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

tarantulas · May 31, 2013 2:11PM

There maybe a sizable number of doctors using iPad but a huge number of other individuals are using Kindle Fire and other brands from China. http://t.co/pFPwirW9I2

christopher126 · May 31, 2013 2:16PM

My daughter is Anesthesiologist and every function I'm invited to, birthdays, parties, etc...all her friends are docs and they all have the latest iPhones & iPads! Pretty cool!

c4rlob · May 31, 2013 2:17PM

Quote:

Originally Posted by mstone

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.

True, iPads don't have multiple users on the system level (yet). But apps do.

And when I say "interface" I mean the interface of using keys and mouse pointers to navigate ugly complicated forms vs. a touch-optimized interface. And while web browsers are capable of rendering better UI design than is currently being deployed, I think a well-executed UI on a touchscreen interface would still be more efficient and user-friendly for quick data collection and consumption.

MayoClinic example: http://www.apple.com/ipad/business/profiles/mayo-clinic/

christopher126 · May 31, 2013 2:19PM

tarantulas wrote: »

There maybe a sizable number of doctors using iPad but a huge number of other individuals are using Kindle Fire and other brands from China.

With all due respect, I disagree.

macbook pro · May 31, 2013 2:25PM

solipsismx wrote: »

Imagine your doctor calling in a prescription for a pill that will precede your visit by a day or two. You take it when the doctor says to then when you go to the doctor he can pull the data from the pill.

I'd actually like something more preventive. Either a pill you ingest every so often that a home device can pull data from or a machine that will take a drop of blood as a sample every day or few days. It reads the levels and determines what you need to do to balance out your diet or exercise to maintain optimal health. It could inform you of potential changes that you may want to see a doctor for, like the "Check engine soon" light on a car's dash.

We have numerous home health monitoring solutions available today. Unfortunately, the cost of a comprehensive monitoring solution is prohibitive:

Blood Pressure
Blood Glucose
Weight Scales
Oxygen Saturation
Heart Rate
Pulse
Electrocardiography

The challenge is that most healthy people want a solution that doesn't require any active participation whereas for many people needing care require much more invasive and pervasive monitoring.

simba37 · May 31, 2013 2:27PM

Token Physician here. I'll add in my 2 cents, considering I just posted about the same exact thing on Quora.

I own and use a variety of iPads. I have a work issued iPad 2 3G, a personal iPad 2 (will be selling soon), and an iPad mini Verizon LTE.

I switched to a mini because of what it excels at, the ultimate in portable computing. I use it every day, with every patient for the following: e-Prescribe meds (through a web app), secure web email with patients (same web app), access my contacts list (for referrals), look up ICD9 codes (Dr ICD9 from DrChrono) patient education with some increadible iOS apps (see 3D4Medical), perform specialty specific disease activity measures and calculators, and quick access to medical research in the exam room (UpToDate).

I also use the iPad mini to keep me up to date to read medical journals through a variety of apps (Papers, docwise, Medpage today, Flipboard, twitter, etc.). Dropbox is very helpful when it comes to this.

I do not use my work issued iPad 2 as much as the size is a bit cumbersome, although I may take it to a meeting to take notes (via the Logitech Ultrathin iPad keboard case/cover).

Do I also use the iPad mini for personal use? Sure. I watch netflix, HBO, few games, art work, photos, shopping, reading, etc.

Separate from the above is about the EHR. My office does not have an EHR, yet, but will probably be like 30% of hospitals and get Epic. Epic and most EHR vendors do not have any native iPad app. The few that claim to support an iPad do it through a VNC or VPN such as Citrix or VMWare, which is a lousy way of working on an iPad. There are only a few companies that are very dedicated to the iPad as an EHR platform, with DrChrono and Nimble EMR coming to mind.

So why don't most EHR vendors develop a native iOS experience? Who knows, but IMHO it comes down to a few things: the 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. The other reason could just be bad leadership at an EHR vendor in regards to usability and UI/UX.

dwbernergirl · May 31, 2013 2:33PM

inkling wrote: »

This is where the iPad mini shines. It's lighter than the regular iPad and slips easily into the large hip pocket in coats and tunics. There's also a market for those who can come up with accessories and apps for medical staff. Cases need to look medical and protect well, including from chemicals. Email and messaging apps specifically designed for in-hospital use should also be popular.

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.

I wholly agree with the article that the iPad interface is a replica of the EHR we use and is awkward because it depends on scroll bars to navigate up and down a page, does not support touch scrolling. So when I am post call, I wait until I get to my Mac to sign the few orders that are outstanding.

Have not checked in a while, but I believe there is only one Mac based fully certified EHR called MacPractice. There may be others developed in the past year or so. There are a multitude of apps that do basic medical testing including one that will take an EKG off a dongle you attach to your iPhone. There is a scanning app that apparently tests urinalysis strips, though the FDA is claiming as a medical device and wants medical device review before it can be marketed as such.

