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Why the iPad Matters (For Healthcare)

By THOMAS GOETZ

Thomas goetzIn case you’ve been preserved in amber the past month, there’s been lots of excitement in  technology circles about the iPad – as well as other tablet computers – and how they’ll transform (take your pick): games and word processing and movies and magazines and newspapers and music composition.

But there hasn’t been a great deal said about their possible usefulness in healthcare.

In truth, healthcare has a horrible record with technology. Medical technology, after all, is one of the principle reasons that annual healthcare costs in the U.S. are at $2.5 trillion, and climbing. The CT scan may beguile radiologists and diagnosticians, but it’s also a horribly inefficient technology (it doesn’t scale, there’s no price transparency, etc.). In short, everything that technology is good for in the rest of the universe – lowering costs, reducing expertise – it has exactly the opposite effect in healthcare and medicine.

There have been attempts here or there to introduce consumer-style tools to medicine. Dozens of companies, for instance, offered versions of the Palm Pilot that promised to recognize a physician’s unique needs. But too often these one-off gadgets fell into the wrong quadrant of the efficiency and expense matrix. And the fact that pagers are long dead in every corner of the world except in hospitals serves as yet more proof that healthcare is a bizarro world when it comes to technology.

And consumer-facing tools have fared just as poorly. Fancy set-top boxes that promise to connect patients to their doctors via telemedicine, and cumbersome monitoring devices for people with diabetes or other chronic conditions haven’t exactly inspired confidence.

So: enter the iPad. Does it have a chance?

Yes, and for two reasons. The first is this: In the past healthcare technology has always been about the hardware – building a box that promises to do something, and then trying to educate patients or providers on how to use the box. That hasn’t worked because of bad interface design; the mission was complexity, not simplicity. But the tablets, and the iPad in particular, are designed to be as simple as possible (just one button). They’re not really about the hardware, at all – in fact, if these tools work as promised, the hardware disappears. The device will let users engage with information immediately, without having to negotiate a cumbersome interface. Indeed, the device itself vanishes and the user connects directly with the experience. That’s a powerful shift, and it has great potential for health.

Because the iPad has a multi-touch screen, it becomes an immersive experience, where gestures replace keyboard clicks. The significance of this shift can’t be overstated, and the iPhone has given us a taste (though not the sweep) of what that means. Gestures become visceral, and there’s far less “friction” to the process. For patients and providers alike, this is a huge leap. The learning curve for new devices will pretty much vanish with an iPad, and all sorts of information – scans, charts, home monitoring data – can be engaged with directly.

And that takes me to the second reason the iPad could be transformative: the software. The iPad and other tablet software will have to be simple and intuitive, by design. A keyboard device lets software coders get messy; they can rely on F-keys and keyboard shortcuts to channel readers. But with a touch-centric device, the software will have to work like our brains work – through a series of intuitive motions.

The iPhone app store has done a terrific job introducing a new aesthetic to software, one that’s fluid and fun (albeit walled-off). The iPad and its ilk should only enhance this aesthetic.

So it’s got good hardware and good software. But what’s that have to with healthcare? Well, it seems to me that the iPad – with it’s seamless hardware and intuitive software – will be a terrific way to engage individuals in health information that’s relevant, timely, and meaningful. If the Web excels at delivering general information in massive doses, my hunch is that the tablet will improve the process – in a sort of Information 2.0 way – and the software will tailor and personalize information so that patients can go on fact-finding missions and find relevant facts. IPhone apps like Lose It! and BabyBump are already laying the groundwork for this approach by letting people calibrate their health decisions to their specific circumstances. The iPad et al should be able to do the same, but with a larger more captivating and immersive presence.

I’ll go farther: when the iPad includes a camera – as it inevitably will, down the line – it suddenly will make telemedicine possible. It’ll also make it easier for individuals to track their health records, including images, because we’ll have an easy way to view an interact with our information.

And simplicity is recursive here, so that a simple interface will allow populations that may’ve been intimidated by a computer/keyboard to engage with information technology. Meaning older populations, meaning people with chronic conditions, meaning the population consuming the majority of our healthcare spending. If the iPad can engage these people on better treatment and behaviors, the savings – in terms of dollars and lives – could be radical.

