What will prevent the iPad from dominating health care IT?

iMedicalApps reviewed some recent news articles regarding business/enterprise adoption of the iPad as a legitimate alternative to Windows machines in the workplace, taking it as a sign that healthcare IT is poised to adopt it, too: “All in all, these developments bode well for the adoption of the iPhone and iPad as a mainstream, IT-blessed mobile healthcare solution.”

iPad enthusiast medical bloggers, and there are many, have been making optimistic predictions like these since the iPad was first revealed. I wish that I could share in their optimism, but I think that they too easily confuse a vision of what is possible with what is probable.

In the abstract, the power of touchscreen iOS devices could be the best thing to happen to healthcare IT ever. I see it benefitting nurses and pharmacists as much, if not more than, physicians. But there are a lot of things that would need to happen to make this vision a reality. Unfortunately, the history of healthcare IT is a story of under-planned implementations of misguided ideas, followed by pessimistic refusals to implement demonstrably better alternatives. Here are the obstacles I see:

1. For the iPad to become ubiquitous in healthcare, IT departments would need to overcome decades of unease with Apple products. Many IT guys I know flat-out refuse to touch them, despite the fact that they are much easier to manage than Windows machines.

2. EMR vendors would need to develop genuinely useful, native apps, and not just for physicians to review records. For the iPad to make an impact, EMR apps would need to offer a complete set of features, including support for nursing, pharmacy, and ancillary personnel. These apps cannot be one-to-one ports of legacy software. UIs designed for mouse clicks won’t work on a touch screen. I need not mention the poor track record of the usability of EMR software up to now. Do we really think that the same guys that gave us our existing crap software can produce compelling apps on an unfamiliar platform?

3. Interoperability is key. Vendors for everything from call-light systems to materials management equipment need to make it easy for new apps to interface with their solutions, either directly or through convenient middleware.

4. Last, and most important, how do we convince healthcare executives and shareholders that the costs of development and implementation are worth the benefits? As a bedside nurse, having a dreamy piece of slick iOS EMR software on an iPad with a barcode scanner would revolutionize the way I work, but how could that translate into terms that executives would appreciate? Will it reduce costs and improve quality? If so, and that is a big if, then the iPad has a chance. But it isn’t possible to reach that brave new world by rehashing the same ideas that brought us to the status quo. Healthcare needs more than an iPad. We need fresh talent and new ideas.

Jared Sinclair is an ICU nurse who blogs at jaredsinclair + com.

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  • Luai

    The problem with Apple products is the fact that they are locked systems, so it wouldn’t be smart to choose them for bigger institutions. On the other hand Android tablets, such as Xoom and the upcoming Asus tablet look promising because they provide more features and allow for relatively easier app creation for companies.
    The other option that might pick up is Chrome OS. I have been using the product for a few months now. It will be a cheaper product with more security and with Citrix developing its native apps on it (which they demo’ed in January) it seems that it will save users time. Currently they only have it in beta testing on netbooks but when/if they release a tablet with Chrome OS I think we’ll be looking at a new revolution in cloud computing

  • http://onhealthtech.blogspot.com/ Margalit Gur-Arie

    Just to reinforce Luai’s point, when you decide to go with iPads for the enterprise, you just tied yourself to both an OS and a hardware manufacturer forever. It is not a very smart business decision because you will have to pay whatever Apple chooses to charge for hardware if your software is “native”, which means that it won’t run on anything else. You cannot shop around for better deals and better technology.
    This model is based on the assumption that the iPad will forever be better than anything the rest of the market can offer. This may be true today, but will not be true forever (it never is), so those IT executives who refuse to join the iWorship camp may be doing you a long term favor.

  • http://Www.Personalmedicine.com Natalie hodge

    Regarding number two, those guys that gave us the first generation pc crap software are not the ones creating next generation platforms for Mac and mobile. These are different developers in new companies with fresh teams and rapid feedback loops in which you can request features through the application and see them in the release the next quarter. I run my MacBook pro and iPhone/iPad 12 hour days 364 days a year without a hiccup. When I forget my password, I reset it and get in within 60 seconds.

