The Healthcare System: An Apple Tablet's Biggest Opportunity
Apple's "iTablet" - whatever it may be - could be destined to transform our care delivery system in a major way. For years, key hardware vendors like Panasonic, Toshiba, HP and Intel have been working hard to embed tablet computers into hospitals.
The promise of improved clinical information systems, based on real-time information updates across patient touchpoints could be a workflow game changer. If the tablet becomes the tool that is carried with a nurse or doctor on their travels from patient to patient, it will save time, money and lives by enabling the first "always updated" system.
Unfulfilled Opportunity
Considering the massive expense of implementing an electronic health record (EHR) system - for example the $4 billion spent by Kaiser Permanente - data synchronization is a huge investment for the healthcare system. At the national level, the Office of National Coordinator (ONC) is administering billions of dollars of stimulus dollars to help systems move forward into the electronic realm.
But early today, the ONC's Charles Friedman told a FDA interoperability meeting that in 2008, a mere 4% of systems in the United States qualify as "fully functional" electronic health record systems. With all the fantastic and innovative work that has gone into creating a healthcare specific devices, such as Panasonic's series of tablet PCs, it's not the mainstream yet.
A big part of this reason is usability of the software. Clearly, vendors have been building creative and durable machines. But in a similar way that earlier smartphones now seem clumsy compared to the iPhone, we haven't yet seen a product that is amazing. Something like what we think the Apple tablet could be would change this landscape overnight and may be priced at a point that's much less than other medical devices on the market.
Mobile Health Momentum
The iPhone has already changed the face of healthcare. Apple shared this fact at last year's iPhone OS 3.0 release and within the keynote at WWDC. The momentum that started with consumer applications has moved to forward-looking doctors and health providers. We know that it is becoming common practice for some doctors and nurses to carry both their company-issued Blackberry and their personally purchased iPhone.
There are already amazing applications in the market. AirStrip allows doctors to monitor patient vital signs and receive alerts from afar. There are now personal health records that can be carried and updated from anywhere.
Additionally, there are information-rich applications that allow nurses, doctors and patients to look up health information in real time. Last week during the Haiti tragedy, an injured individual was able to use an iPhone to treat himself using an first aid application on the iPhone.
Clinician Ready
Apple and EPIC systems have been collaborating to release the first version of MyChartManager on the iPhone. EPIC is a leading provider of EHR in the United States, and powers systems such as Kaiser Permanente and Palo Alto Medical Foundation in the Bay Area, to name a few. The application, named Haiku was released on Jan. 13, 2010, and several health systems are in the process of testing it. It's a clear contender for the "killer app" in the hospital setting. Looking at the screenshots, it's clear that more screen real estate would be ideal - which means it may be just the right time for an iTablet-like device to emerge on the market.
It's the Apps
It is nearly certain that iPhone OS 4.0 will create a path for existing applications to "upsize" to a tablet device, and this includes size. The medical category today is already the highest-aggregate-priced category on the App Store today, and with the promise of applications inside the clinical walls, the opportunity gets much larger.
The iPhone-to-tablet combination may be the biggest reason that a tablet is successful in the market, since the entire iPhone developer community will be able to deliver on this new platform. With Apple's success in having an integrated OS that shares core libraries across both the Mac and iPhone, it is likely that a table device will also connect with apps from both the iPhone and the Mac.
Workflow Wish List
Having had the opportunity to observe clinical workflow and talk with several healthcare providers - including Kaiser Permanente and the Lucille Packard Children's Hospital - we've compiled a list of device capabilities that would change healthcare. Our wishlist includes:
- Real-time observations, including vitals signs: It is amazing that many systems still require doctors or nurses to take down vitals on pencil and paper, even when an EHR is in place.
- Shift changes: Shift transitions between nurses can be greatly improved by having a device that is mobile and moves freely with each part of the staff, so that the shift exchange is a workflow generated process that isn't tied to a physical location. Nurses move, the system should too.
- Rich content delivery: The ability to share with a patient what is going to happen in rich detail, including video, can be a major force in improving readiness of the patient.
- Video: Bringing remote feeds right into the emergency room, outpatient setting or other environment should be easier than ever before.
