Android and iPhone pros and cons for healthcare

by Jeff Brandt

I wrote an article for KevinMD.com several months ago discussing the benefits of Android for the healthcare market. I also compared Android with the iPhone.   I listed the iPhone’s technical shortcomings and really angered the “believers of all things Apple”.  That was not my intent.

Apple’s latest release of iPhone 4.0 and their new operating system (OS) 4.0 corrects many of the problems that I mentioned.  The shortcomings or benefits of a device are not the focus of this article.   I am going to speak to the general philosophies of the two OS and let you make up your mind on which OS is better for your healthcare facility or personal/business use.

The Apple iPhone, as you know, is built on the premise of two primary factors: ease of use and a one vendor solution.  My definition of ease of use: the reduction of complexity to reduce cognitive involvement.  This is similar to the evening news which is written and delivered to be comprehended by a person with an eighth grade education.  I am not suggesting that the iPhone is for people with less intelligence—it is just marketing. Steve Jobs knows that if Apple hits the ease-of-use sweet spot, they will grab the majority part of the market.   The one vendor solution also reduces some of the problems of compatibility, e.g., apps for the iPhone are available only through the Apple iTunes website.  The only issue with this solution is that you are locked into one place to purchase music—or any app.

Android to the contrary has built an open source operating system to run on many phones from many manufacturers.  Android is not a phone, it is an OS.  Manufacturers may license the OS for any phone that they choose. They can also change or add to the OS as needed.  Android’s premise is to allow developers to build apps to the specifications and needs of the end user/customer, not to the needs and desires of the manufacturer of the phone or Google, the company that originally developed the Android OS.  The developer may also choose where their apps are marketed and sold.  There are numerous stores online where you can purchase Android apps, including the Google Market apps store.

Now for the pros and cons of both.

  • First, both operating systems of Apple and Android are based on UNIX, an OS that was built at ATT/Bell Labs in 1969.  The primary difference is the interface for both developer and user (owner of phone).  Apple has marketed the iPhone extremely well and it is a great phone for many users.  Studies have shown that most iPhone users do not purchase apps; many do not even use free apps.
  • The iPhone user is locked into accruing software, hardware and even music from a single vendor and store, the Apple owned iTunes.  CIO/CMIOs know the risk and potential disaster this can present for a mission critical environment like healthcare.  With the Apple solution you have the choice of one phone.  A single manufacturer’s hardware failure would leave an organization with few options.  The latest antenna problem with the iPhone’s new 4.0 is a good example of what I am referring to.  With the Android solution you are not locked into a single manufacturer.   At the end of 2009 there were 18 devices to choose from.
  • Apple’s “one size fits all” solution does provide some benefits. There are not as many issues with compatibility of devices or OS, although the iPhone 4.0 OS does not run on some of the  older iPhones.  Android apps can have problems with apps not running on all released OS versions from different manufacturers.  If the developer is not knowledgeable of these issues or fails to test their apps on all OS versions, yes there are issues.  These Android incompatibility problems are isolated to specific phones, thus you are still not limited to one phone. So, an enterprise solution would not be affected.
  • The Android user interface does take a few extra minutes to learn—not that it is difficult, it just has more options (buttons) for more features.   I have heard rumors that Android is planning to offer an OS feature that provides a similar interface as the iPhone.
  • The only other major consideration when choosing smartphones and mobile device solutions is that you must be concerned about the carrier selection, or should I say lack of.  The iPhone is only available on AT&T (in the US) at this time.   Redundancy and a single point of failure is an issue for mission critical systems.  Android is available on multiple carriers such as Verizon, Sprint and T-Mobile.

The iPhone and Android smartphones are basically both very good devices.   The user or the institutional IT leader must examine the pros and cons for their business or personal use.   For the normal everyday end user, either phone is a good choice.

My prediction is that in a few years, we will look back and laugh about these issues.  However, the incompatibility issues of their OS is a detriment to end users.  The future of application and OS compatibility will become less of an obstacle as the cloud and wireless broadband market matures.

