How the iPad is Changing Mobile Health Care

Since its release in April, the iPad's presence in a wide variety of workplaces has steadily grown, as sales continue to surge. The iPad sold 3 million units in the first 80 days after its April release and its current sales rate is about 4.5 million units per quarter, vastly surpassing the 1 million units the iPhone sold in its first quarter, according to analysts cited in a report today by Fast Money.

The iPad is on track to "pass gaming hardware and the cellular phone to become the fourth biggest consumer electronics category with estimated sales of more than $9 billion in the U.S. next year," writes John Melloy, executive producer of Fast Money.

Part of that success in the workplace is due to health care professionals interested in deploying the iPad as a telehealth mobile computing device. Even before the iPad hit the market, some hospitals had ordered dozens of units for large- and small-scale pilot programs. In places where the iPad wasn't initially considered by mobile IT departments, doctors purchased their own and brought them into the office and began carrying them on their rounds at hospitals.

The iPad is, in some ways, a dream solution for busy doctors, nurses, and other health care professionals. It is lightweight, easy to carry, and can be used for making notes, accessing records, searching medical references, viewing medical images, and illustrating all kinds of things to patients (injuries, progressions of illnesses, surgical procedures, and even physical therapy regimes). It offers access in the office, at a hospital, at home, or anyplace else. Perhaps more importantly, its user interface is intuitive and has very little learning curve. As one doctor put it to me "within thirty seconds, you know how to use it."

I've spent the past few months talking with many health care professionals about the iPad. I've been astounded at the range of ways doctors, nurses, and an array of emergency and supportive care professionals (including physical therapists, home care aides, mental health professionals, and even dentists) have already integrated the iPad as a crucial tool in the daily practice.

iPads Making the Rounds in Hospitals

Hospital rounds are a particular challenge when it comes to electronic medical records when using either laptops or smartphones. Laptops are not easy to use when standing or moving around quickly. They're also bulky and have pretty limited battery life. These are major problems when you're rushing from one room or department to another. Many hospitals have tried to solve this problem with laptop carts that can be wheeled from room to room or floor to floor. Unfortunately, the carts make laptops more unwieldy and may not address the power needs, requiring constant plugging and unplugging throughout the day. In some hospitals, they also become facets of supply turf wars between departments. And for doctors on rounds, they must be picked up when arriving and left when they return back to their practices.

Smartphones are much more portable and generally don't have battery life issues, but they have much smaller screens, may not be able to access a hospital's wireless network or even to a carrier's 3G network in many areas of a hospital. And, some traditional smartphones may have limited appeal because of their design, features, and lack of applications.

The iPad offers a size that is easy to carry (it can fit in many white lab coat pockets) but also easy to view and use, can integrate with many health care systems through freely available clients for virtual desktop infrastructures -- such as like Citrix, which is a key player in both hospitals and medical groups because its solutions address HIPAA requirements by not storing any data on a device and by using secure remote connections. The iPad can also serve multiple purposes. Unlike previous tablet designs, the interface requires no stylus to work with or lose.

Electronic Record keeping and Prescriptions

As I mentioned, the iPad can interface with many virtual desktop and virtual application solutions using a free mobile app. The screen size is large enough to view most electronic records and prescribing systems whether they are optimized for a mobile device's screen or simply appear as a Windows desktop. With many hospitals and practices already utilizing these solutions for security and privacy reasons, access from an iPad is simply another computing device that is largely already supported.

Even solutions that rely on a more traditional but secure client/server approach to electronic medical records can be accessed from an iPad. This can be done either with a native iPad app, a secure web application, or through the use of a virtual desktop or remote access solution installed on a PC in a medical office. The same is, of course, true of notebook or netbook computers and smartphones to some extent (the usability of such solutions on a smartphone's smaller display is rather reduced in most cases).

But perhaps one of the biggest advantages is the iPads ability to connect to a range of options means that the iPad can switch between systems in a doctor's practice, hospital, clinic, or other setting. Again, the same is true of notebooks, but the same battery life and more cumbersome form factor can be an issue.

