Apple has gained a well-deserved reputation for disrupting industries. Witness the impact of the iPod on the music industry, the iPhone on the cellphone industry, and the iPad on the computer industry. Apple’s announcement this past June that iOS 8 (the next release of its mobile operating system) will include tools to manage personal health information has many analysts, journalists, and other pundits debating whether the company can have the same disruptive impact on the health sector that it has had other industries.
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Like me, my Dad is an early riser. Thus, I wasn’t surprised to get a skype message from him as I worked away on the “oh my god its early train” from Toronto to Ottawa yesterday morning. Never one for small talk online (I suspect because he is a two finger typist), my Dad got right to the point … he wanted to know which iPad I had. When I asked why, he said that he was thinking about treating himself to some new technology and liked the tablet form factor.
Seems that my Dad, who turned 76 years old this year and only purchased his first computer when he was in his late 60’s, is not alone among the older generation in their interest in tablet computers. Indeed, a recent survey by QuantiaMD reveals that older physicians (those who have been in practice 31 years or more) are about as likely as those just out of medical school to own a tablet computer or plan to purchase one. According to the QuantiaMD survey:
- 19% of doctors in practice 31 years or more use a tablet in their work.
- 25% of doctors in practice 31 years or more indicated that it’s extremely likely they will get one in the future.
- 20% of doctors in practice less than 10 years use a tablet.
- 38% of doctors in practice less than 10 years indicated that it’s extremely likely they will get one in the future.
An American Medical News article cites the views of several older physicians about tablet computers:
- Dr. Frank Kempf, a 58, year old cardiologist at Pennsylvania Hospital in Philadelphia, notes that the “The learning curve of the device is quite advantageous.”
- Dr. W. Randolph Chitwood, a 65 year old director of the East Carolina Heart Institute at Pitt County Memorial Hospital and East Carolina University in Greenville, N.C., believes that the tablet computer will replace the laptop in hospitals and physician practices. He has even had a seamstress sew what he calls an “ipocket” into his lab coat.
- Dr. Steven Rothenberg, MD, a 52 year old chief of pediatric surgery at the Rocky Mountain Hospital for Children in Denver, stated that “The biggest thing is, as a physician, we are dependent on information to function. And anything like the combination of GCQ and mobile that gives us information in a faster and easier way is so good and relatively straightforward.” (Note, Global Care Quest (GCQ), an iPad application developed at the University of California at Los Angeles, provides remote access to patient data)
So, perhaps older physicians don’t have the fear of technology that many people seem to think. Rather, they may just be better at determining what is truly useful technology.
Despite attempts by some to portray physicians as luddites unwilling to use IT in the practice of medicine, a recent survey by QuantiaMD offers some hard data to refute this belief. QuanitaMD is an online physician-to-physician learning collaborative where, according to the company, 1 in 6 U.S. physicians engage, share, and learn from experts and each other.
According to the recently conducted QuantiaMD survey, more than 80% of physicians responding to the survey indicated that they own a mobile device that is capable of downloading applications (including but not limited to smartphones and tablets). This level of adoption is higher than the general population and demonstrates, in my view, a clear physician willingness to use technology when it fits into their workflow (which is highly mobile). Interesting findings from the survey include:
- 44% of physicians who do not yet have a mobile device intend to purchase one in 2011.
- 30% of physicians surveyed indicated that they use a tablet device. Interestingly, 2/3’s of these tablet users employ their tablet in a clinical setting.
- Despite claims that younger doctors are more apt to embrace new technologies than older physicians, the QuanitaMD study shows that interest in tablets holds steady across years of practice and is, according to the survey report, “as high for physicians with 30 years or more of practice as it is for those with 10 years or less”.
- Approximately 2/3’s of survey respondent state they are likely to select an Apple product. 60% of smartphone users indicate that they have an iPhone while nearly all tablet users have an iPad.
How do physician want to use their mobile? According to the QuanitaMD survey, their top interest is access to EMR data. Other desired uses devices for “peer to peer activities” include receiving treatment protocols alerts, and sharing and discussing cases with other physicians. Desired activities that involve patients include e-prescribing, sharing patient education materials, and receiving alerts when patients need follow-up treatment.
A close to home example of how mobile technology can be used for patient care is the Ottawa Hospital’s massive rollout of iPads and other Apple mobile devices. According to recent articles and anecdotal feedback from sources at the Ottawa Hospitals, the clinical community is enthusiastically embracing these new devices.
I have written in several publications (including this blog) about increasing concerns regarding the usability of electronic medical record software (aka electronic health record software in the US). At a recent conference I was pondering my position on this matter as I listened to one of the speakers when I suddenly released that I was one of the few people in the room who wasn’t using pen and paper to take notes (I was using my iPad). Interesting, I thought to myself. I wonder if these same people type up their notes when they get back to the office, either to share with colleagues or perhaps even to enter into a CRM system of some sort. If they don’t type them up, how often do they refer to them? Do they ever try to search for notes they took in the past?