Medical reference apps have been around for a long time. Epocrates started out on the Palm platform, earlier this year they released an app optimized for the iPad. I utilize a paid subscription of it and it is my go to for lab interpretations, drug to drug interactions, looking up weird disease states, and has a large atlas of illustrations of various conditions.

Am definitely looking towards a medial ecosystem based on OS and iOS!

dwbernergirl · May 31, 2013 2:40PM

I also forgot to mention that one of the biggest complaints from patients that fill out post hospitalization satisfaction surveys is that they perceive their providers spend more time on the computer that speaking or caring for them. This gets tabulated in what is referred to as HCAPS surveys and Medicare and many insurances base reimbursement on the aggregate scores of these surveys and the provider quality bonuses are based on these as well.

I have always found the "cows" computer on a cart setups to be extremely distancing and distracting in the hospital or exam rooms. I have sat next to my patients, shared content on my iPad and they do not react in the same way. It is shared experience to them rather that something I have to turn my attention away from the patient. That goes miles towards patient satisfaction.

jfc1138 · May 31, 2013 2:40PM

Additionally as to why personal iPads? Then all the reference materials specific to an individual provider's area of service are loaded and to hand, along with patient record access. Much like airline cockpits going paperless so is the lab coat pocket.... Oh also that way there's one less surface to cross contaminate each visitor.

christopher126 · May 31, 2013 3:09PM

apple ][ wrote: »

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.

Bingo!

christopher126 · May 31, 2013 3:14PM

simba37 wrote: »

Token Physician here. I'll add in my 2 cents, considering I just posted about the same exact thing on Quora.

I own and use a variety of iPads. I have a work issued iPad 2 3G, a personal iPad 2 (will be selling soon), and an iPad mini Verizon LTE.
 
 
I switched to a mini because of what it excels at, the ultimate in portable computing. I use it every day, with every patient for the following: e-Prescribe meds (through a web app), secure web email with patients (same web app), access my contacts list (for referrals), look up ICD9 codes (Dr ICD9 from DrChrono) patient education with some increadible iOS apps (see 3D4Medical), perform specialty specific disease activity measures and calculators, and quick access to medical research in the exam room (
<a class="external_link" href="http://uptodate.com/" style="margin:0px;padding:0px 12px 0px 0px;color:rgb(25,85,141);background-image:url(http://d1vgw4v7ja2ido.cloudfront.net/-d00b84133c0b47df.gif);background-position:100% 5px;" target="_blank">UpToDate</a>

).
 
 
I also use the iPad mini to keep me up to date to read medical journals through a variety of apps (Papers, docwise, Medpage today, Flipboard, twitter, etc.). Dropbox is very helpful when it comes to this.
 
 
I do not use my work issued iPad 2 as much as the size is a bit cumbersome, although I may take it to a meeting to take notes (via the Logitech Ultrathin iPad keboard case/cover).
 
 
Do I also use the iPad mini for personal use? Sure. I watch netflix, HBO, few games, art work, photos, shopping, reading, etc. 
 
 
 
 
Separate from the above is about the EHR. My office does not have an EHR, yet, but will probably be like 30% of hospitals and get Epic. Epic and 
most 

EHR vendors do not have any native iPad app. The few that claim to support an iPad do it through a VNC or VPN such as Citrix or VMWare, which is a lousy way of working on an iPad. There are only a few companies that are very dedicated to the iPad as an EHR platform, with DrChrono and Nimble EMR coming to mind. 
 
 
So why don't most EHR vendors develop a native iOS experience? Who knows, but IMHO it comes down to a few things: the 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. The other reason could just be bad leadership at an EHR vendor in regards to usability and UI/UX.

Just emailed ur post to my daughter (250 on her step 2) thanks!

Got her mother's brains!

macbook pro · May 31, 2013 3:16PM

simba37 wrote: »

Token Physician here. I'll add in my 2 cents, considering I just posted about the same exact thing on Quora.

I own and use a variety of iPads. I have a work issued iPad 2 3G, a personal iPad 2 (will be selling soon), and an iPad mini Verizon LTE.
 
 
I switched to a mini because of what it excels at, the ultimate in portable computing. I use it every day, with every patient for the following: e-Prescribe meds (through a web app), secure web email with patients (same web app), access my contacts list (for referrals), look up ICD9 codes (Dr ICD9 from DrChrono) patient education with some increadible iOS apps (see 3D4Medical), perform specialty specific disease activity measures and calculators, and quick access to medical research in the exam room (
<a class="external_link" href="http://uptodate.com/" style="margin:0px;padding:0px 12px 0px 0px;color:rgb(25,85,141);background-image:url(http://d1vgw4v7ja2ido.cloudfront.net/-d00b84133c0b47df.gif);background-position:100% 5px;" target="_blank">UpToDate</a>

).
 
 
I also use the iPad mini to keep me up to date to read medical journals through a variety of apps (Papers, docwise, Medpage today, Flipboard, twitter, etc.). Dropbox is very helpful when it comes to this.
 
