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Sandie Allen
Health care industry eyes iPad
The recent coming out of the iPad from Apple Inc. has the tech community once again all abuzz about the tablet computing device and its future in the workplace.
One area that many have talked up as a potential business home for Apple’s latest “i”-device is the health-care sector. But what many don’t know is that hospitals, doctors’ offices and home health care professionals have been using a wide range of wirelessly connected devices for years. While the iPad has some potential, local experts say, the testing hasn’t yet begun to see how it would stand up to the rigors of a health-care environment.
“We use more heavy-duty laptops than any other thing,” said Cara Babachicos, vice president and chief information officer for Partners Continuing Care. “We’ve tried the tablets, but they aren’t practical because the true tablets aren’t really suited for home health care.”
Babachicos is responsible for the technology used by every part of the continuing care operations of Partners HealthCare Inc. That includes visiting nurse services and in-hospital hospice care, and the staff using technology she deals with will see an average of 45,000 patients on any given day, she said.
That kind of a workload is rough on any device, which is why Larry Nathanson, director of emergency medical informatics at Beth Israel Deaconess Medical Center, mostly uses ruggedized laptops in the emergency room, and for very specific purposes. When a patient comes in, the basic medical information can be entered into BIMDC’s system by someone in the emergency room using something like a Panasonic Toughbook, allowing a patient to get into treatment as soon as possible and shaving off anywhere between five and 10 minutes.
“At some point a clerk will come by with one of these COWs (computers on wheels) and get all of the rest of the information,” Nathanson said.
Even the COWs, however, are mobile, wirelessly connected computing devices, since the computer on the cart these days is usually a laptop, primarily to reduce weight. That weight factor is one of the main considerations for which type of device to use in any situation, Nathanson said. Babachicos agrees.
“We also have to find devices that are relatively durable and lightweight, so we are always in a quandary,” she said. Ruggedizing a laptop or tablet makes it tougher but also adds to the weight. Babachicos said she tried netbooks but found that they were too difficult to configure with the required security needs of Partners’ systems.
Security is a main consideration as well for David Hemendinger, chief technology officer for Rhode Island health-care operator Lifespan Corp., which runs Hasbro Children’s Hospital and Rhode Island Hospital, among other facilities. But Hemendinger has solved the problem by using entirely Web-based forms and portals for physicians and nurses to work in, making Lifespan almost device-agnostic.
“It doesn’t matter what kind of browser, as long they support basic VPN standards,” Hemendinger said. For even the most complicated legacy information systems within Lifespan, Hemendinger uses the portal concept by running virtual desktops on a securely connected computer using a commercial product available from EMC Corp.’s subsidiary VMWare Inc. That way, no information is ever kept on any health-care professionals’ device; it is all stored securely on Lifespan’s servers.
Security has been a thorn in the side of greater adoption of tablet devices at Beth Israel, Nathanson said.
“BIDMC and most hospitals require strong passwords, but once you take away the physical keyboard it becomes so much harder to type,” he said. “It was very challenging for people to log in.”
In fact, every health-care application requires different types of devices, Nathanson said, and that means that Beth Israel has everything from iPhones and netbooks to full-blown, ruggedized laptops in its mobile device arsenal. Lifespan also supports a wide range of tech spread among its physicians, nurses and administration staff.
“Right now we are probably somewhere in the neighborhood of 1,100 mobile devices — 500 to 600 laptops; tablets, maybe another 300,” Hemendinger said. “The balance is carts on wheels.”
Lifespan is about to deploy nearly 400 netbooks to nurses and physicians to use on the hospital floor, Hemendinger said. Those would be connected to some of the equipment on the particular floor, so the netbook could get feeds of a patient’s heart rate or oxygen levels from the monitor at his bedside, wherever the netbook happened to be.
Babachicos is also about to make a major purchase for Partners, in her case of ruggedized laptops, and that precludes her from buying a bunch of iPads to try out, she said.
“The likelihood of doing it in the next three years when we just did a purchase of a whole bunch of laptops — the possibility of us doing that is unlikely,” she said.
Nathanson, for his part, is very keen on testing out iPads, but is even more hopeful that Apple might consider making a version specifically for the medical market — and if it isn’t Apple, it will be somebody, he said, and Hemendinger agrees.
“I believe there is going to be tremendous competition out there for the iPad,” Hemendinger said. “I believe the folks from HP, from Dell and even Google have their eyes on what’s necessary for the health-care environment.”
Whoever makes a health-care specific tablet, it will have to be more rugged than the iPad and, oddly enough, able to stand up to being disinfected. That is a major concern for Hemendinger.
