First off, I’d like to put to rest any speculation regarding the iPad’s intended target industry. More than four years ago, MadTV obtained insider marketing material that clearly shows the iPad to be a healthcare play.

In all seriousness, Wednesday’s official unveiling of the iPad by Apple CEO Steve Jobs is likely to launch a whole new round of speculation as potential buyers ponder its many wonderful uses leading up to its target ship-date (late March for WiFi-only, and April for 3G-enabled).

Who doesn’t want one? The device is every bit as beautiful and elegant as it is functional. A little smaller than a magazine, the iPad is 9.7 inches, measured diagonally. It weighs less than a pound and a half and is a mere half inch in width. It looks a lot like an iPhone, just bigger. While you can’t make calls with it, or use it as a camera (sadly), you can use almost 140,000 apps developed for the iPhone.

My initial thought when I heard Apple was coming out with a tablet: holy Newton, this is going to bomb! Seeing the device, its specs, functionality, price… I’d like to amend my original thought to “Ka-ching.”

I think most of my initial doubt stemmed from a belief that this was going to be an enterprise play. I’ve heard endless discussion about how Apple is specifically targeting healthcare with their tablet. If this is true, I don’t get it. There is very little I see that makes me think this is a healthcare game-changer, or even that this device can compete against ever cheaper PCs and laptops. Don’t get me wrong, a lot of healthcare organizations are going to buy this device. But they’re going to buy it for the same reason that I want to buy it – because it’s cool; it’s a hot new Apple gadget; and I want one. They’ll buy it and try to figure out why they needed it after the fact.

The real money is going to come from the consumer market. Period. I think when things shake out, the iPad is going to capture a huge market just north of Netbooks and slightly south of Laptops. At $499 for the 16GB, WiFi-only model, the device is about twice as expensive as a Netbook, but probably 50 times more functional. According to Apple, it has a 10-hour battery life while surfing the Web on WiFi, watching videos, or listening to music. It also has built-in Bluetooth 2.1, which can support a number of peripherals including wireless mouse, keyboard and headphones.

This sounds like the perfect leisure computer. It’s small, lightweight, sleek and powerful. You can stream media, play with any one or more of 140,000 apps, watch a movie on the plane – heck watch 3 movies if the flight is long-enough, listen to music, and a hundred other things.  You can also browse the Web, and while cloud computing makes business applications accessible, we’ve still got a ways to go before browser-enabled means enterprise-ready. Even then, the iPad’s form-factor will limit its enterprise appeal to a few niche markets. It’s real business success – and I think this is especially true for healthcare – will come when individuals are using their personally-owned “leisure” device as their default gateway into the enterprise outside working hours. For the time being, though, it mostly looks like a really fun toy.

What’s your take? Tell me what you think of the new device, and how well you think it will fit into your corner of healthcare. I hope to share many different perspectives over the next few days, so don’t hold back.

In other news…

Epocrates and RealCME partner to deliver enhanced e-learning offerings. The companies are working to create innovative and engaging continuing medical education (CME) curriculum provided online or on an iPhone device. Physicians will be given the opportunity to complete CME courses in new formats, including “Virtual Patient” interactions and interactive grand rounds… “Engaging”? Really? That’s a pretty high bar to set for CME.

Finally, I wanted to thank Vocera for becoming HIStalk Mobile’s first Founding Sponsor to go live on our site. Based in San Jose, CA, Vocera’s mission is to save time, steps and lives by providing instant voice communication solutions. The Vocera® communications system allows mobile workers to instantly communicate with each other, hands free, whether down the hall or across campus, using simple spoken commands. Their easy-to-use wireless voice system runs on a wireless LAN and is ideal for hospitals and other environments where mobile workers need to stay in constant contact to perform their jobs. Again, thank you for supporting us.

We will be announcing a couple of additional Founding Sponsors in the next few days. Please help us earn their support. Take the time to subscribe to our email alerts, post a comment or send me an email with your thoughts and opinions.

Nearly ten years ago, the industry was abuzz with mobile activity. Palm’s introduction of the Palm Pilot a few years earlier, in 1996, launched the personal digital assistant (PDA) revolution. Spurred on by the dot com mania and the rapid market penetration of PDAs, dozens of companies set their sights on healthcare where the opportunities for mobility were mind-numbing.

Most of the early hopefuls targeted either e-prescribing or charge capture – the two functional areas with the easiest to articulate value propositions. Several of these venture-backed companies raised millions of dollars. Yet, despite their undeniable value, nearly every one of these companies either went out of business, or were rolled from one company into the next until they eventually disappeared. Epocrates emerged during this period and had phenomenal success gaining clinical adoption, but suffered from a yet-to-be defined business model.

