6 ms·

A doctor’s review of rounds with an iPad

84 points by mikecane 16y ago

bradleyland 16y ago
This is a really detailed account of the kind of advancement that multi-touch tablets can make in domain specific applications. Why are people rolling around computers on carts to perform simple interactions with web apps? I can't think of a better use case.
- sp332 16y ago
  You think App Store approval is picky, try FDA approval.
  - niels_olson 16y ago
    HHS, FDA's parent agency, covers HIPAA. And a bunch of other stuff (CMS comes to mind).
- patio11 16y ago
  Why are people... Carry a clipboard with patient names and diagnoses on it, OK, you're pretty much kosher. Carry a tablet which accesses patient names and diagnoses over a wireless connection and you probably just bought six or seven figures in infrastructure and auditing requirements. HIPAA: Comply Diligently, Or Get Intimate Domain Knowledge About Emergency Room Operation.
  - niels_olson 16y ago
    > probably just bought six or seven figures in infrastructure and auditing requirements. This has already been paid. Citrix is already deployed at most hospitals, and doctors routinely access it over wifi and 3g from laptops, the "COWs" the author refers to, and even their home computers. And Citrix has an iPhone client, a Linux client, and a BlackBerry client, all free.
    - tl 16y ago
      I can't speak to the quality of the iPhone version, but the Linux version is absolutely terrible. It's slow and crash-prone (think early flash releases).
  - kellishaver 16y ago
    I think a good number of hospitals have that infrastructure in place already. The doctors at ours all carry around laptops, then have to balance them awkwardly or find a table to set them on. Aside from being physically awkward to use at times, there does seem to be a lot of benefits. I can go to one doctor at one clinic and he can pull up my medical records and see what medications another doctor has prescribed me. Basically, any doctor I go to at any medical facility here has instant access to my entire patient history if they need it. This seems to me like it would be particularly valuable in an emergency situation. I'm not exactly in a big city, either. It's a rural area of eastern Kentucky. I tend to think the medical profession is one of the markets with the biggest potential with regards to tablets, the other being schools.
    - sigzero 16y ago
      I have a friend whose "speciality" is wireless in hospitals. The infrastructure is already there.
- niels_olson 16y ago
  > Why are people rolling around computers on carts to perform simple interactions with web apps? Please, don't even ask that question. It's the wrong question. They are a temporary placeholder until tablets come along. The clipboard metaphor is what you want.
petercooper 16y ago
My name is Dr Cheeks and I'm a little behind on my rounds.
pmccool 16y ago
The article describes a situation where an ultra-portable device with long battery life is a winner. It's not clear whether the iPad is any better than a netbook would have been. I would imagine it would win on standing-up use and lose out on typing. At any rate, it seemed more about the virtues of an ultraportable than the particular virtues of the iPad. edit: which is not a criticism of the article, merely an observation that it applies to more than one device.
- YooLi 16y ago
  Netbooks have been around long enough now that if they worked in this situation, they would have been adopted already. Think clip board, not laptop. The standing-up use is essential. He said the typing worked just fine. Add the 12+ hour battery life and the iPad fit the situation quite nicely.
  - pmccool 16y ago
    I was making the point that a lot of the advantages mentioned apply to netbooks. Some of the ones that don't (e.g. standing-up use) would be a case of swings and roundabouts. I agree that standing-up use, particularly data entry, is one of the iPad's advantages. I didn't get how much of the standing-up use was data entry (where it's game, set and match to a touchscreen) and how much of it was passively displaying data (where the advantage is smaller). One place mentioned in the article where the iPad wins over netbooks is ease of cleaning, having way fewer crevices than a device with a keyboard. Not an impossible problem, but I imagine it's nice not to have to worry about it.
- dazzawazza 16y ago
  One plus for the iPad is that it's very easy to clean fairly well. Certainly easier to clean then anything with a keyboard.
  - WiseWeasel 16y ago
    And it's fanless, so there are no vents, and it's not blowing potential infectious agents or allergens around.
kylec 16y ago
