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By VINCE KURAITIS

After attending HIMSS 11 the largest annual health IT conference of the year, John Moore reported that “nearly every EHR vendor has an iPad App for the EHR [electronic health record], or will be releasing such this year.”

Doctors love iPads…not surprising? But, how might you explain this?

There are at least two different possibilities:

  • Coincidence Theory
  • Conspiracy Theory

The Coincidence Theory

So doctors want to access EHR software through the iPad…what’s the big deal?

Apple has built a great new hardware platform with the iPad. There’s nothing else like it in the marketplace.  While other companies are building competing tablets, Apple’s has been the only viable option in the market for over a year.

The iPad is intuitive, easy to use, reasonably priced, easy to carry around, and has a lot of apps that have been developed for the platform. People — not just doctors — love the experience of using an iPad.

Doctors just happen to be one group of zillions buying iPads. Why wouldn’t they? Doctors are smart, affluent, and many are opinion leaders. Doctors like cool new technologies just like anyone else.

Doctors also are mobile. They want to access EHRs in different exam rooms, from the hospital, from their homes. The iPad is the perfect hardware platform to take with you as as a doctor goes about their day.

Why are nearly all EHR vendors making their software work on the iPad?

Because doctors are demanding it.

The Conspiracy Theory

The iPad is Apple’s Trojan horse to create new revenues in an industry in which the company has had minimal presence — health care.

Apple has developed a very appealing hardware platform in the iPad. Recognizing the market strength and lock-in to their walled garden they are creating with consumers, Apple is targeting key market segments to create new revenue streams and business models. Health care is the next target for Apple’s aggressive smarts.

Writing in CNN Tech on February 17, Pete Cashmore explains Apple’s new rules in “taxing” publishers:

Apple this week announced a plan to levy a 30 percent fee on publishers who charge subscriptions through its App Store on the iPhone, iPad and iPod touch. The fee applies to newspapers, magazines and digital books (not to mention music and videos).

What’s more, Apple’s rules dictate that publications can’t offer these same subscriptions at a lower price outside the App Store. And in another blow to publishers, customers will have the option not to share their details — name, e-mail address and ZIP code — with the publisher.

Some publishing industry analysts are aghast at the proposal, claiming that the rate is much too steep and the terms too strict. I don’t disagree: There’s no doubt that Apple is using its dominant position in digital distribution to strong-arm publishers.

But the fact that the tech giant can propose such onerous terms without blinking points to the fact that the battle is already lost: The balance of power has permanently, irreversibly shifted from the media companies to the tech firms. (emphasis added)

You’ve probably heard the metaphor that the most expensive medical instrument is the doctor’s pen — that 70%+ of health care costs flow through a pen because doctors must prescribe pills, hospital admissions, medical procedures, tests, etc.

An EHR software app running on an iPad could become the digital equivalent of the doctor’s pen.

BUT now the scenario is much different:

  • A doctor’s pen is a commodity.  Nobody controls the pen market and there are hundreds of reasonably priced options for writing instruments.
  • The iPad is anything but a commodity — it’s a proprietary platform controlled by the #1 tech company in the world. Apps running on Apple’s platform must follow Apple’s rules.

Could Apple impose a similar “tax” on health care services and products (admissions, ER visits, devices, pills, tests, etc.) ordered by doctors using their iPad platform?  Why not — its THEIR platform. If you want to run your app on their platform, you have to follow Apple’s rules.

What are your options?  Leave the Apple platform?  But wait a minute…its the doctors that are locked in to the Apple iPad platform — they love it, why would they want to leave?

Would Apple tax doctors’ revenues?  They could, but they probably wouldn’t…why disturb the geese as they are laying golden eggs?

The iPad is Apple’s Trojan horse into health care — and it’s being willingly carried in by doctors who love to use it.

Who’s Right?

So who’s right — the coincidence theorists or the conspiracy theorists?

It really doesn’t matter ––  the result is the same.  Apple finds itself leveraging a choke point in the health care value chain. It’s up to you to conclude whether has stumbled it’s way or connived it’s way into the hands of doctors.