Yes, this is a slightly optimistic forecast – and it’s worth noting that I, like everyone else, hasn’t actually laid hands on a device yet. But the first signs are encouraging. In the tablet computer, instead of a device made by healthcare, we may have a device that works for healthcare. And that distinction could be a world of difference.

Also by this author on THCB – “Why Calculators Are the Future of Healthcare

Thomas Goetz is the author of The Decision Tree: Taking Control of Your Health in the New Age of Personalized Medicine. The executive editor at Wired Magazine, you can follow him on Twitter at twitter.com/tgoetz.

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31 replies »

  1. California Medical Board (MBC) has a massive budgets of Millions of Dollars but this budget is spent to increase the cost of Healthcare delivery and worsen the quality of Healthcare delivery to the PEOPLE. An urgent reform of the Medical Board of California can redirect these funds to benefit the public, healthcare and medical practice in our country and eventually solving the Healthcare Crisis dilemma our country is facing. It is questioned as to how the massive budget of the Medical Board of California is being spent. Many have suggested that the Medical Board of California is not doing what it was initially established to do and others are even accusing the members of this organization of all types of unethical or even illegal activities.
    What is clear is that any person can complain to the California Medical Board even without a legitimate reason. Any complaint is enough to start an investigation by the Medical Board of California. Once an investigation is started however, very often the physician ends up getting some kind of probation/letter of reprimand or other disciplinary action filed against their license. The question is how much does it cost the Medical Board of California to conduct an investigation? Most likely hundreds of thousands of dollars are spent on each investigation. Is there sufficient data to suggest that this huge expense is justified? Is there a direct relationship with the activities of the Medical Board of California and improvement of the standard of Medical Practice. Many suggest that actually the opposite is true. It is suggested that the Medical Board of California has resulted in a massive increase in the cost of healthcare delivery and is decreasing the availability of healthcare to the people. Tens of hospitals have gone bankrupt and hundreds of physicians have stopped practicing their specialities. this has resulted in a worsened healthcare crisis whiz continues to hurt PEOPLE every day.
    In addition the field of medicine is a relatively lucrative business and is extremely competitive. Frequently business managers try to employ aggressive and even unfair business practices such as referring other physicians to the CMB for investigation knowing that an investigation by the CMB will result in loss of time, money and resources for their competitors. Attorneys also utilize the threat of investigation by the California Medical Board as a leverage to settle baseless malpractice cases in their own benefit. This will obviously increase the cost of healthcare delivery to the PEOPLE and decrease its availability hence worsening the healthcare crisis we are all suffering from as a nation. If this is true; should Medical Board of California’s existence be permitted to continue? Should Medical Board of California be allowed to cost our PEOPLE Millions of Dollars per year?
    Since the CMB utilizes Administrative Basis of Evaluating Complaints there are very minimal and frequently vague and rarely objective guidelines to evaluate the conduct of the physicians. These guideline are often interpreted subjectively. Further, there are clear political ongoing issues between rival specialties. The EXPERT physicians that are hired by the Medical Board of California are usually of one particular specialty and depending on which specialist’s files they review, there is a great deal of BIASED judgment that they are able to exert. As expert witnesses they are considered immune by the law. This unfortunate situation has continued for years and now has become a simple means of unfair-competition frequently being used by certain specialties against others. If this is true; should the PEOPLE finance such political battles and self serving activities?
    Medical Board of California utilizes a hybrid of Administrative Law and Criminal Law to POLICE AND DISCIPLINE THE PHYSICIANS. To complicate the issues even more, unfortunately there are many limitations that are put in place by administrative-law on the individual being investigated. For example in criminal law a suspect has the right to an attorney and if he/she cannot afford one; one will be assigned to him/her by the State at no charge to the suspect. Further a suspect is considered innocent until proven guilty in a criminal case. In administrative law such guidelines do not exist. This results in frequent accusations that end up in disciplinary action despite the professionals’ innocence. Obviously; if a physician is forced to hire and pay for his/her own legal defense against the ever-increasing threat of Medical Board of California; this huge expense has to be passed on to the PEOPLE who pay for the physician’s services.
    It is needless to describe how stressful and anxiety provoking the experience of investigation by the California Medical Board and the risk of loss of license and the ability to earn a living is for a physician. The ongoing liabilities; frustration with difficult work experiences; poor quality of life; decreasing income and many other negative experiences that physicians have been suffering from has resulted in tremendous dissatisfaction and anxiety for healthcare professionals. The increasing suicide rate of physicians; low life expectancy rate; poor quality of family life further make the healthcare field less attractive for young students. Many healthcare professionals are leaving the field or are encouraging their youngsters to enter other fields outside of healthcare and as a result we are facing terrible physician shortages throughout the United States. If the California Medical Board and other agencies that affect the practice of medicine in our country fail to reform their actions, the frightening physician shortages that threaten our country is expected to worsen and will make the current healthcare crisis even worse. If these allegations are true; doesn’t it make sense that California Medical Board is most likely contributing to the lack of availability of affordable healthcare for the PEOPLE?
    The very frightening and sad realities of Healthcare Crisis which are mostly caused by the Medical Board of California can be confirmed by an online search. We encourage ALL PEOPLE to undertake the responsibility of researching the Negative IMPACTS OF THE MEDICAL BOARD OF CALIFORNIA ON HEALTHCARE DELIVERY AND ON PEOPLE and take decisive action in reforming the Medical Board of California as soon as possible.