- Family and friends: Offering a feature for family and friends to directly communicate with the patient is a huge opportunity. A tablet may be the perfect device to enable more personal discussion and check-ins with family members in the hospital, near or far.
Prediction
If Apple does in fact show a tablet device at the Jan. 27 event, hospitals around the country will react with pilot programs, and we will see tablets and Macs join the iPhone in helping deliver healthcare with a new era of style and grace. It is also true that Apple will have an uphill battle getting past corporate IT; getting support in the enterprise as a new class of device is a daunting challenge. But the "iTablet" will give visionary IT leaders more opportunity to change the status quo and look to the future.
We can hear the doctor already: "Take two moments to fire up your iTablet, and teleconference me in the morning."
What do you think, could a tablet be the product that brings Apple inside the hospital walls and improve the system?
Photo credit: Balazs Gal.
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They won't have it all their way, at least one company who has been in tablet /slate computing for a long time have already made in-roads into healthcare; http://www.motioncomputing.com/solutions/healthcare.asp
Education is likewise a critical vertical, but I doubt it will center around iTunes unless the system can be filtered by age. My take is that communication is also a central component.
Check out what I am thinking at eduk8.com...
Mobile health is getting huge. I read they even have an app for the iPhone that allows you to cough into it and it will tell you what kind of illness you have!
Wouldn't hospitals be happier using tried and true Windows compatible hardware and software? Windows hardware would be cheaper with say a $400 Acer tablet running some light version of Windows 7. And as far as software is concerned, Windows 7 will keep all the old IT managers and staff much happier than trying to integrate some OSX device into the mix. IT managers can't stand OSX and consider any version of Windows far superior.
I doubt the hospital system or any corporation will welcome any Apple tablet with open arms. IT basically runs every business and always has the final say. Microsoft Windows is everything to the IT manager and they will never allow any Apple device in large numbers. They might "dick around" with some Apple tablet pilot project but will wait until Microsoft offers a tablet solution and use that. That's how Microsoft has held the corporate position all these years. Extremely loyal IT managers.
Well, all the drs I've visited lately & their assistants use PC laptops when they come into the examining room. If the tablet idea was so hot for the healthcare world, wouldn't they be using the PC version that's been out forever? They'll probably stick with what they have.
I don't see this happening. Not that it's as a bad thing, I want an Apple tablet myself. But, you will be asking HIT department to support two OS. Most EMR/EHR are based on Microsoft and there are very few apple machines in health care today.
Doctors have been offered tablets for years but most do not want anything to do with them. First thing there is no keyboard, second the EMR system have not been designed to support this type of UI.
There will be some early adopters to the tablet and it will have uses in certain situation.
The Apple tablet may be one of the hardest sell. Microsoft will be coming in right behind to offer a more integrated systems for today EHR's.
Jeff Brandt
www.comsi.com
Two hospitals are using iPhones as part of their workflow, integrated into Exchange and Windows-centric environments
http://www.apple.com/iphone/business/profiles/memorial-hermann
http://www.apple.com/iphone/business/profiles/doylestown
"Extremely loyal IT managers."
Not so much "loyal" as "slow to convert and the people in the company least impressed by marketing hype."
I don't really see this happening, either, although I would suggest state agencies - they tend to love jumping on new bandwagons with piles of tax dollars they must spend. Oregon, where I'm from? The same year NT came out, they went with OS2 Warp. Boy, that must have seemed sexy at the time.
The problem with the US and paper is very specific to us and not about a dearth of exciting new devices to replace paper with over the past few decades. Every nation in our class and a bunch of those not quite have eliminated, for instance, you having to sit around for twenty minutes in the doctor's waiting room, first visit, writing on a clipboard with a chained pen.
Not us. Hell, we still don't have really good money in terms of blocking counterfeiting, and it took...jeez, like twenty years? More? Anyway, it took forever to make *any* changes to our bills because Americans and our politicians freaked the hell out over changing the face of what is, let's face it, America's god. (Of course, that "face" was only a couple decades old at the time, but the same Americans believe dinosaurs were born at the same time as people and that was six weeks ago.)
Honestly, I think I'd just get pissed about my insurance premiums even more if I walked into an office in the future and they handed me a big, expensive iPhone.
