Doctors were one of the first professional groups to embrace the iPad when it launched nearly three years ago. Several doctors I interviewed at the time told me the same story -- that they saw the potential for the iPad to improve their work experience immediately. Within a few days of buying an iPad, all had brought it into their practice or hospital. A couple actually started taking their iPads to work on the same day that they bought them.
At the time, many healthcare IT professionals immediately saw the iPad as a giant red flag -- a mobile device that they neither owned nor managed. Many immediately assumed that the iPad was a giant potential compliance problem related to government regulations like HIPAA, the 1996 law that established clear privacy and security requirements for patient information. That fear wasn't entirely misplaced -- Apple didn't launch iOS 4, the first release to include enterprise security and management capabilities, until later that year.
Over the past three years, iOS has maintained its position as the preferred platform of healthcare professionals. Although sales numbers for the iPad mini haven't been published yet, it is expected to be popular with doctors -- mainly because it easily fits into standard lab coat pockets (companies have launched lab coats with pockets designed for full size iPads, but they haven't caught on with doctors).
Even with the management capabilities that Apple has built into iOS, many healthcare IT professionals are still wary of all consumer-oriented mobile devices -- tablets, smartphones, you name it. They aren't alone. Companies that develop software for the healthcare industry like electronic medical records (EMR) systems also seem wary of iOS and mobility in general. While some major healthcare developers like Epic have rolled out iPad-specific apps, others like have deliberately avoided mobile platforms entirely -- one company even said that it isn't interested in developing for mobile devices beyond Windows 8 and Windows RT devices.
On one hand, this has allowed independent developers and smaller healthcare software companies to make a name for themselves by delivering iPad-specific EMR products. Dr. Chrono is one great example -- the software designed specifically for iOS and Android devices and lets doctors manage their entire practice via those devices. MacPractice, a company that has developed EMR and practice management tools for Macs for years, has leveraged that experience in creating iOS tools -- including one called Clipboard that lets patients enter medical history and other information directly into their records -- that integrate extremely well with its desktop software.
On the other hand, larger institutions like hospitals or medical groups, generally already have EMR and other systems in place from the major vendors. Even without that investment, these entities generally need more functionality and scalability than apps aimed at individual doctors or small practices can offer.
The 2009 HITECH Act offers all healthcare providers major incentives to adopt ERM systems. Those incentives are tied to demonstrating compliance a series of meaningful use criteria by specific deadlines. That puts large-scale health organizations -- like medical groups and hospitals -- under the gun to select and implement scalable tools as quickly and efficiently as possible. The result is that support for the iPad or other mobile devices is seen as something that would be nice, but that isn't a major priority. If iPads are supported at all, it's typically through a virtual desktop (VDI) approach that delivers users a Windows application on their iPads -- an approach that may be effective but not one that takes advantage of iPad or tablet design and features.
Ironically, focusing on the iPad as an EMR client has the potential to deliver better care than some alternatives like the growing number of laptops in the exam room -- to say nothing about the unwieldy laptop carts that many hospitals rely on for in-room access to EMRs and related patient data like lab tests and scan results.
A recent op-ed piece in the New York Times illustrated how some EMR systems can lead doctors to unintended short cuts: copying and pasting notes rather than writing a new set of notes for each interaction with a patient and quickly checking off required boxes without fully performing every related diagnostic step or procedure. One way to handle this from a mobile perspective is to use the data leakage protection built into almost all mobile device management tools to disable a feature like copy and paste within an app.
One concern that bioethicists -- and many patients -- raised when the HITECH Act was passed and as EMRs have became more prevalent is that the act of focusing on a record on a computer screen can prevent physicians from fully engaging with patients. That's something that a number of Americans have experienced at this point and it can lead doctors and nurses to miss important visual cues during an exam -- particularly in fast-paced hospital, urgent care, or overbooked practice environments. The iPad or iPad mini, which have a form factor similar to that of a paper chart, can reduce this concern. With iPads and other tablets supporting stylus input, the experience can indeed feel like a paper chart to both the provider and the patient.
iPads and other tablets also give patients the ability to enter medical history, symptoms, and other key data can into their own digital records -- one study even indicated that such use can increase the amount of information that patients provide to their physicians, which can create significant advantages in accuracy of diagnosis and determining appropriate care.
While the iPad can solve problems like these, the device itself is only part of the solution. To be truly effective, EMR systems and other clinical tools need to be re-imagined and redesigned. A growing consensus among mobile developers and business users is that enterprise mobile apps succeed the most when they are broken down into specific tasks. The monolithic application that offers every possible feature and many ways to slice and dice data is often too cumbersome to work well on a tablet or smartphone -- largely because a user doesn't need all the features in the field. Instead they need to accomplish specific discrete tasks.
Like any enterprise tool, the EMR system needs to be broken down in a similar manner to be fully effective on a mobile device. The typical patient visit to a primary care doctor offers an example. The nurse recording vital signs and the reason for the visit doesn't really need to see or edit the patient's contact information, insurance, or preferred pharmacy -- the nurse needs to enter specific data points like weight, blood pressure, current medications and so on. An EMR app specifically geared to that task can make entering that data as easy as using a paper chart, if not easier. With an EMR solution that puts all the desktop components on a laptop or mobile device, just navigating to that portion of the tool can be a lengthy and cumbersome process.
In short, while there are many ways in which the iPad has improved the workflows of doctors and other healthcare providers -- and interactions with their patients -- there's still a lot of room for improving the integration of the iPad and other mobile devices in medicine. Like the initial adoption of the iPad, efforts for that improvement are likely to be driven by the doctors, nurses, and others that use mobile devices in delivering care on a daily basis. The best success stories will come from a cooperative partnership between these individuals and the IT departments and developers that listen to their needs and support their work.