 
I do not use my work issued iPad 2 as much as the size is a bit cumbersome, although I may take it to a meeting to take notes (via the Logitech Ultrathin iPad keboard case/cover).
 
 
Do I also use the iPad mini for personal use? Sure. I watch netflix, HBO, few games, art work, photos, shopping, reading, etc. 
 
 
 
 
Separate from the above is about the EHR. My office does not have an EHR, yet, but will probably be like 30% of hospitals and get Epic. Epic and 
most 

EHR vendors do not have any native iPad app. The few that claim to support an iPad do it through a VNC or VPN such as Citrix or VMWare, which is a lousy way of working on an iPad. There are only a few companies that are very dedicated to the iPad as an EHR platform, with DrChrono and Nimble EMR coming to mind. 
 
 
So why don't most EHR vendors develop a native iOS experience? Who knows, but IMHO it comes down to a few things: the 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. The other reason could just be bad leadership at an EHR vendor in regards to usability and UI/UX.

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.

gtbuzz · May 31, 2013 3:17PM

As always there are mixed opinions. The legacy world of windows dominates many fields, but there are many who also prefer OSX and iOS given a choice. Developers must give a choice and the clear answer will prevail. Stability and easy of use. I could not tell you how may PC's I have seen in hospitals and offices of MD's that do not work well mechanically. Batteries are a problem with windows laptops. It will be years before the medical technology group and developers get it together, if then. The only way my MD's can access shared information right now is if they are all members of the same geographically centered group that agrees to share information. Aside from this, I cannot tell you the number of times the information my physicians store on me has been incorrect - sloppy work to say the least. No wonder our medical treatment costs so much.

So, just how difficult is it to share data between systems - Ask the IRS, Customs, Passport, and law enforcement - they all have their own problems.

stelligent · May 31, 2013 3:20PM

Quote:

Originally Posted by Apple ][

Are you thinking about NFC payments and such?

Yes, there have been devices that have that already, but as we all know, it hasn't taken off yet, because Android is not influential.

I am fairly certain that Apple has been working on their own solutions for a while and they will be coming out with it when the time is right, and that is also when we will start to see it take off and get more widely adopted.

Nope. NFC's applications go far beyond mobile payment. The fact that NFC payment hasn't taken off is not due to Android's influence, or alleged lack thereof. There is a world out there that is not about iOS v. Android. There is a world out there that is not just about phones.

christopher126 · May 31, 2013 3:26PM

anantksundaram wrote: »

I've stopped flying American Airlines (partially) for this reason.

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

christopher126 · May 31, 2013 3:31PM

apple ][ wrote: »

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.

And the US Air Force! (I think I have that right)

Off topic: The largest Air Force in the world is the U.S. Air Force the second largest Air Force in the world is the U.S. Navy!

christopher126 · May 31, 2013 3:35PM

mstone wrote: »

In my health care provider's outpatient treatment areas, there is a Windows computer in every room. The nurse can log in and enter in BP and other physical records and then log out. When the physician enters the room they log in through the same computer to access or update your records.

In the scenario often being proposed by medical use iPad advocates is that each person will carry around an iPad and do away with the computer terminals altogether. Using iPads might make sense when physicians are visiting admitted patients in the hospital instead of using a clipboard and then letting their assistant record the digital records from the hard copy, 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. It could also use up more of the physician's time as they would have to complete the entire digital record themselves instead of having their assistant do it.

But back to the treatment rooms issue, it seems to me more efficient to leave the computer in the room than for every one of the people involved with your outpatient visit to have their own iPad. Often that is three people. The preliminary nurse's assistant, then the doctor and possibly a LPN assisting the doctor. As it is now they don't have to carry anything and all use the same Windows terminal. I'm not sure how an iPad really improves efficiency in this situation.

Good point! Perhaps an iPad in every room?

macbook pro · May 31, 2013 3:41PM

macbook pro wrote: »

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.

Defining a clinical information system is incredibly challenging:

Clinician: "I need a global view of my patient's care."

Product Manager: [shows mock-up]

Clinician: "Too cluttered!"

Product Manager: [shows another mock-up]

Clinician: "Too many menus. The information is buried."

Product Manager: [massive headache, pain radiating down left arm, sweating profusely] "Fudge!"

macbook pro · May 31, 2013 3:44PM

christopher126 wrote: »

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 really wish Apple would allow for use of their operating system (or some variant) in embedded systems.

A major technology battle for automated systems is forthcoming. The technology company that is willing to embed reliable and secure operating system in a vast array of products will win massive market share. I do not believe any single company will be able to meet the demand on the massive scale that is forthcoming.

macbook pro · May 31, 2013 3:53PM

christopher126 wrote: »

Good point! Perhaps an iPad in every room?

If every healthcare provider has a mobile device then the healthcare provider can input the order at the point of care themselves thereby increasing accuracy thus reducing cost and improving the patient's outcome.

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

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