I started working with MercuryMD when its two founders were still in residency. The Company literally operated out of a loft apartment in the old tobacco district in Durham, North Carolina. MercuryMD began as many other high-flying VC-backed start-ups were crashing and burning. Our premise, unlike that of the solid-gold, “3 month ROI” VC darlings was simple and yet confounding – we would integrate into a hospital’s disparate HIS environment, capture only the pertinent information, reassemble the information in a patient-centric database, and then serve it to physician handheld devices according to their specific census. The premise was confounding because few understood why anyone would pay for just data.

Ultimately, the crux of MercuryMD’s data delivery solution was that everything starts with the information. Clinicians will not use a mobile device simply for the sake of using it. The device must first earn its way into their workflow, which requires having mission critical information. Once that information is in-hand, getting clinicians to adopt adjunct functionality, anything from charge capture to context-based clinical decision support, becomes relatively simple.

To deliver this solution, MercuryMD had to solve several key problems, including rapid low cost HIS integration, a reliable enterprise data conduit, and delivery to the end device.

Fast forward to today, and things look surprisingly similar – with one glaring exception. In 2000, devices were extremely limited in their capability. They were really only beginning to support WiFi, which didn’t matter that much because most hospitals didn’t have it (other than in isolated locations, like ED). You certainly couldn’t make a phone call with your PDA. Color screens were cool back then, but cool generally meant shorter battery life. Back then we used to care about how big an application was, and how many you had on your device. And, to be clear, the devices were purely consumer-oriented, meaning virtually no native enterprise capabilities.

Today, devices all but ship enterprise-ready. They are powerful, capable, and multi-functional. They support Bluetooth, WiFi, and cellular (GSM/CDMA), and they are pretty good at jumping between them. Memory is no longer an issue, nor is processing. Blackberry especially and iPhone increasingly are shipping in an enterprise mode for simple fleet deployment and management. Security, while still suspect, is getting better with each new OS upgrade. I would say that the vast majority of the challenge facing enterprise mobile solutions in 2000 no longer exists.

And yet, despite the capability of smartphones and their ubiquitous presence, most of the smartphone apps leave something to be desired. Yes, iPhone passed a billion downloads, but how many are like the iFart app that my daughter downloaded onto my phone this past weekend? Momentarily humorous and then forever discarded.

Looking back at the MercuryMD solution, it is clear that everything from the database to the data deployment to the end-devices has radically improved. The laggard? Data integration. And, actually, to be more specific it’s data availability – “integration” is an issue only because vendors make it one. Enterprise data is the missing element needed to create enterprise solutions.

While I have plenty of reservations about when and how healthcare information exchange (HIE) is going to happen, I believe it holds the key to breaking enterprise mobility wide-open. Imagine all of the developers and development shops who are sitting around trying to think of self-contained healthcare applications. There doesn’t seem to be a lot to work with. Don’t hold me to anything here. I’m not suggesting we’ve exhausted the limits of useful, standalone healthcare apps. I simply believe that if you want physicians, and clinicians more broadly, to use mobile devices in their daily workflow – and I’m sure they want to – you need to start with enterprise data.

MercuryMD, now part of Thomson Reuters, is more than capable of pulling out read-only data from enterprises… and there are dozens of others who can do the same. But it should not be a required competency to develop and create useful enterprise apps, and hospitals should not be paying for integration every time a new vendor shows up at the door.

HIE, provided it does not become yet another vendor-controlled platform, has the potential to turn-on the data spigot for hundreds of mobile development shops, all vying to create high-value solutions. Let’s hope that this is done correctly, and in our life time.

Email David

Thomson Reuters announces the availability of Micromedex 2.0. According to the Company, the new web-based version of its clinical information system gives clinicians direct Web and mobile access to Micromedex content through an enhanced user interface. A key feature of Micromedex 2.0 is a more powerful search capability that allows for multi-term search, predictive text, synonyms and suggestions for alternative spellings. I’m still not sure why they pre-announced this release back in December, but hats off to them for hitting their target.

Minnesota-based insurance provider Medica releases Main Street Medica for the iPhone. The app, which is based on the MainStreetMedica.com Web application, helps consumers compare cost and quality data for more than sixty common procedures across hundreds of clinics and facilities. I find this particularly interesting as I was just discussing with a couple of physicians how another insurance provider was listing comparative cost and “quality” data on their website. They didn’t understand how the insurance provider could list contracted rates for different facilities and providers on their website, while simultaneously restricting providers from disclosing contract fee schedules amongst themselves. The why is simple: insurance providers do not want physicians empowered with information. Far fewer physicians would take the “standard” contract rates if they knew that their hospital or large system affiliated peers were paid 60% more across the board. This “healthcare reform” scented gesture is far more likely an attempt by insurance companies to un-lever the same mega group practices that they helped create.  And BTW… I’m not an attorney, but non-disclosures generally become nullified when the source party publicly discloses said “confidential” information. Cool app though.