Jeff Brandt is President of Communication Software, Inc., makers of the motionPHR.  This article originally appeared in Telecare Aware.

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  • NoVA doc

    As the iMedicalApps folks have already posted, there are far more medical apps for iOS than for Android. The iPod touch can run almost all of them without having to pay a monthly cellular usage fee.

    Android, even at version 2.2, is far less elegant than iOS. Hopefully Android Gingerbread will simplify the interface. here’s how to delete an unwanted app, a process that’s far more complex on Android:

    iOS: once you find it, hold app icon until it wiggles, tap the X, confirm delete. Very little finger motions required.

    Android: go to System Preferences (2 taps), Tap Applications, Tap Manage Applications, Tap the application to delete, tap delete. Lots of finger scrolling, required.

    • Max

      Or:

      Download App called Uninstaller.

      Open Uninstaller

      Choose App to be unistalled

      Click OK

      Can even uninstall itself.

  • Doc99

    The iPhone has some significant privacy issues.

  • http://blog.carecloud.com Alexander Lopez

    The Apple vs. Google war also boils down to a discussion on native apps (Apple) vs. browser-based (Google) apps. Google seems to prefer browser-based apps that function on every device, which is evident in the highly fragmented and uncontrolled nature of the Android app store. We think physicians need the stability and usability that the quality-assured Apple environment provides. Our CEO wrote an interesting commentary on this subject a few months back for iMedicalApps. Check it out at http://www.imedicalapps.com/2010/05/apps-mobile-health-care-cloud/

  • Ahmad AlSabban

    I am a family medicine physician , and for me iPhone is still superior to the Android ( i am talking about the personal use )

    i prefer the offline medical app because it is more reliable , ( some times the wireless and 3G signals are very poor )

    i hope that apple will have new CEO who will take necessary big steps , e.g. different devices with different screen sizes a replaceable battery

    For the android , i guess they need at least a year if they were good or two years to reach the level of the medical app on the iPhone

  • http://danielhooker.com/ Daniel Hooker

    Do you have a citation or reference for saying “Studies have shown that most iPhone users do not purchase apps; many do not even use free apps.”

    The reason I ask is that I have read the opposite, or at least, that Android and iPhone users are mostly comparable in their app downloading habits. See this post.

  • http://www.comsi.com Jeff Brandt

    Hi Fanboys of all camps, Just kidding :’)

    Alexander, Android is actually all native apps. Remember Google and Android are not one. But you point is well taken and I agree that in the very near future we will not be having this decision about OS. Browser Cloud model application will be the predominant application for everything. Writing and supporting application on multiple OS is stupid! The bandwidth is getting faster by the month the processors are increasing in speed faster than expected. This is the future. User should get to pick any phone device they want and run their apps anywhere.

    Android is already outselling iPhone but this is a moot point. Who cares. Today, It is in the hands of the developers to choose which OS to write for. We develop for both OS at present, but I see Communication Software scaling back on the iPhone development. The business model with the iPhone just doesn’t make sense and Apple is hard to deal with as a partner.

    Thanks for joining in on the discussion, I have been in mobile communication since the early ninety and I have been waiting for this day of Smartphone for a long time.

    Jeff Brandt

  • http://nextroomapp.com Ryan Arp

    We chose the Apple platform to develop NextRoom simply because of the flexibility of the platform and the simplicity of its use. We’re doing things that we’ve never done before with an app on a mobile device, like persistent internet connection and almost realtime updates to each of the users on the account. The iPods and iPhones are working together to give providers and staff instant status and queue updates – abilities we haven’t seen in other platforms (or apps for that matter). Doing these processes through a browser running on a mobile device would be unpredictable and in my opinion unstable.