  2. ths definitely is an optimistic take on what iPad might do for healthcare provided people in the group you mentioned (w/chronic conditions, older pop, etc) actually get the device, or at least access to it. I’m not so sure that wil happen.

  3. Thank you very much for this insightful article on the use of the iPad in healthcare applications. All progressive and forward thinking components of the country’s health care delivery system needs to be figuring out ways to use readily available technology to deliver ever higher levels of quality care and client service!

  4. This might be a revolutionary but costly update. High switching costs in a struggling industry may not be a viable option. But this is a very innovative use of new technologies!
    -Stephanie
    Follow me @L2_Pharma!

  5. As it is, people are already searching the internet more than going to see their own doctors for solutions. Why? May be due to various factors. Perhaps high cost health insurance, mistrust, etc. The iPad is just another avenue into technology and its combined source of medicine for people. Thanks to Apple.
    http://www.karowhomecare.com

  6. I tested using latex gloves on the Droid and on an iPod and I could not observe but a slight difference in operability but nothing significant.
    The Panasonic Toughbook has an anti-bacteria coating of some sort (I don’t know all the details but this is what Dr. Val reported at HIMSS10). This would be a necessary feature for the iPad for clinical use.
    Just an update to something I mentioned in my previous post.
    Thanks,
    The EHR Guy

  7. While my visit to HIMSS 2010 I had 2 terrible experiences: First, my Droid was discharged by noon and I left the charger in the hotel room. Then I had to carry my laptop with me which was painful and I had to recharge it several times in the day since I didn’t take spare batteries.
    Immediately I thought about the iPad. I said to myself: “this is what I need, lighter than a laptop and larger than a Droid phone, it’s the middle lane”. So I will definitely buy one as soon as it hits the market or a few months afterwards.
    But I’ve been thinking about the clinical use of it after a twitter friend mentioned that clinicians wearing latex gloves will not be able to operate it. If this is true than I doubt it will be a useful tool for them.
    Biometrics have failed to be significantly adopted in healthcare because of cold fingers.
    What do you answer to this?
    Thanks,
    The EHR Guy

  8. Interesting points. In particularly with regards to the importance of software in driving better healthcare. Information technology has the potential to improve efficiency and ultimately allow providers to deliver better healthcare to patients. Some of the major healthcare systems that have got it right are the Hong Kong Health Authority or hospitals such as Asklepios Kliniken in Germany, St. Olav’s Hospital in Norway and Georges Pompidou Hospital in France.
    It is worth mentioning that standards can play a key role in increasing the ability to implement eHealth solutions more broadly and efficiently, and to get the most out of innovative software.
    This is for instance recognized in the recent US HHS’s Interim Final Rule (IFR) for Initial Set of Standards, Implementation Specifications and Certification Criteria for EHR Technology which was published in December 2009. The IFR proposes adoption of standards for Healthcare IT and essentially works as a guidebook for developers and vendors who want to be eligible for compliance with the “meaningful use” definition. The upcoming online forum about eHealth and standards on February 25th, 4-8 pm GMT on http://www.talkstandards.com might raise some of these interesting points.

  9. The iPad is nothing new. Good quality tablets have been around for years. I bought a Lenovo ThinkPad tablet a few years ago. An outstanding product.
    PDAs, which are on the smallest end of tablets are too small for anything other than very simple applications. Not that the OS or applications have to be limited. The size of the screen is the issue.