While it might be stretching an analogy, there are some similarities between the process of taking notes at a meeting and the recording of patient data during a medical exam. Perhaps the same reasons that we are more comfortable using pen and paper are similar to the reasons that physicians offer when expressing their reticence to use EMR software. At the very least, making the change to from analog to digital note taking involves letting go of an approach with which we are very comfortable and that we have used for a very long time, just as it for physicians making the change from paper to electronic records.
Is it possible that we are asking physicians to “Do as we say, not as we do?” I can tell you from firsthand experience that trying to go paperless in my day to day business operations has not been without its challenges. My recent foray into getting rid of paper notes is not the first time that I have tried to do so. Over the past two decades I have tried several different technologies, each with limited success. The purchase of my new iPad prompted me to try again and I think that I might actually succeed this time.
So, who else is going to join me and do what we are asking our clients to do?
Many analysts, consultants, and industry pundits (myself included) are fond of pointing out the extent to which the health sector lags other industries with respect to the use and adoption of information technology. Given this common perspective, I was intrigued to read about a recent survey sponsored by Anoto, a company which developed and sells a digital pen that converts handwritten text into digital form.
According to Anoto’s research,”86% of businesses are still using paper-based forms in either their own business or in their clients’ business”. If Anoto’s data is anywhere close to accurate, it appears that other industries are suffering from similar challenges to the health sector in digitizing business processes. Other interesting survey results include:
- “45% said the use of paper-based forms over the last five years has either increased or stayed the same”
- “38% said they are planning to incorporate new solutions, particularly the iPad, into their business processes for data capture”
Even though I am somewhat leery of vendor surveys as they often have a bias towards the company’s products, I thought that the seemingly high dependence on paper forms was worth mentioning and mirrors my experience with many companies with whom I deal.
I have had my iPad for nearly two months. I couldn’t wait for them to come on sale in Canada and arranged for someone to pick one up for me in the US. I continue to be amazed by this device and, like many people, can see many potential medical applications for it. However, I am not a doctor (though my mother, a retired nurse, still secretly wishes that I had picked a career in medicine) and cannot speak with any authority on actual use of the iPad in a healthcare setting. Hence, I have been actively looking for any first-hand accounts of physicians using an iPad and I found one today.
Dr. Henry Feldman is hospitalist in a US hospital and wrote an in-depth account of his experience using an iPad to make his rounds. Overall, he was very enthusiastic, stating that “In general, it was incredibly useful”. Specific comments include:
- “For any provider who is highly mobile this blows the doors off of the COWS (computer on wheels) which is like rolling a file cabinet around.”
- “Battery life is epic …. On an average full 13 hour stretch with heavy use burned 28% of the battery”
- “I was worried that it would be ‘heavy’, but found that it wasn’t hard to carry all day (and we really moved around a lot).”
- “The device itself is very fast and wakeup from sleep or app switching is essentially instant”
- “Performance was amazing, with screens updating faster than many of the desktops on the wards.”
- “Showing patient’s their EDD/ERCP pics, results/trends … really helped with understanding by the patients.”
- “Probably the most useful was rounding (or the nurse snagging you as you walked by) and during a trigger where I could stay at the bedside and do/see everything and not leave my critically ill patient.”
Reading Dr. Feldman’s complete post it is clear that he is a “geek” doctor (he talked about tweaking MySQL from the iPad). That said, his enthusiasm is clear and his observations on what makes the iPad useful are illuminating.
Let me get this out of the way right of the top… I’m a luddite.
It took me 8 years from the launch of the iPod to get one. Why would I buy a device to play all of my music in yet another format after I invested thousands of dollars in CDs. They work and more importantly don’t cost me extra money. For goodness sake I still don’t even own an iPhone or any cell phone right now…shocking I know. Some people have said I’m cheap, but I prefer the term frugal. 🙂
I turn on the TV the other day, and the talking head is droning on about Apple. I ignored him until he mentions that their earnings are up 90%. Now he has my attention. These numbers are huge, largely due to iPhone and to a lesser extent iPad sales. The iPhone I kinda get, it’s a phone with all kinds of apps and looks cool. Can someone explain to me why I should care about the iPad? Is it a phone or the Apple version of a netbook. I’ll admit that sometimes I am “temporarily incorrect” when it comes to some products, but I am mystified about this iPad thing.
To put it into a larger context should healthcare IT decision makers, in Canada or elsewhere, take it seriously. I have read about many of the serious misgivings that CIOs (in healthcare and other verticals) have about Apple products. Less so about the iMac, but more about the iPhone and it’s perceived issue around security and suitability in a corporate environment vs as a consumer device. I would be surprised to hear if Hospital and RHA CIOs have not been approached by staff/doctors about integrating their iPhones into the corporate IT environment. It is not like doctors are afraid of telling you what they think or want.
What exactly can an iPad do in the Canadian healthcare IT market that can’t be done by existing hardware devices. Apple may be successful in selling these to consumers, but what real value does it actually bring to healthcare IT environments?
When I ask these questions, I feel like the teacher from Ferris Bueller’s day off…”anyone anyone…Bueller?”