“That’s one of the key problems we have with the mobile devices right now, the infection control aspect of it,” he said. “And we’ve had situations where folks have tried to wipe down their iPhones numerous times with the type of cleaners we have to use, and the results have been disastrous.”
Health-care smartphone apps
Amid the flood of software applications being written for smartphones, and for the iPhone in particular, more than a sprinkling of apps are focused on personal health management or targeted at health care professionals. Here’s a sampling drawn from iTunes featuring some apps that have at least three stars in their customer ratings:
BMI 2.0
Developer: DVMagic Studios Inc.
Current version rating: ***
Post date: Feb. 25, 2009
http://itunes.apple.com/us/app/bmi-free-version/id325678505?mt=8
http://dvmagicstudios.com/iPhone_Apps.html
Overview: Identify your body mass index before the doctor does it for you. There are probably a dozen BMI calculators for the iPhone, with each using your gender, weight and height as inputs. The output is your BMI number and the real verdict: normal, overweight, obese, etc. This one goes a couple of steps further, suggesting a daily calorie count to maintain your weight and tracking your BMI over time as you lose or gain weight.
Price: Free
Calorie Track 1.0.4
Developer: SkyWolf Tech
Current version rating: ***
Post date: March 23, 2009
http://itunes.apple.com/us/app/calorie-track/id300158902?mt=8
http://www.skywolftech.com/About_Calorie_Track.html
Overview: If you know your daily calorie target, this app lets you know how many calories you still have left after you eat individual food items. So you see details about each food type and track progress against your goal.
Price: $2.99
BP Tracker - Blood Pressure Tracker 1.0.0
Developer: BHI Technologies, Inc.
Current version rating: 3.5 stars
Post date: Dec. 23, 2009
http://itunes.apple.com/us/app/bp-tracker-blood-pressure/id346745157?mt=8
http://www.bhi-technologies.com/
Overview: BP Tracker is designed to easily log your blood pressure, heart rate, medication and other information on an iPhone with graphing and note capabilities.
Price: 99 cents
Epocrates 3.4
Developer: Epocrates
Current version rating: ***
Post date: April 7, 2010
http://itunes.apple.com/us/app/epocrates/id281935788?mt=8
http://www.epocrates.com/products/iphone/
Overview: The company claims that more than 900,000 health care professionals regularly use Epocrates to make medical decisions and improve patient safety. It comes in several versions at different price points and is also available for other mobile platforms besides the iPhone. The free version provides access to things like clinical information on prescription medicines, effective treatments among over-the-counter products and drug interactions. Pricier versions provide information on things like alternative medicines, treatment guidelines and medical definitions.
Price: Free to $199 per year.
WebMD Mobile 1.2
Developer: WebMD
Current version rating: 3.5 stars
http://itunes.apple.com/us/app/webmd-mobile/id295076329?mt=8
http://www.webmd.com/
Post date: July 3, 2009
Overview: The mobile view of the WebMD website allows patients to look up things such as symptoms, drug or treatment information and basic first aid. It also carries a caveat: “WebMD does not provide medical advice, diagnosis or treatment. Always seek the advice of your physician or other qualified health provider.”
Price: Free
Medical Calculator 1.7
Developer: MarketWall.com
Current version rating: 3.5 stars
http://itunes.apple.com/us/app/medical-calculator/id288555653?mt=8#
http://doctorcalc.com/
Post date: April 16, 2009
Overview: Helps doctors and nurses compute useful formulas and equations. With more than 200,000 installs worldwide, this is the most popular Medical Calculator for the iPhone and iPod touch. This clinical calculator gives you quick access to calculations that are too hard to memorize or perform in your head. MedCalc supports US and SI units.
Price: 99 cents
Drugs & Medications 1.5
Developer: By Kavapoint LLC
Current version rating ***
http://itunes.apple.com/us/app/drugs-medications/id337974028?mt=8
http://www.kavapoint.com/
Post date: March 25, 2010
Overview: Provides information on more than 6,000 drugs. Features include online pill identifier, search filter options, improved FDA links, partial word search and updated FDA labels for download.
Price: 999 cents
Dr. Dorian’s Instant Medicine 1.0
Developer: Instant Medicine
Current version rating: *****
http://itunes.apple.com/us/app/dr-dorians-instant-medicine/id355675585?mt=8
Post date: February 15, 2010
Overview: A series of medical videos from Dr. Armand Dorian to determine if you’re suffering from serious medical symptoms. Dr. Dorian is a board certified Emergency Physician who runs a busy emergency room in Los Angeles and has also served as a technical adviser on tv shows like “ER”, “Grey’s Anatomy” and “Hawthorne.”
Price: 99 cents
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