iPads Have Won the Hospital, but Android May Win the Patients
In wards and doctor’s offices, the iPad is becoming a mainstay care device, as Android stakes a spot in patient-facing use
At the gigantic Healthcare Information and Management Systems Society (HIMSS) conference these week in New Orleans, iPads were everywhere. At least half the attendees had one for note-taking, whereas laptops (almost all of which ran Windows) were a distinct minority. iPhones and Androids were also ubiquitous, with a scattering of BlackBerrys.
The 30,000 practitioners, consultants, health care IT staff, and vendors who flock to this show clearly are modern mobile users. But at work, they put those devices away and turn to traditional PCs and even green-screen terminals to access patient records, order procedures, handle scheduling, and manage email.
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Not for long — for a while now, health care has wanted to use tablets in patient wards, waiting rooms, mobile clinics, and the like, but the Windows XP, Vista, and 7 systems available in the last decade were too heavy, hard to use, and power-hungry. Plus, electronic health records (EHR) systems have only recently come online, so there wasn’t much actionable digital information. With EHRs in wide deployment as hospitals race to meet federal implementaion deadlines and iPads prove to be durable, battery-sipping, and powerful devices, the attention is now on marrying EHRs and iPads.
For clinicians, it’s becoming an iPad world
The two largest EHR vendors — Epic and Cerner — already have slick iPad apps that handle much of the workflow in in-patient and ambulatory (outpatient) settings, able to handle most tasks a doctor or nurse needs to do when with a patient. Clinicians (doctors, nurses, and so on) I spoke with at HIMSS want to work in iPads rather than computers for the same reason all workers prefer light, portable, connected devices over laptops and other PCs. The iPad Mini, which fits easily into a lab coat yet has a screen 85 percent the size of a standard iPad, is particularly attractive to clinicians; those who had them loved them, and those who don’t want one. iPhone versions are also typically available, but iPad versions seem to be displacing them.
Pretty much every EHR vendor is working on iPad apps, even though most are a year or two behind Epic and Cerner. For example, major EHR vendor Siemens Health could show only a limited-capability iPad beta, with promises it would catch up in a year or so.
They see in the market what I saw at HIMSS: mobile-oriented sessions so packed with practitioners that rooms had to be closed to some attendees because there were more participants wanting in than fire regulations would allow. No question that mobile is top of mind for health care, and for caregivers, mobile means iPad.
The iPad is a natural for clinicians. In addition to its weight, size, and battery-life advantages, its simple touch-based interface works well in the medical environment used to checklists, forms, and patient records containing a mix of media, from handwritten notes to X-rays. The ability to use voice recognition input from providers such as Nuance helps, though the lack of stylus support in iOS caused an occasional grumble. The iPad is also easy to keep sterile.
Clinicians love that using an iPad is less obtrusive than a laptop or other computer, so the clinician-patient interaction is more personal yet more accurate due to the lookup capabilities. Some facilities are even contemplating using large screens connected via USB cables or AirPlay so that the patient can see what’s on the clinician’s screen and there’s no worry about secrets being withheld.
All the EHR mobile apps keep the patient and other data on back-end servers, using HTML apps in a native wrapper that ensures caches are kept clean as users sign out. This Web approach also lets clinicians switch iPads midshift. Although iPad batteries easily last eight or more hours on a charge, many clinicians have shifts of 12 to 36 hours; at some point they’ll need to swap devices. In addition, iPads are typically locked to hospitals’ and medical offices’ Wi-Fi networks, so they can’t be used elsewhere. However, practitioners who do patient home or workplace visits or who work in mobile treatment trailers or other mobile field facilities need to be granted cellular access, either directly or via a MiFi cellular/Wi-Fi bridge device (which allows locking the iPad to a specific Wi-Fi device).
It’s clear that the iPad will be the primary computer used by most patient-facing clinicians. PCs in offices, nurses’ stations, and cart-based workstations on wheels will be used as a backup device for long data-entry sessions and in situations where big screens are handy, such as detailed examination of radiographs and perhaps some trending data. It was pretty amazing to see some of the charting views available on the iPad, though.
Android is not prominent on the road map for EHR providers, who want to see the market settle down in terms of screen resolution and core services, which now vary widely from vendor to vendor and even model to model. It’s too much effort to design a consistent user experience in that variability, several told me. Of the major providers I spoke to at HIMSS, only Siemens was committed to an Android version — after its iPad effort was done.
No one seemed interested in developing EHR apps for Windows 8′s Metro UI. One top EHR provider even told me customers not only didn’t expect to adopt Windows tablets but also wanted their providers not to divert resources into Windows 8 versions, for fear of delaying the iPad efforts — wow.
Where Windows has a place is on the desktop, where all EHR systems already have Windows 7 versions that would continue to be accessed in Windows 8′s Desktop UI. One provider that is reworking its Windows apps’ UI to work like the iPad version said it saw the benefit of using Windows 8′s touch capabilities for iPad-ized Windows apps.
Android considered for patient-facing uses
Mobile use in health care doesn’t stop at the clinician. Over the next year, you can expect to see your medical provider offer Web-based access to your medical records in what’s called a patient portal. That’s mandated by federal law as part of a pool of incentives tied to getting maximum Medicare reimbursements and extra funds from the feds.
There are several goals in what’s known as Meaningful Use Phase 2, all of which are about changing health care from a fee-for-service system that keeps people sick (because hospitals and doctors are paid only when people get sick and have to come in) to a system where preventive health care (aka wellness care) is encouraged and financially rewarded. The Meaningful Use requirements force medical providers to prove that the new tech is actually used to be eligible for that money, to ensure that practitioner behavior verifiably changes.
One MU2 requirement — with a deadline of May 2014 — is that 5 percent of patients interact via electronic systems. That’s an awfully low bar, but it scares many providers. Thus, you get the patient portals, online appointment scheduling, and ability to reorder prescriptions online. They’re the low-hanging fruit of MU2′s patient engagement requirements.
Given the shift from desktop PCs to mobile devices, it’s become clear to the health care industry that it needs to offer patient portals via mobile devices. At HIMSS, such products and services were everywhere. A few EHR pioneers such as Kaiser Permanente have rolled out mobile access in the last few months, and the major EHR vendors are furiously enabling he in their products; Epic and Cerner again lead here.
But patients use all sorts of devices, not just iPhones and iPads, so these mobile health portals are also designed to work on Android smartphones and tablets — in fact, on any major browser. Thus, most are HTML apps in native wrappers or simply accessed as a mobile-savvy Web page.
Android may get a more prominent role in another patient-facing area: bedside entertainment and information systems. Several vendors showed touchscreen devices that would hang by a patient bed and provide TV, movies, and other entertainment capabilities as well as a variety of other services, such as making Skype video calls, playing games, and ordering a cup of tea.
Such devices would also be used to engage patients in care areas, such as letting them watch videos on their coming physical therapy — and tracking whether they indeed watched them as prescribed — or look up information on their condition or specialist providers. Think of it as a smart TV redefined for in-patient care, not just entertainment.
All the ones I saw were based on Android, an OS that has gained some traction beyond smartphones and tablets for embedded devices. The Google TV effort has faltered, but their variation of the concept could take off.
The sea change in health care platforms
There’s clearly a sea change in the core computing platform being used in health care, with iOS largely displacing Windows over the next few years. There’s also a sea change in user access to health services and information, one that is following the same heterogeneous trend as the rest of the world, with iOS and Android leading. Android’s customizability is also giving it a new life in specialty information devices.
The world of health care is catching up to the world at large. Soon both clinicians and patients will be working with the same tools in health care as they use everywhere else.