The iPad in Healthcare: A Game Changer?


There have been a lot of discussions on the Net regarding the potential impact of the iPad in the healthcare sector.  At this point, there is very little agreement with some pointing to the ubiquitous nature of the iPhone in healthcare as a foreshadowing of the iPad’s future impact, while others point to the modest uptake of tablet computing platforms as a precursor for minimal impact.

Our 2 cents worth…

We believe the iPad will see the biggest impact in two areas: medical education and patient-clinician communication.

The iPad’s rich user interface, native support for eReading, strong graphics (color) capabilities, ability to use various medical calculators (there are a slew of them already in the AppStore) and numerous other medical apps (most of these are iPhone apps and will need to be updated to take full advantage of the iPad’s larger 9″ screen) provides an incredibly rich ecosystem/learning environment for medical students.  Nothing else comes close – a slam-dunk for Apple.

That rich, graphical user interface, it’s inherent e-reader capabilities and portability also lends itself as possibly the best patient education platform yet created to foster patient-clinician interaction.  At bedside, a clinician has the ability to review with a patient a given treatment, say a surgical procedure, prior to the operation showing rich anatomical details (e.g., a patient’s 64 slice color enhanced 3D CAT scan), potential risks, etc. Heck, one could even show a video clip of the procedure right there on the iPad.  Now that is cool and sure beats the common approach today, some long lecture that oft-times is difficult to follow.

Beyond those two compelling use cases, other uses in healthcare for the iPad include its use by nurses and hospitalists to provide bedside care, tap multiple apps (hopefully multi-tasking will come in OS v4.0 to be announced on April 8th), in an intuitive environment.  As to how the iPad may extend beyond these limited boundaries for support of say charge capture and CPOE remains to be seen but in the immortal words of many an Apple iPhone advertisement:

There is an app for that.

And based on some of our initial conversations with mHealth app developers, many are already working on just these types of applications for the iPad, which they hope to bring to market within next several months.

One thing is certain, from at least one data point we received this past weekend, there is strong, initial interest in the medical community as to what the iPad may facilitate.  Speaking to one of the technical folks at the local Apple store this past weekend we learned the following: Of the 1,000 iPads sold on Saturday (this store did sell-out), 700 were sold off the floor and 300 were reserved for business customers.  Of those “business customers” a significant share of those 300 iPads (north of 30%) were sold to local medical institutions.

One of those local healthcare institutions appears to be Beth Israel Deaconess Medical Center (BIDMC) where an ER doc has provided his own iPad review, based on actual use during a shift.  Particularly like his comment about using it for patient education.  Might the iPad truly bridge the information gap between patient and clinician?  One thing is for certain, it will make it much easier for patient and clinician to confer over a given diagnosis, results and creation of a treatment plan with supporting documentation/graphics.

Read into that what you may but one thing is for certain, there is significant interest in the healthcare sector to at least understand how the iPad may be used within the context of care delivery in a hospital.  It remains to be seen as to how end users will actually use these devices and what apps will be developed to serve this market (might Epocrates see stronger uptake for their EMR on the iPad vs. the iPhone?) that take advantage of the larger, 9″ screen, but based on what we have experienced with the iPhone, there are likely more than a few developers right now working on novel applications that clinicians will find valuable. Question is: Will they be valuable enough to augment the extra weight and volume of lugging the iPad versus a smartphone?

Only time will tell.

That being said, based on initial impressions of physicians, such as the one from BIDMC (see above) and our own limited experience in using the iPad this week, the iPad is pretty incredible and could usher in a whole new approach to healthcare IT (interfacing to and interacting with an EMR/EHR system) that may result in physicians adopting and using such technology, willingly.  Could we even go so far as to say that the iPad will be a bigger contributor to HIT adoption and use than the $40B in ARRA funding that the feds will spend over the next several years as part of the HITECH Act?

Again, only time will tell.


Some other perspectives on the iPad in healthcare:

Article in HealthLeaders with some interviews with med professionals buying an iPad at Apple store in SanDiego.

ComputerWorld article looking at various business sector (including healthcare) uses of iPad.

Post by iPhone iMedicalApps on some of the current challenges for those adopting an iPad for medical use (virtually all the problems listed will be resolved within next few months)

Another post, this time at iPhoneCTO looks at the iPad in the med space for workforce mgmt.

John Moore is an IT Analyst at Chilmark Research, where this post was first published.

