Every 2.3 seconds Apple sells another iPad. The company has sold 3 million iPads in the last 80 days. iPads, a device form factor that by many accounts has never really existed before, has created a new market for mobile computing.
Of course, the healthcare industry has seen similar form factors: Look to the many tablet computers launched in the past three years based on Intel’s mobile clinical assistant tech spec. Motion Computing’s C5 and Panasonic’s H1 chief among them. Even these competitors understand that the iPad is a bit different and that healthcare will adopt them:
“Will the iPad come to healthcare? I guarantee you it will. Doctors like the iPhone and the iPad will be right behind it,” Motion’s Vice President of Marketing told me at HIMSS this past year.
Days after the announcement of the iPad, popular medical application developer Epocrates released a survey conducted among its tech-savvy users: One in five Epocrates users said they planned to buy the device once it became available. A full 20 percent.
So, is the arrival of the iPad a watershed moment for healthcare IT? You bet. But like smartphones before it, the iPad is just the first of many tablets to truly get the industry’s attention.
The iPad is just a new beginning for tablet computing in healthcare. It’s not the be-all-end-all.
That’s why MobiHealthNews spent the last month putting the iPad’s arrival in healthcare into context with our newest paid report: iPad vs. the Tablets in Healthcare. Coupled with this special issue on the iPad, we hope you find the analysis and compiled information helpful in place the iPad in its proper context: The first of a new class of tablet computers that just might be taking the healthcare industry by storm.
Rest assured that at least a few of the millions of iPads sold have already found their way into healthcare providers’ facilities. Reports during the past month have demonstrated a wide array of use cases for the iPad in healthcare: Surgery, electronic medical records, CPOE, billing, paging, patient education, speech therapy, and much, much more. Below we have assembled a quick compilation of some of the higher profile mentions of the iPad in clinical or other care settings.
Boston, MA: Beth Israel Deaconess Hospital (BIDMC) hospitalist Dr. Henry Feldman has been using his own personal iPad while making his rounds, according to a report in iMedicalApps. Feldman, who is also the Chief Information Architect for the Harvard Medical Faculty Physicians, said he uses his iPad for five applications at the hospital: WebOMR (BIDMC’s EHR), POE (BIDMC’s CPOE), Personalized Team Census (signout), E-Ticket (billing), web-based paging, and the BIDMC emergency department (ED) dashboard. While Feldman reported a few “occasional quirks,” he said the fact that these applications are all web-based means they run almost perfectly on his iPad.
St. Louis, MO: Children’s Hospital currently has two iPads it uses for three primary purposes: Education, distraction and preparation, according to a local news report. Children’s Hospital’s Tyler Robertson, a child life specialist who helps patients manage stress during their stay, uses the iPads to show patients how physicians prepare for surgery; to play games with patients; and to educate them about their procedures or conditions. Children’s plans to up its iPad count to 15: One for each child specialist on staff.
Visali, CA: Kaweah Delta Health Care’s director of technical services, Nick Volosin has been piloting three Apple iPads for X-ray images, EKG results and other patient monitoring programs, according to a report from Network World. Volosin plans to buy 100 more iPads for use by the care group’s home health and hospice care workers, nurses, dietitians and pharmacists.
Kobe, Hyogo, Japan: Kobe University medical center recently posted a video of a team of doctors at the hospital using an iPad as a display during a surgery. A physician or an assistant used the iPad to zoom in and out of images on the device’s screen during the procedure. Of course, the setup was less than ideal. The device was wrapped in plastic and required two people to operate: One to hold it in place and one to navigate the screen for doctors.
Los Angeles, CA: Cedars-Sinai Medical Center’s CIO Darren Dworkin hopes that the iPad will be the “next evolution in sharing information with patients," according to a report in USA Today. Dworkin is keen on his doctors learning to enter information into a screen that doesn’t require them to turn their backs on patients, like COWs or desktop computers typically do. At the time of the interview earlier this year, Cedars-Sinai already had a dozen iPads out making the rounds with its doctors.
Ormond Beach, Florida: Florida Hospital-Oceanside uses an iPad to conduct speech therapy with stroke victims. The care group uses iPad/iPhone app Proloquo2Go to enable patients to speak through the devices to their care team.
By many accounts the iPad’s biggest competitor in the healthcare sector is from tablet devices specifically designed for the healthcare industry. These ruggedized, expensive devices are typically built on Intel’s Mobile Clinical Assistant (MCA) design spec which takes into consideration sanitization, ruggedization as well as a feature set that is targeted to healthcare users.
