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

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Comments

  • Reply 41 of 82
    eideardeideard Posts: 394member
    My doc's group practice made the change to Apple-based practice management software this year. Using more MacBook Airs than iPads, though.
  • Reply 42 of 82
    simba37simba37 Posts: 13member

    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>

  • Reply 43 of 82
    macbook promacbook pro Posts: 1,605member
    simba37 wrote: »
    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>

    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?
  • Reply 44 of 82
    simba37simba37 Posts: 13member

    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. 

  • Reply 45 of 82
    macbook promacbook pro Posts: 1,605member
    simba37 wrote: »

    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.
  • Reply 46 of 82
    anantksundaramanantksundaram Posts: 19,292member

    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.

  • Reply 47 of 82
    simba37simba37 Posts: 13member

    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).

  • Reply 48 of 82
    kdarlingkdarling Posts: 1,640member

    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.

  • Reply 49 of 82
    macbook promacbook pro Posts: 1,605member
    simba37 wrote: »
    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.
  • Reply 50 of 82
    anantksundaramanantksundaram Posts: 19,292member

    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.

  • Reply 51 of 82
    simba37simba37 Posts: 13member

    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.

  • Reply 52 of 82
    kdarlingkdarling Posts: 1,640member

    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?

  • Reply 53 of 82
    anantksundaramanantksundaram Posts: 19,292member

    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.


     


    image

  • Reply 54 of 82
    hill60hill60 Posts: 6,992member

    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.

  • Reply 55 of 82
    mstonemstone Posts: 11,510member

    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.

  • Reply 56 of 82
    macbook promacbook pro Posts: 1,605member
    simba37 wrote: »
    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.
  • Reply 57 of 82
    mstonemstone Posts: 11,510member

    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.

  • Reply 58 of 82
    macbook promacbook pro Posts: 1,605member
    simba37 wrote: »
    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.
  • Reply 59 of 82
    christopher126christopher126 Posts: 4,317member

    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. :)

  • Reply 60 of 82
    solipsismxsolipsismx Posts: 19,566member
    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. :)

    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). ;)
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