Health care professionals, particularly physicians, have quickly embraced the iPad: More than 30 percent of U.S. doctors now own one, according to research from both Manhattan Research and Chilmark Research, and sales show no signs of slowing. Manhattan Research said last year that Apple's product "continues to dominate the tablet market in health care," and everyone else is eating its dust.
The reason is that in the iPad, physicians have found a user-friendly product. The tablet doesn't cost 50 percent more than a comparably outfitted laptop, as some of its competitors' offerings have.
And the iPad delivers elegant design, good battery life and ease of use to health care users who have been clamoring for all three since tablets-many developed specifically for the medical market-hit the market a decade ago.
David Carleton, vice president and CIO at Heritage Valley Health System, Beaver, Pa., calls the iPad a "new delivery mechanism" for data and applications.
At Heritage Valley, a homegrown app allows doctors to access a clinical data repository from their tablets. "There's very little that we don't present to them on the iPad," Carleton says.
But it's not time for a victory lap just yet. The iPad and its competitors are not a perfect fit for health care for a variety of reasons, experts say: the small screen size is still a problem, as are the virtual keyboards, which make typing even more laborious for physicians who dislike typing in the first place. The are numerous security concerns with mobile devices and platforms, a big issue in an increasingly security-conscious industry.
In addition, software is still playing a bit of catch-up to the hardware.
Last fall, a small-scale iPad experiment failed at Seattle Children's Hospital. Chief Technology Officer Wes Wright issued iPads to five physicians and two nurses and enabled them to log into the hospital's Cerner EHR through an app that effectively turned the tablet into a Citrix terminal, replicating the desktop environment from each user's PC.
Every one of the users said the set-up was not suitable for their day-to-day inpatient tasks. But Wright does not blame Apple. "We made them use a Windows 7 desktop on top of the iPad," Wright explains. "The point wasn't that the iPad was the problem. It was the software," Wright says.
Cerner designed its EHR so certain elements look best on a large, 21-inch monitor, not the 9.7-inch iPad screen. The lack of a "native" iPad app meant that users had to scroll through a lot of screens to view all the information they needed. The software is optimized for a PC, not a tablet, Wright says.
Cerner, an enterprise systems vendor, does have a native iPad app out now that optimizes views for the smaller display, but it's read-only.
Wright says he is not interested in the app because doctors would like to be able to enter data on the iPad. The vendor says an update in the works, but any app that permits data entry on a mobile device opens up security issues, it adds.
So while iPads and its tablet brethren are not yet a fit for every current clinical environment and software infrastructure, emerging computing trends are breaking down some barriers. In addition, HIT vendors are starting to develop tablet-specific software and role out new devices to make the form factor more customized to the industry.
The greater adoption of cloud-based computing services is making mobility suitable for more enterprise-wide health care deployments, even as network administrators and compliance officers fret about how to meet burgeoning demand for mobile access while maintaining adequate data security.
According to Geoff Webb, director of product marketing for Credant Technologies, a company that specializes in data protection, the shift to the cloud is one of a few computing changes underway that are challenging long-held conventions around tethered PCs as the backbone of computing infrastructures.
For cloud-based services, which store data and run apps remotely, "tablets are the perfect devices," Webb says.
Another tablet-friendly trend is mobility of information: health care data is moving in greater quantities and to more places thanks in large part to the surge in adoption of electronic health records and wider availability of mobile broadband data services.
In addition, mobile users, particularly physicians, are buying their own smartphones and tablets, then asking I.T. departments for access to organizational networks. I.T. security departments as a result are moving away from their historic role of putting up walls to a more enabling position of giving users greater choice regarding access, Webb says.
Desktop mentality
But the counterweight to those trends is the still-ongoing transition from traditional desktop software to a mobile environment.
The problems that provider organizations are experiencing trying to fit a conventional EHR onto tablets does not surprise Thomas Giannulli, M.D., the chief medical information officer at mobile healthcare software developer Epocrates.
"You just can't take a desktop mentality and apply it to mobile," Giannulli said at the recent Healthcare Information and Management System Society (HIMSS) conference in Las Vegas. "You've got to get the software right."
During the conference, Epocrates introduced the beta version of its ambulatory EHR, which is designed to run on the iPad.
The EHR is built to replicate the "rich data entry" of commonly used EHR drop-down menus that create documentation based on user clicks, according to Giannulli. Instead of mouse clicks, iPad users select items with finger touches, and can take advantage of the finger-swipe capabilities to "stack" elements of a patient's record or a list of multiple patients for easier viewing.