In mid-2009, VDC Research Group published a research bulletin through healthcare tablet maker Motion Computing’s corporate website that predicted the market for ruggedized tablets in the healthcare industry would top $63 million by 2013. According to the firm the market for healthcare MCA tablets (including Motion’s C5 and Panasonic’s H1 Toughbook) remained a niche opportunity for hospitals with advanced, robust electronic health record (EHR) system deployments.
Worldwide sales for all rugged slate tablets in the healthcare sector totaled $10.2 million in 2007. The majority of those sales were MCA devices, which clocked sales of $8.8 million worldwide, according to VDC. In 2008 total rugged slate tablet sales in healthcare were $27.4 million worldwide, while MCA tablets made up $26.6 million of those sales. VDC predicted that sales in 2009 would be $33.8 million for all rugged slate tablets in healthcare and $33.3 million for MCA tablets. In 2010 the predicted figures rose to $40.2 million (all rugged slate tablets) and $39.7 (MCA tablets). VDC predicted that sales in 2011 would hit $48.2 million for all rugged slate tablets sold into healthcare with MCAs accounting for $48 million. By 2012 sales would hit $55.8 million and MCAs would account for $55.5 million. Finally, by 2013, total rugged slate tablet sales in the healthcare sector would hit $63 million with $62.8 million in sales from MCA tablets.
It’s worth noting that VDC’s research pre-dated both the passing of health reform legislation as well as Apple’s announcement of the iPad. VDC’s predictions assumed that MCAs would continue to be received as a favorable platform for point of care applications; that investments in EHR systems would continue to grow; that mobile hardware investment in current and future MCA platforms would continue at mid-2009 rates; and that EHR and HIS vendors would work with MCA makers to certify products on their systems.
While VDC’s figures were specifically inclusive of ruggedized tablets, which, of course, do not include the iPad. We wonder how many more iPads and other consumer tablets might be sold to the healthcare market: If we open up the playing field to non-ruggedized tablets, will the $63 million market prediction for tablet sales into healthcare prove low?
Let’s not kid ourselves: Apple did not create the iPad for healthcare professionals. Might it still be of use to the healthcare industry? Almost everyone, including its competitors, agree that it will.
“The iPad is a content consumption device that will enable doctors to review images, including zooming in on and annotating x-rays,” Mike Stinson, Motion Computing’s VP of Marketing told MobiHealthNews. “I don’t think the iPad is a real data acquisition device… So, the iPad will be in the mix and will become part of the workflow but it won’t replace slates like [Motion's C5] in the same way that [Motion's slates] haven’t replaced desktops.”
What else is the iPad missing? In which other ways does it fall short for healthcare professionals? Here are a few common complaints or observations about the iPad’s hangups for HC workers:
1) The iPad has no camera, an important feature for any connected health tablet.
2) Despite the iPad’s rather impressive “up to” 10 hours of battery life, some have lamented Apple’s continued use of non-swappable batteries. Most tablets targeting the healthcare environment boast swappable batteries so clinicians can continue using them without waiting for a charge.
3) Industry onlookers have argued that the iPad’s 9.7 inch screen is not quite big enough for use with intensive medical applications.
4) Some people believe that the iPad is perhaps too big for many clinicians who would prefer a device that fits snugly into their pockets.
5) The iPad is not ruggedized and its screen will likely break if dropped. Many healthcare tablets claim to be drop resistant from about three feet.
6) The iPad’s inability to multi-task, meaning it can’t run more than one application at once is another big shortcoming that might hamper uptake for healthcare workers.
7) Most healthcare tablets have barcode scanners — the iPad does not.
8) Most healthcare tablets are easily disinfected, water-proof and dust resistant. The iPad does not appear to address any of those issues.
As another maker of healthcare tablets put it:
“First and foremost the iPad is a consumer device — that is the big thing,” Panasonic’s Senior Developer Greg Davidson told MobiHealthNews. “Doctors say it’s what they want, but when they go and talk to their IT departments and are told ‘it’s not running the right operating system;’ ‘it’s not easily sanitizable;’ ‘it doesn’t have the ports we need;’ or ‘it doesn’t run the particular apps we need.’”
Consumer device or not – some healthcare practitioners are convinced of the iPad’s value. There are plenty of shortcomings to pick at, however, and probably many more than those listed above.
The iFund, a venture fund that provides funding for iPhone apps, created a new $200 million fund for iPad apps when the iPad was first announced. The directors of the iFund mentioned the medical field as one ripe for investment in iPad apps. A few months later and there are already some 160 specifically designed iPad apps in the medical category of the Apple AppStore. Of course, there are also a couple thousand iPhone medical apps specifically intended for use by medical professionals that also port over to the iPad.
