5 ms·

The Healthcare System: An Apple Tablet's Biggest Opportunity

16 points by ca98am79 17y ago

stcredzero 17y ago
I bought a used HP tc1100 tablet. I think Windows XP's Tablet software is amazing. When I hover over an entry field, a button appears to bring up the writing box, and the recognition is very close to 100%. (I always print, however. I hear the recognition for cursive writing isn't nearly as good.) The industrial design on the tc1100 is on a par with Apple's, IMHO. If Windows tablets can be this good while embracing the old Windows UI paradigms, Apple had better be mindblowingly good. I would be very pleased if I can have good pressure sensitivity and accuracy with an eraser stylus, plus multitouch. I think someone made a big mistake by not trying to sell this stuff to the public and concentrating on business instead. Surfing with the stylus is very nice, I find.
jhancock 17y ago
It does seem obvious that such a device may be good for EHR and such. Timing will be the problem. This year is the big push for implementing EHR. The systems that will get implemented are ones in existence from numerous commercial vendors and there is one solid open source solution, VA's vista. Most doctor's offices already have scheduling and billing systems. The gov's incentive funds are oriented to purchase existing approved EHR systems. Its a difficult process to get a new app approved for the gov incentive funds. So the shiny new tablet, as cool as it may be will most likely not be the compelling peice that makes the sale. The compelling piece is integration with the doctor's already existing scheduling and billing system and that which is approved for gov funds.
- stcredzero 17y ago
  If Apple or someone else can do for doctors what iPhoto has done for snapshots, then they've got it! Host EHR software in the cloud. Just make something which doctors and assistants can just buy, which will generate forms or integrate with existing systems in some fashion. Granted, many of these systems are archaic. Perhaps too many of them will be too crusty to be capable. What percentage of the scheduling and billing systems can use Microsoft or Adobe forms for input? Here, a completely closed ecosystem in the vein of the iPhone with its App Store can be a tremendous boon. This will help assure Docs that their hardware doesn't have malware installed. If Apple builds in some form of Hypervisor executable DRM, all the better. The doctors could deduct the cost of such a tablet as a business expense. If it does media, magazines, is a passable e-book reader, can be a home automation and FrontRow remote, then I think Apple could sell tons of them!
  - markkanof 17y ago
    So basically if Apple can come up with a system that can interface with all existing records systems used by doctors and hospitals and can act as a complete personal media device and home automation control then they would sell a ton of them? Seems a bit of a tall order even for Apple. A lot of hospitals have homegrown records systems or a whole collection of interconnected commercial products. The physicians have also gotten used to the existing systems, and in many cases have been involved in customizing the system to their specific needs. If the Apple hardware is nice (which it probably will be) then that is a good first step, but it will require the involvement of a lot of third party developers to create better medical record systems.
  - wglb 17y ago
    I am thinking when you say Host EHR software in the cloud that you mean hosting the data. What are the implications of HIPAA in the cloud, given that Amazon says that S3 is not valid for credit cards?
    - absconditus 17y ago
      Let me shed some light on the subject by explaining what is actually happening currently. CCD/CDA documents (XML documents containing clinical information) are being pushed as the new standard for exchanging medical information (mostly by IHE which is in turn being backed by HITSP). These documents are stored in an XDS repository. Currently these repositories tend to exist at the IDN level (large groups of hospitals and physician offices). The real question is how we are going to get these repositories exchanging documents with each other. http://en.wikipedia.org/wiki/Continuity_of_Care_Document http://en.wikipedia.org/wiki/Continuity_of_Care_Document http://en.wikipedia.org/wiki/Clinical_Document_Architecture http://en.wikipedia.org/wiki/Clinical_Document_Architecture http://en.wikipedia.org/wiki/Integrating_the_Healthcare_Enterprise http://en.wikipedia.org/wiki/Integrating_the_Healthcare_Ente... http://en.wikipedia.org/wiki/Cross_Enterprise_Document_Sharing http://en.wikipedia.org/wiki/Cross_Enterprise_Document_Shari... http://en.wikipedia.org/wiki/HITSP http://en.wikipedia.org/wiki/HITSP
      - 17y ago
GiraffeNecktie 17y ago
Somehow I don't see how a new hardware platform with a shiny interface is going to fix the gnarly problems with electronic health records. A nice UI would certainly help with filling out forms but that's only the tip of the EHR iceberg.
noarchy 17y ago
My regular doctor (I'm in Canada) makes frequent use of tablets, but I've never taken the time to find the make/model. This article reminds me to ask, next time.
- absconditus 17y ago
  The make and model of the tablet itself barely matters. They are likely Windows tablets. The software is what matters. The only question in my mind is whether or not a tablet with the capabilities of an iPod Touch/iPhone will enable better software.
sanj 17y ago