  10. Is this a re-post from 3 days ago or was the article changed? Or is the THCB jiggering their headlines for more page views? Say it isn’t so THCB.

  11. Let me open by saying that I agree that the health care sector needs to, and slowly is, migrating towards a better electronic environment. However, I do disagree that the iPad is going to be a silver bullet that is going to suddenly cause a paradigm shift.
    You neglect to mention that the technology that is included in the iPad has been commercially available for years now. My GP uses a tablet PC for entering notes, tracking things during my wellness visits.
    You say “when” a camera is available it will make telemedecine possible without acknowledging that it is available now! Throughout your article, you continually neglect to mention that this “technology” that the iPad is bringing has been commercially available for years.
    These devices can do everything the iPad does and more and are not locked down by a very protective company. The lower resolution screen, the lack of a physical keyboard, the inability to run more than one program at a time, the lack of any real development that can be made due to protection from Apple…these are all things that are going to keep the iPad (I STILL can’t believe they actually called it that) from having an impact in the health sector.
    I think it’d be a sweet device to have sitting next to the couch to browse the web or look up recipes, however it was not developed to, and will not, be a successful tool in health care.

  12. Great Article! New horizons have been opened with the new screen size, that will provide a great platform for a “digital clip board”, to be used by professionals while on their feet…

  13. Just so you don’t feel lonely, rbar, I’ll jump in. The iPhone was a very cool looking device that did more than any other phone on the market, so it was a game changer to a certain degree. The iPad is a very cool looking device that does less than any other tablet on the market, so it will not change anything much.
    I agree with Matthew about the keyboard. I can’t really type on my iPhone either. And how do you type on the iPad? with your thumbs? With one hand, while holding it with the other? Do you place it flat on a table? It’s really not a very good input device. It would be nice for reading news and surfing, but since it won’t fit in my pocket and you have to have network connectivity, I can only take it where I would be able to take a tablet or laptop. I can’t envision executive meetings where people type on an iPad under the table…
    As to healthcare, maybe consumers will use the iPad, assuming they have enough cash leftover after paying their premiums and copays and coinsurance to actually buy one, but I’m afraid that the IT problems plaguing healthcare are not form factor related.

  14. Do I always have to be the party pooper? I don’t necessarily enjoy that.
    This post is a typical example of technological hype on THCB. It is funny how many health care professionals go along with that – isn’t it obvious that IT, on its own, does not cure people? Lifestyle, time, surgery, medications, procedures and various therapies can contribute to someone staying healthy or regaining health. Sure, IT can help tremendously, in form of optimal organization of medical data, and maybe – to my understanding rather in the future – with decision support software (and of course there is imaging software, which is a very targeted application). But before praising any kind of gadget in general terms, better explain very precisely what it is able to do, and how this potential application could improve outcomes.
    The remark re. pagers is a stereotype for the gullible. How many patients want their docs to have their cell phones on all the time? Yes, you can put them on silent/vibrate and return missed calls later, but then one would need separate lines/phones, one from the hospital and one private, because hospital pages have priority.

  15. Tablets – Nah. Hype for 20+ years that will continue to be that in healthcare. If doctors have to carry around something that large, why not just go to a workstation?
    The innovations have been and will continue to be in PDAs which now has ~60% penetration among physicians and is expected to be around ~85% in just 2-3 years. It really has become a necessity for a number of medical specialists who normally aren’t based in the hospital but wind up being there an awful lot (e.g., OB/Gyn, etc).

  16. While I’d like to believe the iPad could help a private practice, the reality is this: until the EHR vendors give a hoot, it won’t matter.
    Most major EHR vendors are sssllllllllowwwwww to do anything.
    Example: Major EHR vendor – software NOT compatible with Windows 7 – HELLO?
    Combine this with what I would expect to be weak battery life and the iPad will only have extraneous use in a medical facility.

  17. I love Tom making forecasts about a device no one has yet seen! I’m a touch cynical about the iPad speaking as someone who has really struggled typing on the iPhone. I think that there are two separate markets for a tablet/pad/whatever
    1) The professional–my sense is that tablets have had trouble because they don’t have a keyboard. Most professional use is either reading for which an iPhone or lookalike works fine, or requires order entry–for which the iPad keyboard doesn’t work. I’m not sure this is a solvable problem
    2) Patients–if the iPad gets mass adoption it’s likely to be a channel for persistent viewing & reading. So the iPad will be part of that. But so will TV, wifi enabled picture frames, screens on the fridge, et al. Touchscreens for seniors and others will be important components of that for communication as well as information. But I’m not sure the iPad is enough for that. But we’ll see!

