After a few years of similar data points, Manhattan Research's Director of Physician Research James Avallone feels confident that smartphone adoption among physicians in the US has plateaued.

"We have seen this number in the low 80s since 2011 -- it's been static," Avallone said. "In 2010 we were at 72 percent of physicians and then the following year we hit four out of five. Since then it's really plateaued at a low- to mid-80 number in terms of physicians using it for professional purposes."

Avallone is quick to point out that high level metric is, of course, only a part of the story. What has been more interesting to Manhattan and others who track the field is the way that smartphones, tablets, and potentially future devices will each fit into a physician's day. 

"We have seen over the past three years how smartphones and tablets cohabitate, which they do very well, by the way," he said. "We've also seen the smartphone become much more of a solid physician accompaniment throughout the course of the work day. It has really cemented itself with its own professional profile of how physicians are using it."

Avallone said that smartphones are commonplace, but tablets are now being used by a majority of physicians too.

"The iPhone is a top device, and it has been so since its inception," he said. "During its first year being on the market, the iPhone and BlackBerry were neck-and-neck for physicians, and since then the iPhone has just really run away with it. Over the years Android devices have taken a strong second spot, but the iPhone has the majority of the marketshare and it continues to."

For a few years now Manhattan has helped nail down exactly how physicians are using their various mobile and non-mobile devices: smartphones, tablets, and desktop/laptops.

"As with any new technology market, there was an adoption period and during those first few years what the device is going to be used for gets set," Avallone explained. "What we've seen over the past two years is that physicians have really started to use the smartphone for what we call 'short burst' activities, or 'two-click' activities. Physicians are not interested in longform type research on smartphones. They're not interested in reading really long emails or clicking through links. They save those for reading on their tablet or desktop/laptop."

Manhattan has also been slightly surprised to find that smartphone screens have largely remained for physicians' eyes only -- few use so-called "swivel apps" to share what's on their smartphone's screen with patients during consultations.

"The smartphone is very physician-facing," he said. "That's become clear over the past few years. When smartphones first came out there was some talk about smartphone having the potential for being turned and shared with the patient. As of 2014 it's clear that it's not happening. Sharing like that is primarily done on tablets and desktop/laptops -- and mostly desktop/laptops because that's where EHRs are most often used. So desktop/laptops have emerged as the patient-facing screens -- the ones physicians share with their patients -- not smartphones."

Avallone said that physicians don't use smartphones for deep research, videos, or anything that involves inputting a substantial amount of information.

"Those activities are left out of the core smartphone profile, but looking up in a drug reference database, checking a quick email, looking up some other piece of information -- that's really where the smartphone shines." 

And while adoption has plateaued, Avallone said the way physicians use smartphones is still changing a little each year.

"We are still seeing slight tweaks in terms of how physicians are using them and the length of time they are using them," he said. "In 2014 we found that physicians are spending more time on their smartphone than they did in 2013. It's interesting that even though smartphones have matured in healthcare it is still being relied upon more this year than it was last year. Part of that has to do with improved technology. Increased screen sizes, faster processors, better technology in general are all playing a role in causing physicians to turn to these devices more and more."

Avallone points out, however, that there is a finite amount of time that doctors have during the day to sit in front of a screen, and since so much of their screen time needs to be dedicated to the EHRs, smartphones are missing out.

"The EHR is the platform that is demanding the most time from physicians in 2014 and EHRs are not that smartphone friendly," he said. "I'm not sure that is going to change in the short term either. That's one of the last pieces of the puzzle though. It's because there is a lot of data input required, which as I said before, is not a particularly good activity for a smartphone's small screen."

Changes in how healthcare is delivered in practice will inevitably change how physicians are interacting with health IT systems.

"Until we see remote care come much more into the forefront, which I do expect to occur in the next few years, the smartphone is going to continue to be at a mild disadvantage," Avallone said. "The smartphone is a device you have on you all day. It's there when you need a quick update on something, and that could be how remote care is managed in the future -- through quick updates on patients. If the technology comes together on that, that could be the next iteration of what we are seeing on smartphones."

While smartphone apps for physicians have received quite a bit of attention over the years, Avallone said few have found significant adoption.

"Early on, as more physicians moved to the iPhone, we saw the app market take off and we saw physicians moving to apps more and more. There was also very strong mobile web usage. However, app usage for the past few years has been very concentrated -- it's not as if physicians are using 20 different apps on their phones. They only use a handful -- there are five or six app [with significant adoption] -- and then it trails off fairly quickly into the single digits."

Avallone said that mobile optimized web sites have been popular for physicians, and increasingly so.

"As more companies made it a mandate to have a mobile optimized presence, we have seen physicians respond in kind by visiting them. Search queries too have taken off as physicians use their phone more and more for information seeking behavior, and some of those Google queries, for example, from desktop/laptops have made their way to mobile for those quick search kind of queries."