Having started PatientKeeper (http://www.patientkeeper.com http://www.patientkeeper.com), I feel like I have an informed opinion here. 1. Tablets have been around for a while. They didn't take off. I'm not sure why an iTablet would do any better. 2. The integration costs of healthcare are crazy. Tablets won't help. 3. Older physicians have zero interest in using tablets. The dominate the decision-making and the teaching hospitals. 4. If it doesn't fit in a coat pocket, it is hard to get in front of physicians. 5. Battery life and connectivity are crazy important -- if devices don't last a shift, you're screwed. If radiology equipment messes up wireless, you're lost. 6. Entrenched workflows, especially those with legalities around paperwork, are very hard to extract. Finally, I have to say that the "wishlist" in this article is laughable. 1. Vital signs can be measured automatically. It turns out to be a large set of data that a professional needs to interpret to find useful. Realtime makes a great demo, but no one cares in practice. 2. Shift changes are huge, but tables are a tiny fraction of making them work. Shifting the responsibility between provider has never been a technology problem -- it's a communication problem. 3-5. Really? Videos for the patient are a critical element of workflow? How about something real: checklists and best practice management. That makes a real difference. Perhaps the author ignored it because paper works just fine.
- dpcan 17y ago
  Thank you for a great post and your insight. I don't know this, maybe you do, but isn't most health care directed software written for Windows / PC as well? Would having an iTablet limit the software options available to physicians as well?
  - sanj 17y ago
    Most systems have some sort of web interface these days.
- carbocation 17y ago
  MSIV here. Sanj's post is rather insightful, and here's why: If it doesn't fit into my coat pocket, then it will end up being something that probably doesn't become 'mine'. Instead of having one per doc, there will be a few for each floor. Since individual providers don't then have a personal relationship with any particular tablet, they all have less incentive to care for them (charge them, make sure they get put back in the right place, not treat them like coasters). No, the nurses will not do this for us. This brings us to the point where we have a floor with several tablets that, if not stolen or covered in "someone else's" coffee, have no battery. If there is a backup battery system, all of those backup batteries are also drained. So far, so bad. But it gets worse: when the next set of docs rotate onto service, they see a totally dysfunctional heap of tablets and won't go near them. I say this from experience with the current iteration of this idea: 'cows' (desktops mounted on rolling platforms with a battery). In my opinion, the best way to succeed is to make a product that each individual provider will develop a relationship with. You will succeed if you can make me treat my tablet like my iPhone because it (a) is 'mine' - not communal; (b) is portable - fits into my fairly giant white coat pockets, or is otherwise easily transportable; (c) gives me something that I want - not what some non-medical person thinks doctors might want. Regarding point (c), sanj's statement about realtime vitals shows that he has discovered something that AirStrip hasn't: realtime vitals in most cases are for nurses, not doctors. I'm not going to be actively monitoring someone's heart rate unless I'm at the bedside. They are promoting the wrong feature, IMHO. Sanj, it sounds like you have good insight into what doctors actually want. Please keep it up!
drtse4 17y ago
See this old post: http://tinycomb.com/2010/01/09/breaking-apples-tablet-is-for-the-healthcare-industry/ http://tinycomb.com/2010/01/09/breaking-apples-tablet-is-for... It appears that a company named Motion Computing Inc (and i guess they are not the only one) already sells a tablet that targets the healthcare industry.
- bmj 17y ago
  My employer provides solutions for electronic patient reported outcomes for clinical drug trials, and Motion is our provider for tablets for use in clinical settings. We are anxiously awaiting information about the Apple device, and the HP device shown at CES, as the Motion tablets can be a bit overkill for some applications. Our industry, at least, is very much ready for more/better tablets.
joshwa 17y ago
The last few times I've been to doctor's offices/hospitals, I've noticed that a huge amount of doctors'/nurses' times are spent mouse clicking. The docs' offices all have computers in them with EPIC or similar patient record systems, and in the ER they have mobile workstations on carts positioned throughout where docs and nurses input data after every patient interaction. Healthcare IT depts can already put computers very close to the point of care to provide history, lab results, and input functions. A tablet would just be something for caregivers to lug around (how would they carry it anyhow?) and potentially be stolen. The main problems in healthcare IT (as I understand it, anyhow) are not input devices-- it's software quality, usability, integration, and above all, cost.
zandorg 17y ago
I sign tablets when a courier comes to the door, and it's such a random squiggle that I doubt such a tablet is accurate enough for healthcare.
jodrellblank 17y ago
I'm expecting Apple to announce a tablet tomorrow. Apple has been completely tight-lipped on the matter, and the only thing they've said about tablets is that they don't know how to make a good one. So why am I, why is everyone, expecting a tablet? What evidence is there that should support that expectation? Apart from the question "what else could it be"? And given how much effort Apple puts into keeping things under wraps, how did so many people and media outlets get so convinced a tablet is 'due' from Apple?