My mother works in the healthcare field, and when they announced the iPad I immediately knew that doctors would be clamoring to use them, and it's good to know that, at least with the webapp-based systems, that the iPad 'just works'. However, I'd also be interested in hearing from doctors that might not happen to be "chief information officer and dean for technology" and see how easily and effectively they can use the device.
- niels_olson 16y ago
  I'm a surgery intern. I think tablets will have to become as ubiquitous and uninteresting as cell phones before residents would start carrying them. If there's a code and you have to respond, you can't just drop a tablet in your pocket and run. If you leave it at the nurse's station at the county hospital, there's every reason to assume some gangbanger visiting his gangbanger buddy will take it. If you're going to the OR, there is precious little horizontal space where you can safely lay something down, or even lean it. Everything in an OR is on wheels, and is likely to get sprayed with some fluid, before, during, or after the case. I also think authentication will need to get lighter and more responsive. I think thumbprint detectors in the margin would be ideal. Pick it up and login. Logout if it sits without input for 2 minutes. If someone else picks it up, immediately log me out and log them in. Along with authentication, most hospitals use Citrix clients, but not all Citrix servers seem to be configured for various clients. I have never been able to access our Citrix server via iPhone, but the BlackBerry folks can. As for electronic notes, the "eCare" system at Sentara hospitals here in Virginia is overall faster than the paper notes at the naval hospital, but not as coherent. Designers need to come in, look at hand-written notes, and figure out how to lay that out in electronic notes. Tables upon tables of (value, high/low marker, units, normal range) for all 30 or so elements of a CBC is unnecessary when all I want is \ 13 / 7.2 ---- 335 84 N / 35 \ and that should fit on two lines, and the BMP should fit next to it, and the calcium-mag-phos should fit next to that, and the LFTs, and the coags . . . it should take all of 2-3 lines on the note, because that way it all stays in your field of view and you can think about it without having to scroll back and forth past gobs of data you're not interested in. Same with radiology: echo the impression, not the whole report. Vitals: always, always, always Tmax, Tcurrent, HR, BP, RR, SpO2, unless you're in a critical care setting, where you want the same order, but with ranges. It's all really fairly straight forward, but someone who knows CSS needs to sit down and figure it out.
philwelch 16y ago
It's encouraging (to Apple, I guess) that most of the weaknesses are just small points in their system's particular software that don't work well with iPad. Those will just get ironed out.
- metachor 16y ago
  Other than printing, yes. And I recall some email from Jobs where he said printing on iPad would be solved eventually.
jrockway 16y ago
Sounds like the iPad makes for a really good dumb terminal. I guess the advantage over a real computer, in this case, is that it's cheaper and the battery lasts forever. (And it has a good screen, something that Lenovo and others can't figure out how to buy.) And we never thought thin clients would catch on...
- niels_olson 16y ago
  the form factor is huge. The clipboard metaphor is very valuable. However, the maximum dimension that most white coat pockets can accomodate is a 8.5x11 folded in half the fat way, narrow edge down.
  - jrockway 16y ago
    I heard about some touch-sensitive e-ink-based devices that were supposed to come out in this form factor. I don't know about doctors, but I would buy one on launch day ;)
    - stcredzero 16y ago
      I predict that a 8x6 or approximate tablet with multitouch and 10 hour or more battery life will be produced soon. Both the iPhone 4G and the HTC Evo are plays for doctor's money. The larger or more detailed screens of these devices can still fit in coat pockets.
ZeroGravitas 16y ago
How much competitive advantage do Apples traditional strengths bring them in this Market vs generic web tablets? I'd say none.
- jemfinch 16y ago
  The fact that the iPad is the only significant player in this market right now is a pretty doggone big competitive advantage.
zaidf 16y ago
The patient management app at my dad's office is all Flash. There goes any chance of iPad adoption.
ams6110 16y ago
When there was a bug in a MySQL database being used by folks for chart review, standing there on the wards, I was able to securely get into the MySQL server back in informatics THAT doesn't sound HIPAA compliant....