Apple has created a technology platform that people love. That love translates to high switching costs and high levels of customer lock in.

So what’s the point?

Health care providers and companies typically haven’t looked at tech companies as competitors. Wake up!  As health care makes the transition into the digital economy, look sideways before you’re derailed by new technologies and business models.

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20 Responses for “Doctors Love iPads. What Does it Mean? What Does it Mean?”

  1. So far, I’m relying on my steady laptop to get the job done. Soon, the iPad and its cousins and descendants will be in every physician’s hands, at least under the age of 40. We will use them at the bedside and check on our patients’ progress from our own beds. The risk? More time that we will spend drowning in cyperspace instead of enjoying some real life experiences.

  2. Vince, I think there may be another point to consider.

    Whether conspiracy or coincidence, the net result is the same – you are now locked-in, not just with a piece of software, but also a piece of hardware. And when the next shiny thing comes along, and it always does, you will have doubled the magnitude of your problem.

    As you know, I never liked the iPhone, and now iPad, aspirations for HIT, and I find it peculiar, to say the least, that while everybody is busy decoupling data from applications, we are also busy irreversibly coupling applications to hardware. Haven’t we seen this movie already?

  3. propensity says:

    I thought doctors were the Luddites for pointing out the defects, flaws, and facilitated random of EHR and CPOE contrivances…and now you come along with this statement; : “Doctors like cool new technologies just like anyone else.”

    Please send your statement to the name callers on this blog and to some of the other bloggers out there, including Mr HIStalk, who resort to Ad hominem attacks when they do not like the message or the truth.

    These Apple products may solve one component of the usability problems, but there will be unintended consequences from doctors placing orders from the golf course…neglect anyone?

  4. BobbyG says:

    “Could Apple impose a similar “tax” on health care services and products (admissions, ER visits, devices, pills, tests, etc.) ordered by doctors using their iPad platform? Why not — its THEIR platform. ”
    ___

    I seriously doubt it.

    Even Steve Jobs (specifically Steve Jobs) needs a doctor, LOL.

  5. Gary Levin says:

    It’s pretty simple, actually. iPad as a very well designed thin client. Someone else could do the same thing, but iPad can be used for many other purposes. If the PC platform could do the same things a PC tablet would be fine. Perhaps Apple will now develop a tablet which can be booted in either MacOS or Windows 7. the iPad format is the best human machine interface in the clinic workspace. It interferes the least with Dr-Pt eye contact. I wrote about this four years ago on Health Train Express.

  6. Michael: are we that much less likely to drown in cyberspace on our laptops than our iPads?

    Margalit: Yes, the risk of some type of lock-in rises as the types of platforms proliferate. Platforms can exist at one or more levels of the technology stack – data, apps, hardware, OS, etc – but you know this.

    Apple’s platform is particularly powerful because it extends across hardware (computer, iPad, iPhone), software, app store, control over apps/developers, etc. But you know this.

    Yes, the risk is that while we’re trying to decouple the data, we get locked into a hardware platform. Watch out for tradeoffs and watch your back.

    Propensity: OK, I hereby declare “Doctors are not Luddites”. Doctors like to use iPads that are friendly and fun. Doctors don’t like to use EMRs that are counterintuitive and slow them down. Maybe Apple should make EMRs :)

    Bobby G: even in my made up scenario I agree it’s not wise for Apple to tax doctors. Apple is testing the power of its platform business model first by taxing subscriptions…who knows where they’ll go next.

    I would not have written this post 30 days ago, i.e., before Apple announced its new subscription taxing policies. Read some of the tech blogs & journals to understand the depth to which Apple has pissed people off, e.g.,

    http://www.independent.co.uk/life-style/gadgets-and-tech/features/is-this-the-start-of-a-maclash-2220593.html

    http://www.pcmag.com/article2/0,2817,2380742,00.asp

    Gary: Yes, “It’s pretty simple, actually. iPad as a very well designed thin client.” …and the difference is that for now it’s a one of a kind, vs. commoditized PCs.