16 points by ca98am79 17y ago

I bought a used HP tc1100 tablet. I think Windows XP's Tablet software is amazing. When I hover over an entry field, a button appears to bring up the writing box, and the recognition is very close to 100%. (I always print, however. I hear the recognition for cursive writing isn't nearly as good.) The industrial design on the tc1100 is on a par with Apple's, IMHO. If Windows tablets can be this good while embracing the old Windows UI paradigms, Apple had better be mindblowingly good. I would be very pleased if I can have good pressure sensitivity and accuracy with an eraser stylus, plus multitouch. I think someone made a big mistake by not trying to sell this stuff to the public and concentrating on business instead. Surfing with the stylus is very nice, I find.

jhancock 17y ago

It does seem obvious that such a device may be good for EHR and such. Timing will be the problem. This year is the big push for implementing EHR. The systems that will get implemented are ones in existence from numerous commercial vendors and there is one solid open source solution, VA's vista. Most doctor's offices already have scheduling and billing systems. The gov's incentive funds are oriented to purchase existing approved EHR systems. Its a difficult process to get a new app approved for the gov incentive funds. So the shiny new tablet, as cool as it may be will most likely not be the compelling peice that makes the sale. The compelling piece is integration with the doctor's already existing scheduling and billing system and that which is approved for gov funds.

stcredzero 17y ago
If Apple or someone else can do for doctors what iPhoto has done for snapshots, then they've got it! Host EHR software in the cloud. Just make something which doctors and assistants can just buy, which will generate forms or integrate with existing systems in some fashion. Granted, many of these systems are archaic. Perhaps too many of them will be too crusty to be capable. What percentage of the scheduling and billing systems can use Microsoft or Adobe forms for input? Here, a completely closed ecosystem in the vein of the iPhone with its App Store can be a tremendous boon. This will help assure Docs that their hardware doesn't have malware installed. If Apple builds in some form of Hypervisor executable DRM, all the better. The doctors could deduct the cost of such a tablet as a business expense. If it does media, magazines, is a passable e-book reader, can be a home automation and FrontRow remote, then I think Apple could sell tons of them!
- markkanof 17y ago
  So basically if Apple can come up with a system that can interface with all existing records systems used by doctors and hospitals and can act as a complete personal media device and home automation control then they would sell a ton of them? Seems a bit of a tall order even for Apple. A lot of hospitals have homegrown records systems or a whole collection of interconnected commercial products. The physicians have also gotten used to the existing systems, and in many cases have been involved in customizing the system to their specific needs. If the Apple hardware is nice (which it probably will be) then that is a good first step, but it will require the involvement of a lot of third party developers to create better medical record systems.
- wglb 17y ago
  I am thinking when you say Host EHR software in the cloud that you mean hosting the data. What are the implications of HIPAA in the cloud, given that Amazon says that S3 is not valid for credit cards?
  - absconditus 17y ago
    Let me shed some light on the subject by explaining what is actually happening currently. CCD/CDA documents (XML documents containing clinical information) are being pushed as the new standard for exchanging medical information (mostly by IHE which is in turn being backed by HITSP). These documents are stored in an XDS repository. Currently these repositories tend to exist at the IDN level (large groups of hospitals and physician offices). The real question is how we are going to get these repositories exchanging documents with each other. http://en.wikipedia.org/wiki/Continuity_of_Care_Document http://en.wikipedia.org/wiki/Continuity_of_Care_Document http://en.wikipedia.org/wiki/Clinical_Document_Architecture http://en.wikipedia.org/wiki/Clinical_Document_Architecture http://en.wikipedia.org/wiki/Integrating_the_Healthcare_Enterprise http://en.wikipedia.org/wiki/Integrating_the_Healthcare_Ente... http://en.wikipedia.org/wiki/Cross_Enterprise_Document_Sharing http://en.wikipedia.org/wiki/Cross_Enterprise_Document_Shari... http://en.wikipedia.org/wiki/HITSP http://en.wikipedia.org/wiki/HITSP
    - 17y ago

GiraffeNecktie 17y ago

Somehow I don't see how a new hardware platform with a shiny interface is going to fix the gnarly problems with electronic health records. A nice UI would certainly help with filling out forms but that's only the tip of the EHR iceberg.

noarchy 17y ago

My regular doctor (I'm in Canada) makes frequent use of tablets, but I've never taken the time to find the make/model. This article reminds me to ask, next time.

absconditus 17y ago
The make and model of the tablet itself barely matters. They are likely Windows tablets. The software is what matters. The only question in my mind is whether or not a tablet with the capabilities of an iPod Touch/iPhone will enable better software.