The iPad also mitigates one of the greatest concerns about EMRs from a patient and health care perspective. When laptops are introduced into the exam room (or even the hospital room), nurses and doctors tend to spend more time looking at the screen and typing than they do glancing at paper charts and making quick notes.

This creates a barrier between the provider and the patient that can be disconcerting to the patient, who may not feel he or she is getting the provider's full attention. More importantly, laptop use with patient care decreases the level of eye contact and general observation of the patient's appearance and behavior, which can crucial clues to a patient's well being and state of mind. For instance, is he or she grasping the information being provided, is there an overt change in appearance or attitude from previous visits (particularly important when a patient is on medications that impact mood like anti-depressants), does there seem to be something that the patient isn't saying? The iPad, being roughly similar to a piece of paper in size and use significantly reduces that barrier.

Accessing Health Care Data on the iPad While Out of the Office

Continuing from the last point, the ability to access records and reference material anytime and anywhere is a big advantage of the iPad. While the same is true of notebooks, the iPad's form factor -- once again -- is a key differentiating factor here. Notebooks are more cumbersome to carry and, in some cases, use. While a physician might have a laptop with him or her during office hours, the same isn't likely at other times.

One doctor pointed out that carrying his iPad was much easier if he was out to dinner while on call. He also pointed out that in many instances (at a restaurant, grabbing coffee, or even while driving), opening a notebook and using it is more difficult and can be intrusive. Pulling off to the side of the road to look at an iPad or quickly glancing at it during a meal doesn't require opening a clamshell device or shifting items to find a convenient way of using it for quick tasks.

Companies including Airstrip are even pioneering remote monitoring and alert capabilities for mobile devices, beginning with iOS, that enable remote access to real time hospital and intensive care patient vital sign data.

iPad and Medical Imaging

Medical imaging on the iPad is something that I didn't really consider until I sat down with a radiologist who has become a passionate iPad proponent. He pointed out that while the iPad doesn't offer the resolution or fine-grained adjustment features of radiology work stations, it does provide a good way of referring to X-rays, CAT scans, and MRIs at a moment's notice without needing other devices (such as a light board for X-rays) as well as for emailing or sharing images electronically. He said being able to refer to images as well as records while on call and out of the office, as well as being able to show them to patients in exam or hospital rooms without any specialized equipment, are both huge benefits of using the iPad.

In fact, Apple recently highlighted medical image viewing in an iPad commercial. For a more in-depth look at the iPad from a radiology perspective, there's a review in the Advance for Imaging and Radiation Oncology magazine.

Patient Illustration and Education

In addition to medical imaging, the iPad is also being used for illustrating injuries and conditions to patients, which goes well beyond showing X-rays and other diagnostic scans. It can be used to illustrate medical textbook-style images, such as specific issues with the eyes like a damaged retina, cataract, or macular degeneration; different stages of pregnancy; or to illustrate the steps in a surgical procedure. It can also show things such as the signs of infection or side effects from a treatment or medication.

I got to experience the iPad in action first-hand when seeing a physical therapists in relation to a back injury I incurred earlier this year. One therapist used an iPad to show the shape and functionality of the trapezius muscle and why my injury to it was impacting other parts of my neck, shoulder, chest, and arm. He then used the iPad to illustrate both stretching exercises and how those exercises would help reduce strain of the muscle and ultimately work towards healing it. That was an eye-opener to me both in terms of understanding the injury itself as well as seeing that the power of the iPad as a patient education tool was much broader than I'd realized.

Many doctors who have used an iPad for patient illustration and education in this way report that their patients are both more interested in learning about a problem in ways other than a lecture-style format and that they show a great understanding of issues because of the enhanced ability to visualize the related information.

iPad as Medical Reference

Every health care professional I've spoken to has praised the iPad (as well as the iPhone and, to a lesser extent, Android phones) as a reference device. There are dozens, if not hundreds, of medical references apps for health care professionals. Many are specific to either specialty or profession. For example, there are references specific to nursing, medical billing and transcription, and for EMTs and other first responders. There are also references specific to oncology, post surgical care, emergency medicine, cardiology and other specialties. And, of course, there are drug references that are both general and granular that correspond to different fields, specialties and professions.

