A is for Apple, H is for Healthcare?

Michael Aratow , MD

Published August 22, 2012

“Daddy, I want an iPad.” This is a common request heard by parents, but this one was coming from my daughter in medical school, who already possessed a MacBook and an iPhone! Just beginning her clinical rotations in her third year, she noticed many of her peers using iPads to look up questions they had on a medication, the pathophysiology of the disease the attending was lecturing on at the moment, or even to study a lecture or required reading.

It is no secret that physicians have flocked towards the iPad for both work and play, with multiple surveys showing high penetration rates in this demographic. Mobile technology is clearly overtaking healthcare with the term “mHealth” achieving buzzword status. But, is the tablet the right tool for the job?

The word “tablet” itself has gone through its own evolution. It started as a rather large, heavy touchscreen-enabled device that initially required a stylus to operate. It then morphed into a lighter machine which allowed true finger touch input, and then became a hybrid laptop/tablet contraption with a monitor screen that could pivot around. Finally, the game changed with the introduction of the iPad, a light, elegantly designed device running an operating system which supported the swipe interface made popular by its “i” predecessors, the iPhone and iPod Touch.

While iPads were not built from the ground up for healthcare (then again, some might say neither was EMR software), they have been adapted quickly for the healthcare setting. The more traditional and heavier tablets for healthcare were enshrouded with a robust outer casing that could take the inevitable abuse of a drop from an overbed table or while running to a code. These tablets had built-in handles for carrying and the outer casing allowed for easy washing in case that 9 month old with gastroenteritis vomited in your direction while you were trying to get a history.

Yet the flourishing iPad accessory industry caught on, and soon enough there were antishock cases and screen protectors with the option of antibacterial properties. White jackets were made with larger side pockets so the iPad could fit. There were even special slings that allowed you to carry the iPad on your back like a messenger bag when you were in transit, and then to stabilize it on your hand for easy access when you had no desk. So cleanliness and convenience in the healthcare environment are now accommodated by the iPad, but what about the software?

iPads and iPad-like tablets are great for looking up clinical information, doing focused tasks like point and click e-prescribing, reviewing a patient’s imaging results at the bedside, or even providing patient education through rich media such as graphics and animation. Clinical documentation is where things start to break down. In fact, EMR software is a key factor which is slowing down the iPad right now. You know that swipe interface that made the iPad a phenomenal success? Well, try to find a major EMR vendor that fully implements that type of interface. There are very few programs that are even web based. Herein lies the problem; you can point and click, but not swipe, and there is no simple intuitive interface. This is because EMRs were created for Windows clients with larger screen real estate and a mouse.

Another limitation of the iPad is the absence of a full size keyboard. Want to free text your HPI? What about your treatment plan? Most people do, and the iPad virtual keyboard is not an optimal solution. Yes, you can get a physical keyboard that will fit into the antibacterial case, but now the iPad is starting to look a little like that hybrid/laptop model. Or you can replace the keyboard with voice recognition, but then you deal with the lack of a real time product. Due to processing power limitations, voice is recorded on the tablet and then transmitted to a cloud based service for voice recognition, then sent back later to the tablet for inclusion in the record. This is a lengthy process that doesn’t always fit well with clinical workflows and providers’ time.

So EMR software will need to catch up with current tablet hardware before the full potential of the iPad can be realized in the medical setting. Instead of being just a digital rendition of the paper chart, EMR software needs to embrace an interactive and data input paradigm that is tablet friendly. The EMR software industry’s last mile, clinical documentation, is the final barrier to widespread tablet adoption in the clinical workplace. Once that is solved, hopefully the tablet operating system ecosystem will have settled on a standard, such as HTML 5, to allow developers to create products that can run on what may turn out to be the three dominant tablet operating systems: Android, Apple (iOS) and Windows (Surface).

Oh…and that iPad my daughter wanted? She wound up buying it herself while I was still trying to analyze the pros and cons!

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