The mobile clinician…and why last weeks post doesn’t matter – 6/26/12

After seeing the not-terrribly-positive comment on my Surface vs. iPad post last week and reading more about the Surface, I got to thinking over the weekend and realized the Surface can’t really be compared to the iPad because they represent different categories of devices. Just as a tablet can’t be compared to a netbook, the Surface and the iPad can’t be directly compared. Sorry for figuring this out after my post. The Surface is trying to define define a new category, call it a productivity tablet or a tabletized notebook or something else (I’m not a marketing guy).

What I also realized is that the announcement of the Surface has reinvigorated the MS/PC vs. Apple/Mac debate, bringing with it years of baggage and emotion. Most people see the debate in a binary way, and Apple’s approach doesn’t really help in this. In reality I guess it makes sense because going either all MS or all Apple makes life a bit easier. Or you could go all Google I guess, not to have them left out. I don’t have any Google OS-driven devices, at least as primary devices, but I do use Google for all mail, contacts, calendars, and web browsing.

Then I read the recent National Physicians Survey from Sharecare and saw what seem like relatively low numbers for both smartphone (20%) and iPad/tablet (12%/9%) use in clinical settings. This post is not about smartphones but the 20% seems very low to me, especially given the use of tools like Epocrates. Maybe my opinion is skewed a bit because many of my physician friends are young and either in training or pretty close to training?

But, looking at iPads and Tablets in the survey you see numbers that are pretty low, at least lower than I think some of the commentary would lead you to believe. To me those iPad/tablet numbers (12%/9%) seem exactly where I’d peg them. My guess was that ~15% of physicians use tablets in a clinical setting, with the vast majority of these being iPads. I’m not sure what the other 9% of “Tablet” users in the survey are using but this bumps up the overall tablet usage to close to 20%.

10-20% for tablet usage is still pretty low overall, especially with the investment in and potential of mobile. So what is going to drive up that percentage of clinicians that use tablets in a clinical setting. First, it has to fit into and improve the clinical workflow. That sounds like a broken record, to me at least. I had to say it because everybody says it and most of the time I don’t think much thought goes into what that actually means. It’s like saying our technology is “robust”. Clinicians are a mobile workforce, whether it be clinic to hospital, office to ASC, house to house, or even room to room. Clinicians can’t sit still to care for patients. Well, maybe radiologists and some telemed practitioners have patients come to them but these are obviously the edge cases.

It’s because of this mobile nature of practice that mobile technologies are perceived to have such great potential with clinicians. And since EMR is what you gets you the stimulus bucks, that’s the obvious choice for how we can empower physicians with mobile. I really don’t think it’s going to be full fledged tablet EMRs (viewing + charting), like drchrono, that are going to raise the percent of physicians using tablets in practice. And I don’t think it’s going to be a full fledged EMR running on a device with 10.6 16:9 inch screen, USB port, built in keyboard, or better enterprise management (that was what I was trying to say in my last post). What I wonder is if people think the tablet (either how Apple or MS defines it) is ever going to represent a standalone EMR product (I know, I know, drchrono already has this as a product)?

I think the real power of tablets, especially in healthcare, is not as mini-versions of computers. I don’t think mobile is going to be where users fully document patient encounters in an EMR. I think the real potential of mobile and what doctors are looking for from it is 1) mobile access point for summary views (including imaging and monitors), especially if you can aggregate content from multiple sources, 2) order entry (including Rx), 3) messaging, 4) access to clinical references, and 5) educational material for patients. That’s why I really like what AirStrip is trying to do as a mobile EMR extender.

Now finally tying back to my post from last week about the Surface and iPad in healthcare. My conclusion is the same, the Surface is not the disruptive mobile force that is going to drive up mobile user adoption in healthcare, but the reasoning behind my conclusion is different. It’s not because the iPad is superior (I’m betting the Surface and iPad are are superior to each other for specific features), it’s because the tablet, as a category, is more valuable to clinicians than the new category that Microsoft is defining with the Surface. Tablets, at least how we defined them before the Surface, accomplish what I think needs to be accomplished to drive adoption. Time, and the associated apps to enable the functionality above, will define the mobile clinician experience.