By many accounts the iPad’s real draw is not its form factor at all – it’s the AppStore. Which other healthcare tablet can claim to have thousands of apps built for it?
Here’s a look at just a few of the app developers that have either already launched or hinted at plans to launch dedicated iPad apps. These examples include EHR apps, unified communication apps, patient education apps, remote monitoring apps and more.
Medical iPad App: Canto by Epic Systems. While it has yet to make a formal announcement about its iPad specific app, Richard L. Paula, MD, CMIO at Tampa General Hospital told CMIO magazine that his facility plans to rollout Epic System’s EHR app for iPads, called Canto, sometime in the future. According to Paula, Epic plans to translate its Haiku application, which it developed specifically for Apple iPhone, into an app designed for the iPad’s larger form factor. Paula said Canto would launch “with similar functionality yet more capabilities due to a larger screen.” Paula’s hospital will equip clinicians with individually owned iPads at an entrerprise level to allow them to download the Canto program and have access to patient data. Paula is counting on Canto to include Nuance’s Dragon Medical voice recognition software for transcribing physician’s notes. He also is rooting for more imaging features on the iPad Canto app since the iPhone version, Haiku, does not include any.
Medical iPad App: PatientKeeper’s iPad app, Mobile Clinical Results, gives physicians a comprehensive set of aggregated and up-to-date patient information from virtually any system, putting the power of patient information along with documentation and communication tools in the hands of physicians, according to the company. With MCR physicians can: Review and manage an accurate, up-to-date patient list; Trend lab results from hospital-based and community laboratories; Review microbiology, radiology and pathology test results; Review medication lists and see a history of discontinued meds; Review a patient’s complete dispensing history (including doses not given); View all clinical notes including admit, progress and discharge notes; Review an at-a-glance presentation of temperature, blood pressure, heart rate and other vital signs as well as input/output measurements; Review a patient’s known allergies, including substance, type (drug, food or environment) and a description of any reactions; Monitor the order status of all recent orders on the patient. Free to PK customers.
Medical iPad App: Blausen Medical Human Atlas HD specifically developed for the iPad is a point of care patient education tool that includes 3D animations of 150 common medical treatments and conditions. The video animations average one to two minutes in length with accompanying narration and are organized into 15 categories. The individual categories are: Cancer, Circulatory, Digestive, Ear, Endocrine, Eye, Immune, Muscular, Nervous, Pediatric, Reproductive, Respiratory, Skeletal, Skin and Urinary. ($3.99)
Medical iPad App: LifeWatch announced plans to offer a remote ECG TeleViewer application specifically developed for the iPad that integrates with and enhances the remote monitoring company’s ECG services. The TeleViewer app will take advantage of the large iPad screen to produce clear and accurate viewing images of both reports and ECG strips, according to the company. LifeWatch is providing iPad TeleViewers to physicians enrolled in its Atrial Fibrillation TeleClinic service for post-procedure AF patients.
Medical iPad App: Voalte One. While Voalte has not officially come out with a dedicated iPad app, the company certainly seems interested in doing so if its customers are interested: Voalte (derived from Voice, Alarm, Text) consolidates those three communications for iPhone users, enabling them to send and receive text messages, voice calls and receive critical care alarms. Voalte believes that the iPad will be a great tool for healthcare clinicians, while it may not necessarily be a nurse’s only device. Physicians and others will find the increased screen size attractive for EMR, medical images, and patient education. It only makes sense to include consolidated communications in that same list.
“Will people bolt on all sorts of medical functionalities? Sure, but look at the iPhone. It has some bar code scanner apps that use its camera, but as soon as the user need to use an iPhone bar code scanner a hundred times a day, you can bet they won’t want to do that for too long." – Motion Computing’s VP of Marketing, Mike Stinson.
Stinson hit on a common theme that iPad enthusiasts in the healthcare industry like to come back to – the iPad will become ever more useful as medical-grade peripherals hit the market. The iPad’s not ruggedized? Don’t worry, there will be a ruggedized case for the device. The iPad’s not really sanitizable? They’ll make a case for that, too, or just keep it in a plastic bag like surgeons in Japan did recently. The iPad is missing a camera? Well, it has Bluetooth so attach one that way.
The peripheral argument is one that is likely to gather steam in the short term, but will be proven by the quality of add-ons device makers are willing to create. Will medical device companies see the iPad as an opportunity to sell more devices as an FDA regulation problem waiting to happen? Time will tell, but in the meantime, peripherals could be key for iPad’s success in healthcare.