sanj 17y ago

Having started PatientKeeper (http://www.patientkeeper.com http://www.patientkeeper.com), I feel like I have an informed opinion here. 1. Tablets have been around for a while. They didn't take off. I'm not sure why an iTablet would do any better. 2. The integration costs of healthcare are crazy. Tablets won't help. 3. Older physicians have zero interest in using tablets. The dominate the decision-making and the teaching hospitals. 4. If it doesn't fit in a coat pocket, it is hard to get in front of physicians. 5. Battery life and connectivity are crazy important -- if devices don't last a shift, you're screwed. If radiology equipment messes up wireless, you're lost. 6. Entrenched workflows, especially those with legalities around paperwork, are very hard to extract. Finally, I have to say that the "wishlist" in this article is laughable. 1. Vital signs can be measured automatically. It turns out to be a large set of data that a professional needs to interpret to find useful. Realtime makes a great demo, but no one cares in practice. 2. Shift changes are huge, but tables are a tiny fraction of making them work. Shifting the responsibility between provider has never been a technology problem -- it's a communication problem. 3-5. Really? Videos for the patient are a critical element of workflow? How about something real: checklists and best practice management. That makes a real difference. Perhaps the author ignored it because paper works just fine.

dpcan 17y ago
Thank you for a great post and your insight. I don't know this, maybe you do, but isn't most health care directed software written for Windows / PC as well? Would having an iTablet limit the software options available to physicians as well?
- sanj 17y ago
  Most systems have some sort of web interface these days.
carbocation 17y ago
MSIV here. Sanj's post is rather insightful, and here's why: If it doesn't fit into my coat pocket, then it will end up being something that probably doesn't become 'mine'. Instead of having one per doc, there will be a few for each floor. Since individual providers don't then have a personal relationship with any particular tablet, they all have less incentive to care for them (charge them, make sure they get put back in the right place, not treat them like coasters). No, the nurses will not do this for us. This brings us to the point where we have a floor with several tablets that, if not stolen or covered in "someone else's" coffee, have no battery. If there is a backup battery system, all of those backup batteries are also drained. So far, so bad. But it gets worse: when the next set of docs rotate onto service, they see a totally dysfunctional heap of tablets and won't go near them. I say this from experience with the current iteration of this idea: 'cows' (desktops mounted on rolling platforms with a battery). In my opinion, the best way to succeed is to make a product that each individual provider will develop a relationship with. You will succeed if you can make me treat my tablet like my iPhone because it (a) is 'mine' - not communal; (b) is portable - fits into my fairly giant white coat pockets, or is otherwise easily transportable; (c) gives me something that I want - not what some non-medical person thinks doctors might want. Regarding point (c), sanj's statement about realtime vitals shows that he has discovered something that AirStrip hasn't: realtime vitals in most cases are for nurses, not doctors. I'm not going to be actively monitoring someone's heart rate unless I'm at the bedside. They are promoting the wrong feature, IMHO. Sanj, it sounds like you have good insight into what doctors actually want. Please keep it up!

drtse4 17y ago

See this old post: http://tinycomb.com/2010/01/09/breaking-apples-tablet-is-for-the-healthcare-industry/ http://tinycomb.com/2010/01/09/breaking-apples-tablet-is-for... It appears that a company named Motion Computing Inc (and i guess they are not the only one) already sells a tablet that targets the healthcare industry.

bmj 17y ago
My employer provides solutions for electronic patient reported outcomes for clinical drug trials, and Motion is our provider for tablets for use in clinical settings. We are anxiously awaiting information about the Apple device, and the HP device shown at CES, as the Motion tablets can be a bit overkill for some applications. Our industry, at least, is very much ready for more/better tablets.

joshwa 17y ago

The last few times I've been to doctor's offices/hospitals, I've noticed that a huge amount of doctors'/nurses' times are spent mouse clicking. The docs' offices all have computers in them with EPIC or similar patient record systems, and in the ER they have mobile workstations on carts positioned throughout where docs and nurses input data after every patient interaction. Healthcare IT depts can already put computers very close to the point of care to provide history, lab results, and input functions. A tablet would just be something for caregivers to lug around (how would they carry it anyhow?) and potentially be stolen. The main problems in healthcare IT (as I understand it, anyhow) are not input devices-- it's software quality, usability, integration, and above all, cost.

zandorg 17y ago

I sign tablets when a courier comes to the door, and it's such a random squiggle that I doubt such a tablet is accurate enough for healthcare.

jodrellblank 17y ago

I'm expecting Apple to announce a tablet tomorrow. Apple has been completely tight-lipped on the matter, and the only thing they've said about tablets is that they don't know how to make a good one. So why am I, why is everyone, expecting a tablet? What evidence is there that should support that expectation? Apart from the question "what else could it be"? And given how much effort Apple puts into keeping things under wraps, how did so many people and media outlets get so convinced a tablet is 'due' from Apple?