Amistaff Healthcare Technology selects RightSignature as electronic signature integration partner. According to Amistaff CEO Ron Gonzalez “RightSignature’s iPhone application and Google Docs integration make working with traveling healthcare providers easier than ever, reducing the time between application and placement.”

iPhone helps save man’s life following earthquake in Haiti. In a story covered by the Today Show, American filmmaker Dan Woolley told how his iPhone and digital SLR camera helped save his life while being trapped under rubble for 65 hours. The filmmaker used a first-aid app on his iPhone to treat a compound fracture in his leg and a laceration on his head. Then, heeding the advice of the application which warned not to sleep if he felt he was going into shock, Woolley set the device’s alarm to ring every 20 minutes. Awesome story, and I’m glad it wasn’t me. I can’t even remember that I have turn-by-turn GPS navigation on my phone when I’m driving around hopelessly lost. They’d have found the nubby remains of a phone in my hand that I’d been pointlessly using as a shovel.

How I Use My Mobile Device

by Joseph Crozier, MD/PhD

As a psychiatry resident at an academic medical center I am in contact with many patients each day with a wide range of psychiatric and other medical diagnoses. I use my mobile device – a Palm Centro – as a way to carry medical references with me wherever I go in the hospital or clinic with the ultimate goal of having key information available to aid medical decision-making.

The main applications that I use are the Epocrates Essentials suite and several digital books that I read using Mobipocket. These books include the DSM-IV Handbook of Differential Diagnoses, the Quick Reference to the APA Practice Guidelines, and the Quick Reference to the DSM-IV Text Revision. The main utility for me of these mobile applications is in having clinically useful information available immediately when needed. For instance, when I am admitting a new patient to the hospital I can use Epocrates to check the patient’s medication list for harmful interactions and for a guide in dosing medications that I may add to the patient’s regimen.

In the past I have also used the full Epocrates Professional suite including Epocrates Lab for advice in interpreting labs and Epocrates Dx as a quick refresher on medical conditions that I don’t encounter frequently. In addition to Epocrates, I use more psychiatric specific applications through digital textbooks that I purchased from PsychiatryOnline. These textbooks are useful for constructing differential diagnoses, planning initial work-up of patients, and provide advice in constructing evidence-based treatment plans.

I have found that having information on medication, labs, and diagnosis readily available saves me time in that when I have factual questions I do not have to find an open workstation and log on to look up information. I just pull out my mobile device and most of the times can find what I need. I have also found some of the attending physicians that I work with have grown to appreciate that fact that I have this information readily available and will also rely on what I can quickly find on my various references to help with decision-making.

Favorite Non-Clinical Apps/Uses:

What I use my device most for is texting my girlfriend who lives a thousand miles away. I also use the Palm calendar for my work and non-work appointments and as an alarm clock.

(Joe was kind enough to kick-off what I hope is a long and successful series of first-hand accounts from clinical-users in the trenches.  Please tell us your story.)

Epic releases Haiku for the iPhone.  I really don’t know much more than Epic’s description on the iPhone App Store at this point. We’ve heard a couple of grumblings about performance. If anyone out there has had a chance to use it, let us know what you think.

Healthcare Data Solutions announces the release of PrescriberPRO Mobile. The Windows Mobile and Blackberry compatible solution provides access to HDS’ full database of more than 1,000,000 healthcare providers and facilities. Users can search by hospital, pharmacy, provider name, GPS location, city, state, NPI or DEA number. I’m not sure if this is better for traveling salesmen or CMS auditors.  

Unbound Medicine announces the release of Medicine Central, an integrated mobile and Web reference.  Medicine Central includes:  The 5-Minute Clinical Consult, A to Z Drug Facts, Drug Interaction Facts, Pocket Guide to Diagnostic Tests, and MEDLINE Journals.

As a Palm Pre owner, here’s something I haven’t seen too often – PEPID announces support for the Pre! In fact, according to PEPID, this makes them “the original developer of point-of-care medical applications for the device and Web OS operating system.” OUCH! Is Web OS really that far behind? Epocrates is expecting to offer native support for the Pre sometime early this year.

nGenx and Wallace Wireless announce a co-marketing agreement to offer a hosted version of Wallace Wireless’ WIC Pager.  The WIC Pager integrates paging functionality into Blackberry devices, thereby eliminating the need for multiple devices. Just goes to show – the simplest ideas are often the best.

This caught my eye – business VoIP provider IP5280 acquires CEWest Consulting. CEWest Consulting is a Denver-based IP communications service provider specializing in broadband and hosted solutions for the healthcare industry. I just happen to be in the midst of a VoIP/hosted PBX conversion and would compare the difficulties to that of migrating from cable or satellite television to pure internet-based streaming media. Both are technologically sound solutions, offer tremendous enhancements at lower cost, and yet both are not quite accessible to the masses (nor me).

Finally, Allviant Corporation announces its CarePass technology is now available to Dossia’s consortium members. CarePass is an interesting concept – a bit like a personal healthcare ‘channel’ for consumers.  Clearly a great fit for PHR offerings, but I think both technologies have a steep hill to climb to get consumer adoption. It’s worth noting that Allviant Corporation was spun out of Medicity.