  • ErnieG

    I think the writer brings up issues that are often forgotten by those who see iPad in health care. The iPad is a piece of hardware that provides certain benefits (portability) but it is the software that makes a piece of hardware useful (ease of data entry and retrieval, intra-operability, open access) and the relationship of hardware and software developers with the end user. Up until a few years ago, use of computers in health care has been very successful when used in a niche (i.e. billing, department record keeping, lab databases, etc). The advent of EMR (i.e. the transition from paper charts to computer patient records linked to pharmacies and lab data) has been largely unsatisfying. I think the real good stuff for healthcare will eventually come from non-Apple hardware and software producers- the pie is too big and too variable to think one company is going to solve it.

  • http://www.MedicalTabletPC.com Chris Wilkerson, DC

    The iPad remains a, “consuming device,” to the consumer and industrial user. For health-care EMR use, hand writing recognition and voice are prerequisites to acceptance.
    In the meantime, Radiology and othereducationall material to view is wonderful on this device.

  • luai zarour

    I don’t think we should settle for view only options for EMR at this point since we have the software and the operating systems that can do much more including hopefully soon allowing healthcare providers to hand write notes with automatic recognition on a tablet

  • Molly Ciliberti, RN

    The prejudice of IT in favor of the PC crap is the greatest obstacle. I always thought they feared Macs because they empowered the user and the IT folks felt threatened. I think the iPad is a superb tool for bedside care and maybe if we are lucky there will be software developers savvy enough to build on them

  • Ryan


    You erroneously conflate your personal choice with an institutional choice. Commenter 2 brings up an excellent point: “when you decide to go with iPads for the enterprise, you just tied yourself to both an OS and a hardware manufacturer forever.” This might work well for you personally, but it makes no sense for the institution. The Android mobile OS functions independent of hardware manufacturer, meaning if you do not like the quality or usability of one, you can go and find a better value or model that fits your needs. Additionally, the open nature of the platform allows for modification to fit specific needs, an important point when considering the variable needs of different institutions. With any iDevice, you are always playing by Apple’s rules with zero choice. If you’ve been following the news you can also see some of the dubious ways Apple has been leveraging this customer lock in power lately, enough to being on repeated DOJ inquiries. Institutions should not put themselves in this vulnerable position. It is absurd to assume Apple will always produce superior products to competitors that justify a permanent hardware-software lock in; Apple will rise and fall as it did before, as will its competitors. Thats’s why it’s so important to have flexibility as an institution to adjust to the cyclical nature of technology.

    You will see beginning this month month several wi-fi only Android based tablets that meet or beat out the ipad in terms of specs and pricing. On top of that, Android runs Flash (an internet standard, no matter how much Apple wants people to believe otherwise) and does not need to ever be synched up with other software like itunes, so better functions as independent computing devices. This isn’t a matter if you’re “a Mac or a PC,” this is about what makes more sense for sustainable institutional implementation with scarce institutional dollars. Android is clearly the better mobile OS choice in this context.

  • http://SimonBramfitt.com Simon Bramfit


    If you were to replace “iPad” with “tablet”, I largely agree with you. The use of lightweight easy to use tablets does have the potential to significantly improve many aspects of healthcare, but just because Apple created this market in the consumer space does not inevitably mean that they will or should dominate it in healthcare.

    Yes, many IT professionals (I am one) do not particularly like Apple. However, my concern is not that they are empowering, I, and I hope many of my associates, truly understand the need to provide the IT tools to allow professionals like you to fulfill your responsibilities effectively. My concern is simply that, from an IT perspective, management options for Apple devices are significantly limited. They are without question delightfully easy to use, but trying to manage OS X and especially iOS devices is an experience too much like herding cats for most enterprise IT organizations to be willing to attempt. Unfortunately, the same has to be said of Android powered devices today.

    Things are changing, solutions are being created to fill this void, solutions already exist to deliver (managed) Windows and web apps effectively on on multiple tablet devices (iPad, Android, Backberry, and soon webOS). The key is to focus more on your final point, communicating the value of this class of device, rather than focusing on the strengths of one particular device in the field of many.



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