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15 replies »

  1. Todd, does the fact that you are the VP of Sales for M2, developers of MicroBloggingMD, factor into your detailed analysis?
    While it is true that the iPad is available with wireless (and now cellular) connectivity, this should not lead one to believe that all mobile use cases are created equal. Hospitals have not uniformly adopted strong wireless networks, to say nothing of physician practices who often cannot afford to install and maintain a stable wireless environment. Furthermore, physicians are constantly on the go, from office to hospital and everywhere in between. This creates a need to access data synchronized and encrypted locally on their device, allowing them to review and make treatment decisions from literally anywhere, anytime.
    There are many reasons why one would choose access via mobile app over a browser requiring constant connectivity, performance and user experience chief among them. There is a reason why users opt to access their favorite content via apps provided by CNN, AP, ESPN and countless others instead of using their mobile device browser. And companies would not elect to invest in the R&D resources to develop apps if they did not feel their users would benefit from the app experience as compared to mobile browser.
    There can be no doubt that device form factors, browsers and connectivity has and will continue to improve – the iPad is perhaps the biggest and best example of this. It’s for this reason that PatientKeeper provides access to aggregated health information via both native apps AND mobile browser. While the aforementioned benefits of a native app remain, there are benefits to browser access, including administration and management of a large staff of remote users with individually-owned devices.
    The bottom line, limiting provider access to either apps OR Browsers is a limiting approach. Improved device, application and network quality together will contribute to the sizeable and growing impact of mobility on physician adoption of healthcare IT.
    Heath Umbach
    Product Marketing Manager, PatientKeeper

  2. iPad apps can as well be a splendid example of healthcare services ad kit. While waiting at some healthcare facility one can browse through pages representing filled teeth, corrected noses etc. In general, it will suit more beauty surgery or dentist practice where rich content is more important, but again poopularity of Apple’s platform and iPad hardware in particular depends on the iPad application development and those apps that foster the demand for the gadget at some particular target fields

  3. With multiple handsets and now the iPad in the wireless arena, the “App” concept seems very limited and narrow.
    The technology to embrace mobile healthcare has been around for sometime. Recently I checked out two mobile software solutions, Patient Keeper and MicroBloggingMD and after a detailed analysis, I am leaning towards MicrBloggingMD.
    They do not use an “App” to access patient data but rather they use an IP address to work on any internet browser. No need for an “App” you just bookmark the IP then log into the solution and you can access patient data.
    The best part is you can sign off on all the patient data from your iPhone (Or Android Phone, which I have) without having to log back into your clinical solution to do so.

  4. The issue has never been the end user device, it has been the software that the physicians and other care providers are stuck using. Almost all EMR’s are based on a billing cycle because they grew out of companies that were billing based. Even today, when you look at an EMR is a mirror of the paper chart.
    Paper charts take a significant amount of time to sort through to see your data. As a former CIO of a large healthcare organization I struggled in finding good solutions for my physicians. I came across MicroBloggingMD and have found that physicians access sky rocketed in its use. It runs on ALL Apple products and any other Smartphone.
    The solution is the right software on the right platform.

  5. It never came to my mind that iPad can be used in medical area but I must agree with your article, yeah it can be a great help but the question now is – will there a budget for this and are we to expect developers to give their support?

  6. Implementing new technology is the key to success in medical business. Maintaining the medical records of the patient as Electronic Medical Records (EMRs) is one of the recent technologies that would help the growth of the medical business.