    The fact that Apple has a limited set of devices and a single platform to develop for is a plus. It allows you to build a product that works in a controlled environment with predictable results. It also greatly simplifies support and issues when all the users are on the same device/platform. You can learn more about our product at nextroomapp.com.

    • http://www.comsi.com Jeff Brandt

      good point, This is what I am speaking to. It is up to the developer to know what OS to develop for.

      FYI, almost all of our reported problems were on iPod/touch and did not occur on the iPhone. The OS are close but not the same.

  • http://www.comsi.com Jeff Brandt

    Daniel, I should have said articles. I will have to look. I also ask people about their app usage anytime I get a change. I didn’t mean to single out iPhone. This i believe will change as the apps become more useful and users start to be come more educated about what is available. I had one customer contact me and ask why he should buy motionPHR when all of the other healthapps that he had downloaded were “crap”.

    thanks for the link
    Jeff

  • Surain Rajadurai

    Jeff, you cite the fact that Android has multiple handsets with multiple versions of the software running on each one as a strength.

    I know that at my institution (an academic hospital) the IT department would rather support one or two different architectures rather than a whole heap.

    There are so many different android handsets all with different compatibilities and operating systems (new versions of android e.g. Froyo etc… may not run on handsets as little as a year old and handsets don’t necessarily ship with the latest version either).

    It’s going to take a lot more IT work to support an application to run across all these architectures (closely related as they may be). Surely this is a detriment rather than a strength!

  • http://www.comsi.com Jeff Brandt

    Surain, Good point, but it is not really the responsibility of the HIT dept to determine what releases of OS and hardware a vendors product will run on. It is the vendors job to provide information on which hardware and software release are supported. If you look at any of your software products at home our in your institution there will be a hardware and software requirements page. Example; I will bet that Allscripts EHR or MS-SQL 2008 will not run on windows 95, or NT 0S with a 286 AMD processor .

    Jeff

  • http://nextroomapp.com Ryan Arp

    A good example of what you’re dealing with on Android development is the list of 60 smartphone devices that run the software…http://en.wikipedia.org/wiki/List_of_Android_devices

    Testing and supporting your app on this number of devices is not only intimidating, but could lead to a never-ending cycle of revision, de-bugging, and instability. Not what the medical field is searching for in my opinion. With Apple you have 3 iPhones (3G, 3GS, and 4) and a few iPod touches.

  • http://www.comsi.com Jeff Brandt

    “Android or iPhone: Your business. Your life. Your decision”, the original title to this article, so not to offend the Fanboys. But it looks like it did anyway. Have to talk to Kevin about not changing titles.
    http://www.telecareaware.com/index.php/android-iphone-apple-google-hit.html

    You do not need to convince me of your selection of Apple over Android or Symbian, Blackberry, is the correct decision for you. It is up to each of you to come up with your own conclusions. As a consultant of mHealth, it is my responsibility to inform, provide facts, I have my preferences but they should not come into the decision process. Not unless you pay me. It really depends on the application on which device and manufacture to choose. I do consider both platforms for development currently have more iPhone apps on the market than Android.

    Ryan, Please refer to my last post on number of phones and release is a moot point. I suggest that 1 phone is not enough for an Enterprise solution.

    Please enough with the Mine is better than yours. It is a waste of time for us that want to talk about mHealth issues.

    You want an iPhone get one, I really don’t care.

    BTW, typed on my Macbook Pro, get the best tool for the job.

    Jeff

  • Surain Rajadurai

    Sure, I get you there Jeff, but which programs our institution uses is a joint decision between us the clinicians and the IT department.

    If the IT department says – we can’t offer tech support for 60+ devices (thanks Ryan) – then obviously that changes whether we as clinicians are really going to push for it.

    The single vendor model that the iPhone uses in some ways is much easier to deploy.

    I mean in a perfect world everything would be web and HTML5 based and it would run the same on any device, but then again maybe you want the security of a dedicated app.