Avallone says that while smartphone adoption has plateaued, tablet adoption still appears to be rising -- even if just a few percentage points each year.

"When tablets entered the market, the big question was would they cannibalize smartphones? That's what everyone was worried about. There is only so much screen time in a day, so where is this screen time going to come from? What we learned was that there really is a niche that tablets were filling, and they did not cannibalize smartphones among physicians that owned all three devices."

Manhattan has found that now two-thirds of physicians own a tablet, smartphone, and a desktop/laptop.

"The tablet's profile in healthcare has not reached maturity yet," Avallone said. "We are still seeing physicians evolve on how they are using this device, especially as it has become mainstream. This year 76 percent of physicians own a tablet, which means we are starting to see adoption begin to level out -- we were at 72 percent last year. I expect it to be at or very close to four out of five doctors in 2015."

Avallone says that while the majority of physicians do own and use tablets for work purposes, Manhattan doesn't see them breaking into the work day as much.

"Part of that has to do again with how much screen time EHRs take up," he said, "and that EHRs are not as tablet-friendly as many expected them two years ago to be by now. That makes the tablet, especially at the point of care, less utilized than many had thought it would be. It's significantly less than smartphone use during the work day."

Tablets may get used less but when they are in use the amount of time physicians spend on them per session is more similar to desktop/laptop usage than smartphones.

"It's really become this immersion devices that is good for immersion learning, what we call lean back learning," he said. "Things like eCME becomes very good for tablets -- things that we're not actively searching for but where you'll be taking a lot of content at one time. It has that great screen so video, eCME, journal reading -- anything of that nature is what a tablet has come to be." 

A brief history of smartphone adoption among physicians

Manhattan predicted in early 2012 that the three screen world of desktop/laptop, tablet, and smartphone will become the norm for US physicians. About 40 percent of US physicians used all three of those screens at the time. Manhattan Research said that group actually spends more time on each device than physicians who just use one or two of them, meaning more devices are additive — not cannibalizing.

At the time Manhattan found that between patient consultations, physicians were likely to use their tablet or a desktop/laptop if they were looking to read a full journal abstract, watch a video, or fully access an EHR. These continue to be among the activities many physicians refuse to do on a smartphone. During patient consultations the range of activities physicians are likely to do on smartphones is a little bit narrower. These often include simple tasks that have one or two steps, the research firm noted. Back then about 18 percent of physicians used some aspects of EHRs on their mobile devices — even on their smartphones.

At the end of 2012 KLAS Research conducted a survey of 105 CIOs, IT specialists, and physicians, that found that about 70 percent used mobile devices to access electronic health records. The vast majority of organizations, 94 percent, were supporting Apple, with 49 percent and 44 percent supporting Android and Microsoft, respectively. KLAS noted that 86 percent of respondents had some kind BYOD policy, and 31 percent had full BYOD. The report showed 52 percent of providers using virtualization, 46 percent using encryption, and 35 percent using mobile device management.

Another survey found that about three-quarters of physicians in the United States are using their smartphones at work.

According to a survey conducted by Epocrates, almost 50 percent of all clinicians in the US are now using smartphones, tablets, and desktops — all three of these devices — in professional capacities throughout their workday. This second annual survey included responses from 1,063 clinicians in May 2013.

Clinicians use the three devices at different times. Epocrates found that personal computers were used mostly during standard workday hours — 7 AM to 5 PM. Tablet and smartphone usage is taking up about 40 percent of the average clinician’s screen time at work. Epocrates found that physician assistants and nurse practitioners are the heaviest users of mobile devices during the workday, but all clinicians spent the majority of their screen time after work on smartphones and tablets.

Epocrates also found that for those clinicians who do use all three devices (computers, smartphones, tablets), they rely on their mobile devices much more “for communicating with colleagues, visiting professional resources, email and reading journal articles than their peers.”

A survey by Deloitte in mid-2013 found that 43 percent of doctors use smartphones or tablets for clinical purposes, which the firm suggested included EHR access, e-prescribing, and physician-to- physician communication. The study polled 613 physicians in the US. Of the 57 percent of physicians that do not use their mobile devices for clinical purposes, 44 percent said that their work doesn’t provide mobile devices and they’re unwilling to use their own, 29 percent were concerned about patient privacy, and 26 percent said the apps and programs available weren’t suited to their needs. However, 22 percent of the non-users indicated a plan to use mobile health technology in the future.

The latest numbers from Manhattan Research in early 2014 indicate that smartphone adoption among physicians in the US has plateaued in the low- to mid-80s. The adoption percentage has held steady for a number of years and the iPhone continues to dominate rival Android devices, Windows phones, and BlackBerry. 

