite.

The revenge of the typewriter is a very sad event. Schools appear to be dropping cursive writing in favour of making sure everyone becomes a good typist. It's really odd.

Anyway, I am very happy with my Samsung Galaxy Note 8.0 and any future buying will not be from Apple until they stop pushing this medieval way of communication. Very strange as there was a time when the Mac was leading in moving away from strictly ASCII input.

Philip
post #74 of 79
Quote:
Originally Posted by pmcd View Post


The real weak point with the iPad, and I am an iPad user, is the lack of handwriting capability. 

 

There have been studies that show that one of the biggest liabilities when it comes to medical mistakes is handwriting. Often folks jot things down quickly and it's not always legible. And mistakes happen. This is part of why typing is such a big thing, particularly at hospitals. Plus with digital systems you can have checks and balances for dosage calculations etc. 

 

So in this particular case, the lack of handwriting capability is a bit moot. 

A non tech's thoughts on Apple stuff 

(She's family so I'm a little biased)

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A non tech's thoughts on Apple stuff 

(She's family so I'm a little biased)

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post #75 of 79
Quote:
Originally Posted by charlituna View Post

There have been studies that show that one of the biggest liabilities when it comes to medical mistakes is handwriting. Often folks jot things down quickly and it's not always legible. And mistakes happen. This is part of why typing is such a big thing, particularly at hospitals. Plus with digital systems you can have checks and balances for dosage calculations etc. 

So in this particular case, the lack of handwriting capability is a bit moot. 

Huh, I have never seen a doctor type in his notations during a consultation, it's always handwritten. Even in a hospital environment and I've spent my fair share in one. They will probably later transcribe their patient info into a computer sure but the initial notes always start as pen. Your point's are all valid though, maybe they will change policy.
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post #76 of 79
Quote:
Originally Posted by MacBook Pro View Post

Which PACS are you using?

We are on Philips iSite, but it also works with GE centricity. They need to set it up to open a new Citrix server connection. Our Epic install is across several hospitals and they use different PACS. It's smart enough to open a new window to a server that can direct connect to the appropriate PACS server. As long as there is a windows client for the PACS they can set it up appropriately.
post #77 of 79
Quote:
Originally Posted by pmcd View Post

The iPad mini would be ideal with an active digitizer or equivalent. I far prefer the 4:3 aspect ratio to say the 16:9 ratio of the MS Surface. The Samsung Note 8.0 is 16:10 which is not bad. There are some excellent writing programs for the Note 8. For the life of me I just don't understand why Apple is disregarding this issue. Mind you, on the basis of the responses here it is clear that handwriting just isn't an important need for most users. I wonder if signatures will have to be disregarded since it appears as though people no longer handwrite.

The revenge of the typewriter is a very sad event. Schools appear to be dropping cursive writing in favour of making sure everyone becomes a good typist. It's really odd.

Anyway, I am very happy with my Samsung Galaxy Note 8.0 and any future buying will not be from Apple until they stop pushing this medieval way of communication. Very strange as there was a time when the Mac was leading in moving away from strictly ASCII input.

Philip

I'm still up in the air as to which aspect ration I prefer, I really like 16:9 but 4:3 does seem more suitable for work related tasks. My notes have never started in typed format, during a meeting I always write things down first. I'm a programmer so I use lots of diagrams, workflow depicted as shapes scribbled all over a sheet of paper or as of late in my tablet. I use a Asus program called Supernote first then keep my notes organized in Evernote, probably now one of my most used programs along with NovaMind.
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post #78 of 79
Just came across this article which states that a hospital calculated the ROI of an iPad at 9 days. That's not a typo - 9 days to save enough to pay for the iPad. Even if they're off by several hundred percent, it's an incredible investment.
http://www.forbes.com/sites/danmunro/2013/06/02/hospital-calculates-the-roi-of-an-ipad-at-9-days/?goback=%2Egde_50556_member_246188397

I wonder where all the people went who were claiming that the iPad was a toy and no one would buy them. Oh, yeah - they've just changed to equally inane newer arguments.
"I'm way over my head when it comes to technical issues like this"
Gatorguy 5/31/13
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"I'm way over my head when it comes to technical issues like this"
Gatorguy 5/31/13
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post #79 of 79
Quote:
Originally Posted by jragosta View Post

Just came across this article which states that a hospital calculated the ROI of an iPad at 9 days. 

 

Thanks for the link.  I could use that at work :)

 

Of course, it's not at all hard to believe.  Such ROI is easy to come up with.

 

They used time-motion analysis, so they were basically looking at how long it takes to do things like entering or looking up data.

 

Saving a few minutes per hour per tablet over 24 hours a day, could easily come to $400+ in "savings" over a week or two.

 

Of course, so would walking faster.  But it's not as cool sounding :)


Edited by KDarling - 6/3/13 at 7:27am
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