84 points by mikecane 16y ago

This is a really detailed account of the kind of advancement that multi-touch tablets can make in domain specific applications. Why are people rolling around computers on carts to perform simple interactions with web apps? I can't think of a better use case.

sp332 16y ago
You think App Store approval is picky, try FDA approval.
- niels_olson 16y ago
  HHS, FDA's parent agency, covers HIPAA. And a bunch of other stuff (CMS comes to mind).
patio11 16y ago
Why are people... Carry a clipboard with patient names and diagnoses on it, OK, you're pretty much kosher. Carry a tablet which accesses patient names and diagnoses over a wireless connection and you probably just bought six or seven figures in infrastructure and auditing requirements. HIPAA: Comply Diligently, Or Get Intimate Domain Knowledge About Emergency Room Operation.
- niels_olson 16y ago
  > probably just bought six or seven figures in infrastructure and auditing requirements. This has already been paid. Citrix is already deployed at most hospitals, and doctors routinely access it over wifi and 3g from laptops, the "COWs" the author refers to, and even their home computers. And Citrix has an iPhone client, a Linux client, and a BlackBerry client, all free.
  - tl 16y ago
    I can't speak to the quality of the iPhone version, but the Linux version is absolutely terrible. It's slow and crash-prone (think early flash releases).
- kellishaver 16y ago
  I think a good number of hospitals have that infrastructure in place already. The doctors at ours all carry around laptops, then have to balance them awkwardly or find a table to set them on. Aside from being physically awkward to use at times, there does seem to be a lot of benefits. I can go to one doctor at one clinic and he can pull up my medical records and see what medications another doctor has prescribed me. Basically, any doctor I go to at any medical facility here has instant access to my entire patient history if they need it. This seems to me like it would be particularly valuable in an emergency situation. I'm not exactly in a big city, either. It's a rural area of eastern Kentucky. I tend to think the medical profession is one of the markets with the biggest potential with regards to tablets, the other being schools.
  - sigzero 16y ago
    I have a friend whose "speciality" is wireless in hospitals. The infrastructure is already there.
niels_olson 16y ago
> Why are people rolling around computers on carts to perform simple interactions with web apps? Please, don't even ask that question. It's the wrong question. They are a temporary placeholder until tablets come along. The clipboard metaphor is what you want.

petercooper 16y ago

My name is Dr Cheeks and I'm a little behind on my rounds.

pmccool 16y ago

The article describes a situation where an ultra-portable device with long battery life is a winner. It's not clear whether the iPad is any better than a netbook would have been. I would imagine it would win on standing-up use and lose out on typing. At any rate, it seemed more about the virtues of an ultraportable than the particular virtues of the iPad. edit: which is not a criticism of the article, merely an observation that it applies to more than one device.

YooLi 16y ago
Netbooks have been around long enough now that if they worked in this situation, they would have been adopted already. Think clip board, not laptop. The standing-up use is essential. He said the typing worked just fine. Add the 12+ hour battery life and the iPad fit the situation quite nicely.
- pmccool 16y ago
  I was making the point that a lot of the advantages mentioned apply to netbooks. Some of the ones that don't (e.g. standing-up use) would be a case of swings and roundabouts. I agree that standing-up use, particularly data entry, is one of the iPad's advantages. I didn't get how much of the standing-up use was data entry (where it's game, set and match to a touchscreen) and how much of it was passively displaying data (where the advantage is smaller). One place mentioned in the article where the iPad wins over netbooks is ease of cleaning, having way fewer crevices than a device with a keyboard. Not an impossible problem, but I imagine it's nice not to have to worry about it.
dazzawazza 16y ago
One plus for the iPad is that it's very easy to clean fairly well. Certainly easier to clean then anything with a keyboard.
- WiseWeasel 16y ago
  And it's fanless, so there are no vents, and it's not blowing potential infectious agents or allergens around.