Physician adoption of tablets

Way back in early 2011 a survey conducted by Knowledge Networks of more than 5,400 doctors found that only 27 percent of primary care doctors and specialists said they had a tablet – as opposed to 64 percent who reported having smartphones.

In June of 2011, another survey -- this one of 3,700 physicians by QuantiaMD put the number of physicians using tablets at 30 percent. Of those using tablets at that time, almost 20 percent were already using the device in clinical settings.

The majority of physicians who responded to the survey purchased their mobile device personally or for a private practice. Interestingly, 18 percent received their devices from the institutions they work for but those that supplied their physicians with mobile devices usually provided smartphones, not tablets. Only 16 percent of respondents with institution-supplied devices were provided with a tablet.

“What did surprise us was the momentum of tablets, which we knew to be strong, turned out to be even faster than we had originally expected,” Mary Modahl, the then Chief Marketing Officer of QuantiaMD stated at the time. “Also of interest was the growing role of institutions in supplying mobile devices and the fact that though a physician’s age is a slight barrier to smartphone adoption, tablet adoption has met with no age-related resistance.”

In January 2012, research firm NPD Group published a survey, conducted in September 2011, examining tablet adoption plans for small practices. About 76 percent of small- and medium-sized medical and dental offices planned to purchase tablets in 2012. These practices expected to spend about $6,800 on tablets, NPD said.

By February 2012, hospital IT professionals were reporting, in a survey by wireless networking vendor Aruba, that more of their networks supported iPads than iPhones (83 percent vs. 65 percent). In addition, 52 percent supported BlackBerry devices, and 46 percent supported Android tablets and phones. Also 58 percent either planned to or already used virtualization software like Citrix to give iPad users remote access to hospital applications.

An April 2012 survey of 971 physicians found that about 74 percent already owned an iPad or planned to buy one in the next six months. The survey, called the April 2012 Joint Survey of Physician Digital Behavior, was conducted by virtual event platform provider ON24 and MedData Group.

Of the physicians surveyed, some 45 percent currently owned an iPad and about 52 percent were already iPhone users. About 10 percent said they use a non-iPad tablet, while some 25 percent claimed to use some kind of smartphone other than an iPhone. The researchers asked respondents which type of device they planned to buy in the next six months: 29 percent said an iPad, 17 percent planned to buy an iPhone, 4 percent expected to purchase a non-iPad tablet, and nearly 6 percent said they planned to buy a non-iPhone smartphone.

By May 2012, about 62 percent of physicians in the United States were using tablets, according to data from Manhattan Research, up from 30 percent a year prior. Most of these physicians were using iPads and about half of all tablet-toting physicians use the devices at the point of care, the research firm found. What’s more, physicians who use smartphones, tablets, and computers tend to spend more time online on each device than those physicians who only have two of those devices.

Manhattan’s numbers have a substantial survey size: The research firm polled more than 3,000 physicians in the US for its annual Taking the Pulse report.

“I still cannot believe some of this data. I had to double and triple check it because it is just astounding,” Manhattan’s VP of Research Monique Levy said at the time. “The iPad will [continue to] be the dominant platform through the end of 2014, for sure,” Levy said. “We haven’t seen any major second player — a little bit from the Kindle Fire — but beyond that a lot of companies have one and two percent, low single digits.”

When the Kindle Fire was first released there was some buzz about it being a lowcost option for tablet EHR access. iPad EHR vendor drchrono even launched a version of its patient intake app OnPatient for the Kindle Fire. MobiHealthNews heard from other major mobile medical apps developers who were planning to bring hospital apps to the Fire. But after the initial buzz, interest in the Fire died down in healthcare.

Many of the perceived advantages – like the smaller, lighter design – were matched and improved upon by the iPad mini.

A June 2012 study by Sharecare found much lower adoption numbers for tablets among physicians – it found that about 12 percent of doctors use iPads for clinical purposes, and 9 percent employ some other brand of tablet for accessing or inputting clinical data. According to the survey, which included 1,190 physicians across 75 specialties, about 30 percent of specialty surgeons have iPads for clinical purposes, compared to just 10 percent of primary care doctors.

In early 2013 Manhattan Research announced survey results that found 72 percent of physicians owned tablets.

“There’s 72 percent who own one but they’re not all using it the same way,” Manhattan president Meredith Ressi said at the time. “There’s a minority who are very active users treating it as a quasi-mobile device, using it throughout the day for both information look-up and content consumption. And then there’s more of a lean back crew, more of an ‘on the couch’ thing, watching video and reading emails.”

In the upcoming edition of the Taking the Pulse survey, Manhattan is set to announce that tablet adoption among US physicians has eked up to 76 percent, but within that group a large number are note using their tablets at work.