  18. Mark – just to clarify, though the iPad is getting all the attention, I’m not *just* talking about that one piece of hardware. There could be as many as 30 tablet computers out this year, and Apple’s limitations – no video cameras, etc – offer an opportunity for these other manufacturers to make a better device.
    So my post should be read as a musing on the tablet as a platform, not about any single device.

  19. This is interesting and I think the iPad could have some influence in some settings, but as an interface unit, it does not solve the underlying architecture problems that have been stunted HIT adoption, namely – information interoperability, and issues dealing with privacy, safety and confidentiality. A doctor can have a beautiful tablet to use, but it is useless if the information it contains is still not integrated across the care spectrum and is plagued by informed consent clauses that freeze data wherever it is created.

  20. From January 28th 2010
    The net effect that devices like the iPad will begin to have on health care and the information technology market as they begin to provide access to information that many of us in this industry have been preaching for the last 20 plus years.
    Consider that what seems like just a few short years ago in 1972 the first mobile phone call was made in New York City and today we have over 270 million subscribers to various carriers for cellular service. This is by far the most disruptive technology in the history of our country and most assuredly the world. Not the Television, not the Internet not even the Personal Computer can compare to the pace and the socio-economic penetration that this device and service has had on the world. From the farmer in India who earns less than $300.00 dollars a year in income checking grain prices on his mobile to the Wall Street executive managing his client’s portfolios from his mobile between meetings. Never has there been such a disruptive technology. In addition, it would seem that the market is just getting started in this area of innovation with introductions such as the iPad this past month. The “Brick” phone with a battery in a satchel is not that far back in our history when you consider the advanced handsets of today.
    There are also market shifts with respect to Health Care Information Technology that are also important to mention. For the last 20 years as I and many of my colleagues have traveled the around the US and the globe we have all heard some of the same statistics quoted about the adoption of health care IT in the United States and what a positive impact this can have on the quality, cost, and access to health care services. The overwhelming favorite claim is when a particular vendor promises that their technology will statistically change the cost and quality of care. However when asked for any studies they can only produce literature search material and no real empirical evidence? This point no withstanding there are many impressive and powerful software applications on the market and being used by different segments of health care throughout the United States and newer packages being offered almost every day that do provide positive changes in the health care process and in many cases patient care. Consider EPIC on the iPad and WellDoc’s disease management platform for the mobile phone as great examples of advancements and innovations.
    The convergence of devices like the iPad, Dell Netbook, and HP Touchsmart products with 3G/Wi-Fi services that allow access to information anytime, anywhere that have and will continue to shape our lives and how we live day to day. The speed at which applications can be developed, implemented, and integrated in this new environment leveraging the Web 2.0 infrastructure is less than half the time than the older development paradigms. This will now empower New and Incumbent health care information technology vendors to remove the shackles of old development life cycles and begin to innovate almost at the speed of thought. This will have a greater impact on cost, quality, and access to health care than any legislation could ever hope to achieve. The issue is how and when. This evolution is not limited to Electronic Health Records, Personal Health Records and content provisioning services that seem to monopolize the news media but it goes to the heart of all health care processes that desperately need re-tooling.
    As has been presented on this and other Blogs in the past it is imperative that the information technology industry begins to address the paper bottlenecks that continue to thrive in the current health care process. Even with the advent of electronic claims filing as part of the recent reformation efforts when a claim is denied or pended by the payer for any reason often times this drops back to paper. Personally, the number of EOB’s I file on a yearly basis is overwhelming and that is just for routine care for my family. Imagine receiving a message on you mobile phone that a claim has been filed against your new high deductable insurance plan which you can then access your health saving account and authorize payment all without leaving the meeting you are attending with your boss. The physician is paid immediately, no claims process for routine care, which saves frustration on the patient’s side, saves money for the physician, and helps them to regain control of their A/R to some degree. I do not want to trivialize this process there is far more going on here than has been presented but compare how far we have come with new technology to how far we have come with the health care payment process, Is it not possible? This is just one process, add to this the availability of private health information via your mobile device securely and we will begin to see impacts on quality just by having simple access when needed to medications, disease management services, and health coaching to name a few.
    The point here is simple, the personal computer and the mobile phone are on a collision course and soon we will manage more and more of our lives with these new personal lifestyle management devices. The development environments and the markets for these new devices have already moved away from license software to open source and from purchasing hardware to accessing services bureaus and using SaaS offerings on an “as needed” basis. All of these developments will place pressure on the health information technology vendors of today to innovate at a more rapid pace and provide applications as part of a service and not an implementation. Those who do not see the convergence of technologies and the lifestyle changes taking place in the market will not make the turn. Those who recognize the coming shift in consumerism in health care and with that the demands for speed and instant access will begin to innovate in this new environment and will begin to shed some of the proprietary methods used to generate revenue in the past and move towards service provisioning.
    In conclusion the iPad may have it’s critics as the iPhone and like innovations have had however you cannot deny the profound impact they have and will have on the way people think and behave in their everyday lives. Innovations such as these are market changers and the new market at the table is health care. Although many may see the iPad as a consumer product, it will have a substantial impact on the way we manage our health care in the future. Those who see this shift will enjoy success and those who do not well they will end up in the bottom of the closet so to speak right next to the BETA MAX VCR and the land line phone. Consumerism is coming to health care and health care information technology will have to change to accommodate this shift and survive.
    Frank Avignone