  7. I think this blog from John Murrell expresses the problems well. We should all be very careful. Apple is creating a walled garden where the consumer’s job is to send money to Apple.
    “Apple giveth and Apple taketh away
    “So it turns out that while Steve Jobs was out on stage Thursday generously granting some of the wishes of his various iPhone OS 4.0 constituencies (like multitasking of a sort, an ad platform, and a big helping of new application programming interfaces), behind the scenes, Apple was further tightening the straitjacket that it requires app developers to wear. And the new restrictions, among other things, make it clear that Apple’s refusal to support Adobe’s Flash is not a beef with the technology but with Adobe itself and anyone else who dares try to worm their way into the walled garden.
    “The latest version of the iPhone Developer Program License Agreement includes this little clause: “Applications may only use Documented APIs in the manner prescribed by Apple and must not use or call any private APIs. Applications must be originally written in Objective-C, C, C++, or JavaScript as executed by the iPhone OS WebKit engine, and only code written in C, C++, and Objective-C may compile and directly link against the Documented APIs (e.g., Applications that link to Documented APIs through an intermediary translation or compatibility layer or tool are prohibited).”
    “This means that not only must developers create apps that meet with Apple’s approval in matters of taste and function, they must create them using only the tools specified by Apple rather than the tools of their choice. And it means that developers who want to use tools that let them create an app for multiple platforms and then run it through a cross-compiler to produce an iPhone-compatible version are also out of luck.
    “Hardest hit by this looks to be Adobe, whose Flash platform is widely used for video, games and ads across the Web but has never been supported on Apple’s mobile gadgets, putatively over its technical shortcomings. To get around the ban, Adobe is just days away from releasing Flash CS5, which features the ability to translate a Flash app into code that was, until now, acceptable in the App Store. Where this leaves Adobe is still uncertain, but the word “hosed” comes to mind. In fact, in a new SEC filing today, Adobe for the first time mentions this risk factor: “To the extent new releases of operating systems or other third-party products, platforms or devices, such as the Apple iPhone or iPad, make it more difficult for our products to perform, and our customers are persuaded to use alternative technologies, our business could be harmed.”
    “It’s going to be hard for Apple to credibly justify this on the grounds of quality control or optimal user experience or anything other than the desire to cement its current mobile dominance. As Daring Fireball’s John Gruber wrote, “The idea though, is to establish the Cocoa Touch APIs and the App Store as a de facto standard for mobile apps — huge share of both developers and users. So what Apple does not want is for some other company to establish a de facto standard software platform on top of Cocoa Touch. Not Adobe’s Flash. Not .NET (through MonoTouch). If that were to happen, there’s no lock-in advantage. If, say, a mobile Flash software platform — which encompassed multiple lower-level platforms, running on iPhone, Android, Windows Phone 7, and BlackBerry — were established, that app market would not give people a reason to prefer the iPhone.”
    “Needless to say, this has not gone over well in some quarters of the developer community. “So much for programming language innovation on the iPhone platform,” said Joe Hewitt, developer of the Facebook iPhone app. “I’m upset because frankly I think Objective-C is mediocre and was excited about using other languages to make iPhone development fun again. It’s so hard to reconcile my love for these beautiful devices on my desk with my hatred for the ugly words in that legal agreement.”
    “Oh-oh, Hewitt may have just violated another section of that agreement: “Press Releases and Other Publicity. You may not issue any press releases or make any other public statements regarding this Agreement, its terms and conditions, or the relationship of the parties without Apple’s express prior written approval, which may be withheld at Apple’s discretion.” As always, Apple customers and developers, you play it Steve’s way or you don’t play.”

  8. Mark, you’ve outted yourself as someone who reads anti-fanboi blogs and hasn’t actually used or built anything on this platform. Regardless of Apple’s walled-garden approach, the fact remains that they’ve set the tone for everyone. Timing is everything. The tablet’s time is now. In 2 years, everything in mobile computing will look just like this. Apple is the Ducati of computing.
    The “weakened” hardware is on purpose. It enables Apple to reap revenue from interest in the device. They will add a camera. They will add other things. You will buy every version. This is the same strategy used with the iPhone. It didn’t stop it from changing the way we use phones. It validates them as leaders in the space. Everyone will be perpetually catching up. It’s the brilliant part of Steve Jobs that no one really notices.
    Developing on these platforms is trivial. You can have a simple app up and running in about 20 minutes. Objective C is not klutzy. It was around before Java. The stuff that gets rejected by the App Store is mostly because it’s garbage. Most developers have no trouble getting their wares through the process. I’ve seen one app get approved in 4 hours. It’s had hundreds of thousands of downloads. There’s never been a more fluid and rewarding market for a developer. Ever.
    How this gets used in health is another story. I think John Moore focused on all of the obvious stuff. That is a typical industry viewpoint. How does this game changing platform give me more of what I already have? Boring. What’s more important is to think about how this thing will give us something that we haven’t even thought of before. It will likely disrupt more of the examples that John gives than actually accelerate any of them. That I am greatly looking forward to.

  9. Yesterday, Apple’s unveiling of the new OS for iPhones and iPads came with an announcement of multitasking support. The new OS V4.0 also includes improved security features for enterprise use of these devices. These new features enhance what is already an extremely nice platform.
    As for webcam, just don’t see the need in most healthcare scenarios – the desktop will work fine for that.
    Nick, an ER doc has also done a nice review of the iPad which can be found at: http://www.epmonthly.com/features/current-features/how-the-ipad-can-change-emergency-medicine/“EPMonthly

  10. Tablet computers have come and gone many times. Each time they are heralded as the second coming ready to take over the world. Each time they retreat to narrow niche markets.
    I don’t see anything different here. The iPad is also somewhat problematic due to lack of basic functions (multitasking and webcam) but the worst problem is that it is totally locked down to a rather narrow arbitrary model that support Apple revenue generation (no flash, only one rather klutzy programming language, difficult to add third party apps that don’t meet Apple’s capricious ‘standards’).

  11. Hmmm. No webcam. No multitasking. Weak WiFi. I’d wait for the next iteration. Sorry.

  12. Wonder how long before someone tries to get one reimbursed under their section 125 plan as a medical expense?