Has the iPad leveled the playing field between patients and doctors? The iPad is easy to use, but it is sophisticated enough to handle applications that can monitor health issues, diagnose medical problems, and communicate progress and statistics between medical staff and patients — especially concerning medical information. The big issues about using the iPad for health include security concerns, Health Insurance Portability and Accountability Act (HIPAA) compliance, and user experience. In the meantime, within two short years, the iPad and its possibilities for medical use has gained attention from hospitals, the government, and medical schools. Where does the iPad stand now on medical information, and where can it go in the future?
Popularity of Medical Use
The iPad has had the fastest adoption rate of any consumer electronics device in history, and nowhere is this use felt more than in the medical industry. No numbers exist for iPad sales specific to health care, but major institutions such as Stanford University School of Medicine in California are handing it out to medical students and to physicians. These new iPad users, who might have bought the $500 to $800 devices for their personal use, are adapting them to their professional day. Stanford also is looking at potential downsides to using tablet computers while it assesses their usefulness.
Another journalist states that more than 30 percent of U.S. doctors now own an iPad. These statistics, gathered by both Manhattan Research and Chilmark Research, show initial excitement over a new technology; however, this excitement was initailly dampened by one issue that arose immediately…iPads failed miserably in a test at Seattle Children’s Hospital, where clinicians returned the instruments stating that they were “unwieldy.” But, Seattle Children’s made its doctors gain access to the Cerner EMR not through a native iPad app but via the Safari Web browser. Certain elements of the EMR were designed for viewing on 21-inch monitors, not the 9.7-inch iPad.
So, the iPad isn’t ideal in every healthcare situation, and it appears that the iPad incident at Seattle Children’s Hospital is a mere growing pain. According to the adoption rate, new apps, and doctor and patient willingness to use the iPad, it seems clear that this two-year-old technology is making a dent in the medical industry. In one 2011 survey, 30 percent of doctors have an iPad. In this same survey in 2010, the device hadn’t even been released.
As if to acknowledge the trend toward using iPads in a medical environment, Southern Medical Journal (SMJ) is now available for the iPad. This journal went to an online-only format in 2010. Their app, which is one among many others developed for physicians within the past year, delivers essential content on interdisciplinary disease management.
Apple has made it clear that current iPhone apps will run on the iPad. For patients or users interested in the medical field, this is great news. Some apps, for instance, are enhanced by the iPad’s 9.7 inch 1024 x 768 pixel display. While the display provides a format to make some apps “prettier,” the idea is to make the apps more useful as well. Some of the most recent and useful apps to appear on the market for medical use include:
- Envisioner introduced a suite of cloud based mobile and desktop software that was bringing endoscopy video capture into the modern era. Now, this company is taking another leap with the introduction of its Endoscync wireless video transmitter and companion iPad app. Together, these allow any endoscope to send its video data wirelessly to a nearby iPad, which thus replaces the traditional video monitor as well as functioning as a simple report generator.
- Skeletal System Pro II is a learning tool; but, can also be used as a fast and innovative reference tool. This app is ideal for physicians, educators or professionals, allowing them to visually show detailed areas of the bone system to their patients or students, helping to educate or explain conditions, ailments and injuries.
- Mobile MIM iPad Readiology App provides a cloud-based radiology (DICOM) viewing and sharing web application, and is the first app ever to obtain Food and Drug Administration (FDA) clearance for mobile imaging software in February 2011.
- Epocrates iOS User Experience features a customizable Epocrates homepage, improved access to resources, an all-new App Directory, and faster and more intuitive access to medical information.
- Proloquo2Go is a product from AssistiveWare that provides a full-featured communication solution for people who have difficulty speaking. It brings natural sounding text-to-speech voices, close to 8000 up-to-date symbols, powerful automatic conjugations, a large default vocabulary, full expandability and extreme ease of use to the iPhone, iPod touch and iPad.
- Weigh What Matters is a new app developed by the American Medical Association (AMA) to help people work with their doctors to establish health goals and track their progress, all in an effort to help slim American waistlines.
These apps are part of a larger picture, one that contains medical information about patients. Is it safe? Is it confidential?
Vetting iPad Apps
While medical apps are proliferating (almost 20,000 health apps that are already in the market), the concern is certification, or approval for various reasons. Happtique, a subsidiary of the for-profit arm of the Greater New York Hospital Association (GNYHA Ventures), is the first organization to vet health apps. Happtique recently put together a blue ribbon panel that is constructing a certification process that Happtique will use to decide which consumer health apps and professional medical apps it will promote based upon functionality, usability, and security.
The first iPad app to receive official ONC-ACTB certification is Drchrono, which offers a free electronic health record platform on the iPad. According to Healthcare IT News, “the drchrono EHR platform has been awarded ambulatory certification (ONC-ATCB) as a Complete EHR by San Luis Obispo, California-based InfoGard, an Office of the National Coordinator (ONC) Authorized Testing and Certification Body (ATCB).” The app tracks a provider’s use of the EHR and offers them key metrics to report to CMS, and includes many other features, such as billing and e-prescribing.
Finally, in July 2011, the FDA issued guidance regarding the agency’s plans to regulate select software applications intended for use on mobile platforms (mobile applications or “mobile apps”). According to the Health IT Law Blog, “FDA’s guidance does not establish any legally enforceable responsibilities, but describes FDA’s current thinking on this topic and should be viewed only as recommendations.”
Certification and regulation may provide some security that apps do work, and that they provide some benefit and security to patients and to the medical community. But, the long clearance time for FDA approval (sometimes up to two years) also means that health-related apps are only now starting to appear in significant numbers. This approval process may mean that even more medical facilities will adopt the iPad as a regular tool in a physician’s arsenal.
With enticements like the Medicare and Medicaid Electronic Health Record (EHR) Incentive Programs, who can not help but jump on the iPad medical bandwagon? These programs will provide payments to eligible professionals, eligible hospitals and critical access hospitals (CAHs) as they adopt, implement, upgrade or demonstrate meaningful use of certified EHR technology. Practitioners who use certified apps can receive up to $44,000 as Medicare incentives, or up to $63,750 as Medicaid incentives.
Additionally, the Health 2.0 events group received a $6 million dollar grant from the federal government to create more health app challenges. These challenges may focus on creating apps for people with cancer or for reporting adverse effects of medical devices. These challenges are an important force guiding health app developers now.
Stabilizing these innovative strategies is important, which is why many health care advocates proactively create and seek certification and approval for apps that will work. The hope, however, is to create a tool that can replace many other tools that doctors currently carry with them on their rounds. The ability to streamline is important, from inputting medical information to tracking it for patient safety.
The bottom line is convenience, stability, confidentiality, HIPAA compliance, and user experience. Although some patients may not be able to afford iPads, it may be important that the medical community is on board, especially when it comes to patient safety and health. It appears that hospitals are on the move to create those environments, and — with dozens of new apps making first appearances this year — the future could be very exciting for iPad users and the medical information field.