This article was written two weeks ago by TinyComb. Are you stealing content? Give credit where credit is deserved.
http://tinycomb.com/2010/01/09/breaking-apples-tablet-is-for-the-healthcare-industry/
Hi Jared,
Just read the post by TinyComb that you mentioned. Thanks for pointing out that we came to a similar conclusion. The answer is a firm NO. All the ideas in this post were self generated thoughts.
For the record, I hadn't seen (or heard) about this post prior. I guess that we've seen independently seen enough evidence out there that this idea makes sense, in fact Apple may benefit in a big way from a Tablet computer in healthcare.
Have been working in the mobile health application space for over a yea as an iPhone developer and am in a good position to see this opportunity first hand.
Best wishes - and thanks for the heads up. And also to TinyComb, enjoyed your post too!
Yeah, unless you can figure a way for an expensive piece of electronics to survive in a bedside setting it's just going to be a big money waster.
There will be places and settings where a tablet would be advantageous, like out-patient visits to your primary care or other specialist docs, pre-operative settings and even the OR to some extent.
But where the rubber meets the road, where real-time access to patient information would make the biggest impact would be at the bedside. And they are going to have to design something near impregnable to stand up to the rigors involved. Toughbook? Yeah, maybe. But is Apple really able to design a piece of hardware like that? Can they make a tablet that can stand up to an ER? And make it affordable for a hospital to equip them? They could do one, but not both.
Besides the survivability index, as I would call it, having tablets that roam from room to room could be a huge infection control risk. We're having a hard enough time eradicating nosocomial infection in our facilities without adding another fomite to spread the so-called "superbugs" like MRSA and VRE from patient to patient.
I'm all for using technology to improve outcomes, but I think there would be better uses of the money to do so.
Just my 2 bits...
Posted by: lostonthefloor.wordpress.com
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January 26, 2010 12:41 AM
There are few things as heart stopping as watching a surgeon handle a tablet PC. It is one thing to intellectually understand that they're hard on equipment, but it is another thing to watch them throw it around like a two dollar clipboard.
The fact that the surgeon then blames either the tablet or IT when it breaks as a result of being hurled across the room is almost secondary.
-Rob D.
I am looking forward to the new Apple Tablet.
IT will be good fit for business men and layers.
Thanks
http://www.OnlyJust.net
I think this is critical!!! I still feel like technology within the Healthcare and Education systems lacks far beyond where could and SHOULD be.
I want to contribute to the game changing, I just don't know how. Any ideas?
Cool perspective on what these new gadgets might be used for. I must admit I don't have an iPhone, but seeing how my friends keep finding new uses for their Apple gadget I know there's great potential for this thing! The iSlate/iTablet/MacBook Touch/Apple Tablet... etc... should certainly live up to that!
Can't wait for tomorrow, hehe
Microsoft software and Windows in unreliable and Winmo 6.5 sucks big time. It is no where close to Apple iPhone OS (based on BSD UNIX). Major helath providers runa nd trust their backbone on UNIX and Linux not Windows. It is very easy to integrate iPhoen OS with backend UNIX system Applications.
I work in healthcare IS and have been hearing the promise of mobile/tablet computing inside the walls for 20 years. It is not about the hardware and OS it is about the application. E-HR's have big visual footprints and the GUI on applications designed for tablet has not been good enough yet. Try scrolling through a drop down list of 10,000 diagnosis codes because you have no keyboard.
These are not desktop applications that you buy for a Windows or Apple OS it will need to be developed to integrate into enterprise E-HR database like the Epic iphone application. It will happen someday, perhaps now with Apple, but they have to break the paridigm for tablets with a better imput solution. For example hand writing recognition that works in data entry fields.
Appreciate your wish list.
Essentially, your wish list functions are not at all a 'device-specific capability'.
Virtually every 'device capability' you mention is the function of patient-identified, HCP-specific, application integration, delivered over whatever network is deployed, delivered by whatever device is secure.
Application integration is, HCIT standards-based systems have been the challenge for decades and a device launch will again drive this lesson home for the HC industry.
So to be clear, how does a new device launch (cool as it is) accelerate reimbursement? Deliver Decision-support?