  7. [...] recent article on The Health Care Blog titled “Doctors Love iPads. What Does it Mean? What Does it Mean?“, declared Apple the winner in the EHR/EMR world because it is the “#1 tech company in [...]

  8. Mark Cohen says:

    Interesting article!

    It is probably a coincidence in that the iPad was designed to be used “on the go.” No one is more on the go than physicians. Other professions, like salespeople, could use these as well. It just so happens that doctors were a good new market to tap. If there is an “conspiracy,” it is that Apple saw a potential market and sold a product it would like. Novel idea, making a smart marketing decision!

    Mark Cohen
    markdanielcohen.wordpress.com
    mark.cohen580@gmail.com

  9. [...] This “coincidence vs. conspiracy” theory was advanced in a recent Health Care Blog. [...]

  10. A fascinating and revealing post!
    check out http://hubslist.org/2011/03/07/vol-41-march-7-2011-hey-pc-guys-get-over-it/ for my comments summed up in the title, “Hey, PC guys. Get over it.”

  11. John Lynn says:

    It’s amazing that putting together the form factor, 3G and wireless connectivity, an accelerometer and a nice touch screen interface could cause such a change. That’s exactly what the iPad’s been able to do. I’m sure we’ll see even more over time.

    John
    http://www.healthcarescene.com

  12. FDA 483s says:

    I know of one large MD group that decided to forgo the iPad in favor of netbooks because their EHR/EMRs don’t support touchscreens yet. All just a matter of time, though…

  13. Naomi says:

    I think the IPAD is light-weight and better than carrying bulky books or papers. Publishers love the IPAD – they can sell ebooks, news, etc. without ever printing anything and having to pay for ink/paper/print-workers etc. Have you also considered Android? It is less restricted than the controlling Apple universe even though it doesn’t have as much style (just yet) I also have a blog at get into medical school if you are interested.

    Naomi

    Have a good day,
    Naomi

  14. “Could Apple impose a similar “tax” on health care services and products (admissions, ER visits, devices, pills, tests, etc.) ordered by doctors using their iPad platform? Why not — its THEIR platform. ”

    Yeah…I HIGHLY doubt that. If they were ever to impose such a tax, I would slowly be losing hope in my own country. We seem to want to take everything. I’m not a doctor, but I’d strongly be against this sort of taxation.

  15. [...] And despite all these great things, iPad gives more. What more can you ask from a 499 Apple device? iPad is perhaps not only the most hyped device in recent history, but is also a device that has cau…at you can tell who love and who hate iPad. On one side, the techies hate it. They hate the fact [...]

  16. Hello There. I found your blog using msn. This is a very well written article. I’ll be sure to bookmark it and come back to read more of Doctors Love iPads. What Does it Mean? What Does it Mean? | The Health Care Blog . Thanks for the post. I’ll definitely return.

  17. [...] Currently, there are tons of medical apps being developed for iPad and according to John Moore, nearly every EHR (electronic health record) company has an iPad App, or is in the process of developing one. read more… [...]

  18. Simon says:

    We use iPads for meetings and this is the way technology is going. On iPads now we can use iCloud which allows you to run applications from a cloud. This means that you download them to your cloud and can run them from your phone and ipad, it’s great. More and more doctors we deal with are using iPads and the applications they come with. Traditional working pc’s and laptops will become a thing of the past and people will simply hook there iPad to a screen and a keyboard shortly. Also using iPads on the move allows these doctors to research things at the touch of a button. At Sciquip we have noticed one other thing to, and that is when we send meeting invites out doctors are accepting them via iCloud.

  19. Danial Garcia says:

    If Apple doesn’t adapt to the changing environment of technology then it may soon find itself outdone by android phones which are cheaper and don’t run proprietary software for everything. Just a thought!
    http://www.docboard.org/ok/ok.htm

  20. This particular is definitely an great site you’ve going here. The difficulty is extremely beneficial along with immediately to the level. Thrilled to read simple things more details on your blog the next occasion.

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