Travis Good is an MD/MBA involved with health IT startups. More about me.

Chris Wasden

when ever we see these low numbers we need to ask, is it low because providers aren’t using the apps on these devices or because there aren’t any apps to use?

We are finding that doctors are demanding apps for these devices, after all 60% of docs have iPads, 90%+ have smart phones, they are demanding applications in the clinic for them to use these devices, but the CIO and organization haven’t been able to keep up with demand.
Laura

Although I usually agree with your points, I have to disagree with the idea that tablets are where things are headed for mobile health computing. By way of disclaimer, I love my iPad and my iPhone but when it comes to a real computer I’ll take a PC over a Mac any day. I can run whatever software I need, use the university lecture computers without incompatibilities and swap out hard drives, memory,etc. myself without waiting endlessly in line at the Apple counter for help.

I also happen to be one of the 20% who uses a iPad or tablet clinically. I’ve been carrying my iPad on rounds for about 6 months now. If its a relatively leisurely day when I know we have plenty of time, I carry the iPad and use it to look up information on each patient and use that info to catalyze detailed discussions with my students and residents. On the days when we have multiple new admits and rounds are more rushed, I leave the iPad in my office as its not worth the hassle of carrying it.

Why would I say it’s a hassle when I love my iPad? Because our hospital has purchased an EHR product (from a major vendor) than is horribly designed AND they have implemented it a way that makes a clunky and cumbersome piece of software even worse. It’s hard enough to use it from a desktop computer but on an iPad it’s barely usable for viewing med lists and labs (and even switching between the two is painful). When you click on something you don’t know if the lack of responsiveness relates to a misguided touch, an insufficient touch or just poorly responsive software (in fact, it’s usually the latter). So you end up double clicking by mistake, clicking on the wrong item, or just getting disgusted. Heaven help anyone (and especially the patient) if you try to enter an order! And if you use it for longer than about 15 minutes, the network kicks you off (in the interest of security) requiring that another 2+ minute, multistep login process be repeated.

Unfortunately, the tablet has the identical pitfalls (though the screen size is a bit better for those of us with presbyopia). The only difference with the tablet is that it’s heavier to carry, won’t fit in a large lab coat pocket and is an even be pain to keep logging into. At least our hospital tablet require that you rotate it to use the keyboard to enter ones name and password and then switch back to enter everything else with touch/stylus. The system response is just as bad and the handwriting recognition is poor. (another disclaimer: my handwriting is so GOOD that pharmacists have called me to verify scripts specifically believing they were too legible to come from an MD and must be forged).

Within a week of getting a hospital owned tablet, I gave up on it and preferred to return to a functional and ergonomically preferable Desktop PC. The iPad is ok under some circumstances but is much better for non medical functions. (the clumsiness of switching back and forth between our hospital EMR and drug databases, pt education, etc. Li,it’s the use of these non-EMR functionalities).

My bottom line is that the iPad has its limitations in clinical contexts but tablets are no better (and in some ways worse).
Charlie

As others have commented, I too love my iPad and we support them within our facilties to the limits of our abilities. However, for a community hospital system, with limited IT resources, in a “Best of Breed” environment, we need hardware that integrates smoothly with the multitude of vendor software packages. For better or worse, in today’s environment, that pretty much dictates Windows as the defacto standard.
Brian

The above are really software problems. If you had native iOS software that operated by basic touch human interface guidelines then you would be horrified if someone said you had to instead run it on a Dell on wheels while, instead of tapping a screen, you had to move a “mouse” that triggers similar movements to a “pointer.”
mr_histalk

Axxx

The mobile clinician…and why last weeks post doesn’t matter – 6/26/12

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