  • http://www.comsi.com Jeff Brandt

    Surain, The perfect world is right around the corner, the current Build Many times run once does not make any sense. That is why you haven’t seen a lot of enterprise software for the phones other than Browser.

    As for the 60+, again not an issue for consumers just vendors. Not unless you have a poor vendor, which is another subject all together. Most HIT groups are waiting for the Windows mobile 7 savour to solve the one vendor solution MS. The only reason Blackberry has been around so long, Microsoft integration. Keep waiting…

    Jeff

  • echo

    Good article – although I would argue that it still feels a little biased towards Apple-hatred, I do think you addressed the main difference between the two phones. Apple is a very controlled environment. While the iphone has never been the best featured phone on the market, it does have the benefit of doing what it does do very well. That is to say, what you see is what you get. Its not very customizable or expandable, but it has a relatively gradual learning curve compared to android phones and just works the way you expect it to, nothing more, nothing less. Android has the potential to be extremely powerful and versatile, but at the moment the market is so fragmented that the wide variety of phones on the market works almost to the consumer’s detriment. The high end phones on the market currently each have their own “hook” that makes you wish that the manufacturers would get together and combine all those cool features into one phone. This is the major flaw of the android market – it is so fragmented that many times people are left feeling like something is missing still. I believe that android is better at Apple at being “cutting edge,” but Apple has the more polished user experience. So, like you said, it basically comes down to which philosophy you prefer.

    I would have liked to see your article address more about specific smartphone uses in medicine. Your article focuses mostly on the pros and cons of the devices in general, but I would love to see a conversation get started on how doctors can best use technology to benefit their practice, and which phone might be best for doing so.

    It is also worth noting that iphone users are not locked in to the apple marketplace for purchasing music. Ripped CDs and even Amazon marketplace songs will easily import into itunes to listen to on your phone. Apps, however, are limited to the itunes store only (unless you are willing to void your warranty and jailbreak your phone).

  • http://www.comsi.com Jeff Brandt

    Echo, Good thoughts, I have written several article about the best phone for MD, but it has become moot. Especially with the Apples 4.x release. It is the applications on the phones not the phones that counts. The future of medical is wireless. It cost less, easier to implement and they will soon work anywhere anytime. But, we are not there yet.

    Things that will need to change to make a better healthcare device:
    - Get rid of proprietary OS, Including Android. Write once run everywhere. or cloud based solutions, which will take care of most of these problems
    - Carrier freedom, Google tried this but failed with Nexus. If Google would have a customer service department it may have worked.
    - Correct the store models, you can not run a business when a sales channel get 30% for hindering sales.
    - Clean up stores. You don’t go to a seafood store to buy Beef. The stores are a mess, 98% crap
    - Pricing model, the low pricing of app on the markets has lead to a field of problem from poorly designed product that have not been tested and little or no customer support. Until this changes happen, most of the healthcare apps will be written by non-skilled non-medical hacker, not software company. Most company cannot afford to do anything else.
    - Governance, many of the so called healthcare apps on the market are in FDA violation. We are going to need some over sight to cull the herd and protect patients and providers. Once this happen the amateurs will go away the quality will increase and the cost of the apps will go up.

    I have heard rumor that Android in going to add an additional UI feature; a simplified iPhone like UI, so user that want the simple interface can have it. I envision it being like a calculator that has a scientific option. Maybe Apple will add a scientific version. After all both phones are UNIX at the core.

    As for the fragmentation of the market, as I mention before it is a vendor problem more than a consumer. Yes, I got a flashlight app for free that doesn’t work on my phone. Sometime free is not cheap enough. Fragmentation has always been an engineering problem of utilizing OpenSource software as Google did with Android and Apple did with both their Macs and iPhone software. The world of OpenSource has come to Healthcare in a big way and we will have to get use to it. It does have it’s drawbacks. Healthcare had it’s own track at OSCON last week, where the NHIN was leading the charge with OpenSource in their national HIE solutions.

    thanks for replying,
    jeff