kylec 16y ago

My mother works in the healthcare field, and when they announced the iPad I immediately knew that doctors would be clamoring to use them, and it's good to know that, at least with the webapp-based systems, that the iPad 'just works'. However, I'd also be interested in hearing from doctors that might not happen to be "chief information officer and dean for technology" and see how easily and effectively they can use the device.

niels_olson 16y ago
I'm a surgery intern. I think tablets will have to become as ubiquitous and uninteresting as cell phones before residents would start carrying them. If there's a code and you have to respond, you can't just drop a tablet in your pocket and run. If you leave it at the nurse's station at the county hospital, there's every reason to assume some gangbanger visiting his gangbanger buddy will take it. If you're going to the OR, there is precious little horizontal space where you can safely lay something down, or even lean it. Everything in an OR is on wheels, and is likely to get sprayed with some fluid, before, during, or after the case. I also think authentication will need to get lighter and more responsive. I think thumbprint detectors in the margin would be ideal. Pick it up and login. Logout if it sits without input for 2 minutes. If someone else picks it up, immediately log me out and log them in. Along with authentication, most hospitals use Citrix clients, but not all Citrix servers seem to be configured for various clients. I have never been able to access our Citrix server via iPhone, but the BlackBerry folks can. As for electronic notes, the "eCare" system at Sentara hospitals here in Virginia is overall faster than the paper notes at the naval hospital, but not as coherent. Designers need to come in, look at hand-written notes, and figure out how to lay that out in electronic notes. Tables upon tables of (value, high/low marker, units, normal range) for all 30 or so elements of a CBC is unnecessary when all I want is \ 13 / 7.2 ---- 335 84 N / 35 \ and that should fit on two lines, and the BMP should fit next to it, and the calcium-mag-phos should fit next to that, and the LFTs, and the coags . . . it should take all of 2-3 lines on the note, because that way it all stays in your field of view and you can think about it without having to scroll back and forth past gobs of data you're not interested in. Same with radiology: echo the impression, not the whole report. Vitals: always, always, always Tmax, Tcurrent, HR, BP, RR, SpO2, unless you're in a critical care setting, where you want the same order, but with ranges. It's all really fairly straight forward, but someone who knows CSS needs to sit down and figure it out.

philwelch 16y ago

It's encouraging (to Apple, I guess) that most of the weaknesses are just small points in their system's particular software that don't work well with iPad. Those will just get ironed out.

metachor 16y ago
Other than printing, yes. And I recall some email from Jobs where he said printing on iPad would be solved eventually.

jrockway 16y ago

Sounds like the iPad makes for a really good dumb terminal. I guess the advantage over a real computer, in this case, is that it's cheaper and the battery lasts forever. (And it has a good screen, something that Lenovo and others can't figure out how to buy.) And we never thought thin clients would catch on...

niels_olson 16y ago
the form factor is huge. The clipboard metaphor is very valuable. However, the maximum dimension that most white coat pockets can accomodate is a 8.5x11 folded in half the fat way, narrow edge down.
- jrockway 16y ago
  I heard about some touch-sensitive e-ink-based devices that were supposed to come out in this form factor. I don't know about doctors, but I would buy one on launch day ;)
  - stcredzero 16y ago
    I predict that a 8x6 or approximate tablet with multitouch and 10 hour or more battery life will be produced soon. Both the iPhone 4G and the HTC Evo are plays for doctor's money. The larger or more detailed screens of these devices can still fit in coat pockets.

ZeroGravitas 16y ago

How much competitive advantage do Apples traditional strengths bring them in this Market vs generic web tablets? I'd say none.

jemfinch 16y ago
The fact that the iPad is the only significant player in this market right now is a pretty doggone big competitive advantage.

zaidf 16y ago

The patient management app at my dad's office is all Flash. There goes any chance of iPad adoption.

ams6110 16y ago

When there was a bug in a MySQL database being used by folks for chart review, standing there on the wards, I was able to securely get into the MySQL server back in informatics THAT doesn't sound HIPAA compliant....