Beyond that wealth of information, there's what one doctor referred to as "Doctor Google" -- meaning the entirety of medical reference material on the Internet including publicly available resources and health care specific online databases and journals.

iPad for Home Care Workers and Social Services

Getting beyond what many people think of as mainstream medicine, the iPad is an amazing solution for a variety of supportive care organizations and employees.

For home nurses and health care aides, the iPad is a great solution for tracking progress and making case notes. Equipping a full staff of home care providers with notebooks and ensuring remote access is cost prohibitive and challenging for many organizations. The result is that most rely on binders of forms for initial assessment, ongoing progress, and case notes for individual visits. These can be cumbersome in their own right to carry and work with, but it also introduces an extra level of work and delay since these handwritten notes must later be entered into a record keeping system.

For organizations that provide supportive and follow-up care that fall under a social services oriented framework (getting elderly patients to medical visits, ensuring treatment compliance, supporting developmentally disabled populations, and working as part of a low-income or child services organization), these issues can be particularly problematic. Often these organizations rely on government, university, or private foundation funding sources that typically institute their own record-keeping and reporting compliance policies for receiving funds (often with time requirements for reporting or interaction with other providers). That means that being able to enter information quickly and accurately is extremely important - as is being able to quickly refer to policies and/or contacts.

Once again, the anytime, anyplace functionality, lower-cost than a PC, and ease of carry and use attributes of the iPad are ideal along with the easy to learn and use interface.

Patient Tracking and Follow-up

Finally, the iPad (along with other mobile devices and smartphones) may revolutionize health care on the other end of the spectrum. As mobile devices become more common in our everyday lives, they stand to provide us with easier ways to track our own health, manage conditions, and receive follow-up care from our doctors and other health care providers.

Already, there are hundreds of health care mobile apps for iOS and many for Android devices, too. These apps and devices help us track our weight or body mass index and make healthy eating and fitness choices; monitor and manage blood glucose if we're diabetic; monitor our blood pressure; track our heart rate, calories burned, and distance while running or exercising; and provide us with more information about our medications as well as help ensure we remember to take them properly.

There are also many generalized apps for tracking a variety of conditions in a journal-like format that can be used for depression and mental health issues, stress level, migraine or headaches, muscle/joint pain, and many other long-term or chronic health issues.

The potential to link this information with patient care tools is already on the horizon and could lead to health care providers having better tools to enable them to be an ongoing partner in keeping us healthy.

Android Tablets, Cius, PlayBook Ready to Join the iPad

Throughout this article, I've referenced the iPad specifically. It has been the first tablet to be widely adopted by health care professionals (by hospitals, medical groups, and individuals). While no other tablet has seen this level of success in or out of health care, many of these advantage will apply to Android tablets when they hit the market in large numbers. Many will also apply to Windows 7 tablets (though the health care professionals that I've spoken with seem much less enthusiastic about a Windows-based tablet) as well as webOS tablets that HP is expected to launch next year or beyond.

Other tablets may have advantages that the iPad doesn't as several are expected to include front- and rear-facing cameras for video calling. The iPhone 4 has already illustrated the potential of FaceTime and similar technologies in remote telemedicine and there's little doubt that a tablet with such features would have a leg up in health care.

Finally, tablets with an enterprise focus, such as the Cisco's Cius and BlackBerry PlayBook, may have an advantage because hospital and medical group IT departments might find them more appealing. Whether doctors, nurses, and others will agree is yet to be seen.

Overall, it seems clear that iPad has launched the era of tablets in medicine, but exactly what the arena will look like in one, two, or five years from now still remains a bit of a mystery.


iPad, Apple, health care, mobile apps, mobile health care