  21. I think you summed it up well when you said “In the past, healthcare technology has always been about the hardware…” You rightly point out that is should be about the software and software design.
    Unfortunately, you then decide that a particular piece of hardware is the answer. A tablet format could be useful in medicine and indeed, various tablet formats have been tried. For the past 20 years tablet hardware has been heralded as the “next big thing”. The usual hype cycle applies and then fades in the face of hardware and software limitations.
    Technology marches on and now we have faster, cheaper tablets that may prove useful… if they have the right software.
    I understand that you are enthusiastic about the iPad (terrible name) even though only a very few people have actually used one.
    Software design is complex and it is difficult to design “simple” applications.
    The “one button” on the iPad only turns it on and off. You need more than that to make software work. I have found multi-touch on my wife’s MacBook to be anything but “intuitive”. In fact, the learning curve for the Mac or the iPhone/iTouch is about the same as any other computer (and worse when you have to un-learn some “intuitive” actions from other devices).
    I have seen good and bad applications for the iPhone, Android, Java smartphone apps, etc. as well as good and bad applications for their predecessors (Palm, Newton, PocketPC) and their precursors (Windows Tablet PC).
    Yes, tablets have potential but it will be all about the software, not the hardware (which is all very similar).
    The iPad may have a disadvantage with their very restrictive locked-down model of software development and glaring omissions on the first announced hardware design but hopefully these will be addressed.
    It is all about the software. Time for some truly bright people to write some genuinely useful applications.

  22. so clearly there’s enthusiasm about the iPad from the industry side. that’s terrific. I just hope that individuals recognize their opportunities with a tablet computer soon enough.

  23. I generally agree with this post but the applications to healthcare need to take a lead from Panasonic and others that have made the device “tough” to spills, liquids, drops, etc. This will cause the device to explode in markets for healthcare, IMHO.

  24. Agree w/your “hunch” that the iPad “will be a terrific way to engage individuals in health information that’s relevant, timely, and meaningful.” Clearly the device, with its portable/larger screen real estate, will be very easy for caregivers and patients to use to access information right at point of care. You mention iPhone apps that are already out there, but few are focusing on the nexus of caregiver/patient and patient education. Our Blausen Human Atlas iPhone app (www.blausen.com/iphone) does just that w/3D animations of 150 common medical conditions and treatments. The iPad et al will be able to present such rich media learning in a more captivating and immersive environment. The net result for clinicians…better patient education, time savings and reduced patient anxiety.
    Bruce Blausen, CEO Blausen Medical http://www.blausen.com

  25. No one, I hope, is under the delusion that the current system gives their doctor or nurse anywhere near 100% of the information they need now. Edward

  26. I think health care is slow to adapt to new technology because of the sensitivity of the profession. If a writer screws up with an iPad app, big deal. But a doctor, nurse or other physician needs accurate information 100% of the time.

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