The iPad 2, healthcare, and platform agnosticism

Bertalan Meskó, MD (reproduced with permission)

I am platform agnostic.

I have a Mac desktop computer, a Windows laptop, and an Android phone.

When it comes to operating systems and the devices they control, I find the maxim ‘don’t believe the hype‘ usually stands me in good stead.

Whilst the fact that Apple’s iPad is currently leading the way in tablet computing is undeniable, some of the rather more effusive outpourings the announcement of the iPad 2 has generated with regard to its potential to ‘revolutionize’ healthcare surely need to be kept in perspective… don’t they?

If I’m seeing this wrong, be sure to call me out.

However, my take is that the understandably aggressive commercialization of the iPad 2  is likely to benefit Apple rather more than it does the majority of healthcare stakeholders on the basis that:

a) Apple has a monopoly on the sale and distribution of apps, and

b) Apple refuses to share end-user data with developers, in any context.

Obvious points about measuring improvements to patient outcomes, exclusion, geographies and financing aside, for me this second observation explodes the idea that the iPad 2 or any future iteration forced to labour under the same restrictions could ever have the potential to expedite some sort of universal amelioration of healthcare delivery.

It’s one of those things that just sound embarrassing when you say them out loud.

I would consider the fact that the iPad 2 will as a consequence never be a platform capable of resolving the EHR issue to be sufficient refutation of claims to universality, but then I’d be disquieted by any assertion that a particular tablet, mobile device or given piece of technology considered in isolation could achieve a similar goal, even without the constraints that Apple applies.

I maintain that asking ‘what problems can the iPad (or indeed any device) solve?’ before prioritizing the answers to the question ‘what problems in healthcare need to be solved?’ is looking at the world upside down.

Personally, I try to maintain some equilibrium in the face of the overly-enthusiastic response among some healthcare commentators that the announcement of any Apple product has a tendency to provoke in two ways:

1) I subscribe to Phil Baumann‘s ‘Health is Social‘ blog. Click here to subscribe yourself.

2) I keep a very close eye on the work of Bertalan Meskó, MD.

Dr. Meskó, pictured above holding his tablet PC of choice (no, it isn’t an iPad) is a recently qualified MD, post-doctoral researcher, lecturer and healthcare publisher who for me exemplifies not only the next generation of connected healthcare professional, but also consistently displays the sort of even-handed, level-headed approach to the ‘design vs. delivery’ debate in healthcare that I fervently wish were more in evidence across the health conversation.

24 thoughts on “The iPad 2, healthcare, and platform agnosticism

  1. We can hope that they hype will die down. What I found particularly funny was the noise about the iPad *2* – the product was barely out and tons of buzz was whizzing about. And about the only new thing was a camera. That and and more silver color.

    These mobile devices are just that: mobile devices. They’re just tools that allow for portability, internet access and viewing and application use. That’s pretty much all there is to it.

    What’s key now, is for systems to figure out how to better integrate the various tech.

    If products like iPad do much, it’s to help catalyze the proper use of tech, especially among the ranks of those who have don’t use it much now.

    • Hi Phil

      If the advocacy of the iPad that we’re seeing was focusing on your last point, namely that it has the potential to make solutions for health easier to implement, integrate and use, then I’d be placated.

      In the long term, this could be tablet computing’s greatest (and seemingly largely hidden at present) benefit: realizing the utility of health apps and SaaS away from the desktop.

      That is until we all have palm augments, HUD implants and ‘Matrix’-style ports. 😦

      Hopefully this won’t happen fast enough for any generation that would still disturbed by the concept (and I’d be a member of it) to still be alive.

  2. While I agree completely that all of the hype needs to be kept in perspective, I am slightly more accepting of some of the seemingly hyberbolic language.

    The iPad has completely changed the way I as an individual interface with the world, I accept that technology, and more importantly-online communication, is an intrinsic part of my job but there you are.

    The camara was an important addition. What we also have to remember is that the graphics are now 9 times faster and perhaps more importantly, people expect this high level of technology on the move, mobile as google would have it, is everything.

    Dare I say that I agree with Steve Jobs, we are entering a post PC age?

    Will it transform the practice of medicine? I think it might. Not instantly in the way that people think regarding medical device applications (although this will happen, some of the apps I am personally working on could be incredible) but in the art of communication. We know that this is an area that has been historically categorised ‘room for improvement’ with regard to healthcare professional, patient interactions.

    Can technology change human behaviour? I believe the evidence says it can.

    On another note we have already seen malicious apps for Android, could this itself be an issue for Android based tablets and medical practice? We shall see…

    • Right on the money from Mr Butler again I think. Quite a post to attract both Phil and Alex to comment, I enjoyed reading it. On another note if you think the Samsung tablet is the best I would suggest a trip to the ‘head doctor’ 🙂

      • Thanks Alison, your comment is very kind. I actually agree with regard to the tablet being ‘modelled’ by @berci, I have had the use of this to compare with the ipad for work and it is not in the pad’s league, in my humble opinion.

        I think it is also fortunate that @berci has the stethascope slung over the shoulder, how else would we believe he is a doctor? 🙂

      • Hi Alison

        Thanks for taking the time to comment.

        For the avoidance of doubt, please don’t think the post is some sort of crypto-promotion of Android tablets.

        It isn’t.

        When I said I’m platform agnostic, I really meant it. I couldn’t give two tweets about these lame head-to-head performance tests you seem on YouTube. I’m not a tribe-member in that sense, and try to make informed decisions about matching my personal requirements to the capabilities of the technology I am considering.

        I therefore elected to upgrade my smartphone rather than get a tablet on the basis that there was nothing I wanted to do that I could not achieve on the former, and could not see a reason for purchasing what a friend rather uncharitably described as ‘a manbag with a screen’. There was also the Flash and Adobe issue with iPads, which helped orient me towards the decision I made.

        The theme of this post is really just to guard against either making or giving credence to claims which are indefensible. To defend the proposition that ‘the iPad 2 will revolutionize healthcare’, we have to bring so many adjacent possibilities into play as to propel the hypothesis into the realms of the fantastical.

        We want measurable improvements in patient outcomes, not rainbows and unicorns.

    • Hi Alex

      You’re publishing comments faster than I can type. I’m already three behind. 😀

      Following on from my response to Phil above, yes, if we’re looking at this from a ‘longue durée’ perspective in the manner of the Annales School of historiography the potential for tablet computers to play a significant part in the development of healthcare en route to Whatever Comes Next is assured.

      However, I’d characterize the responses we’re seeing so far as being more of the order of ‘OMG! Revolutionz!’ rather than cold-blooded, non-partisan Braudelian analysis.

      The tablet is a way station for healthcare, not a destination.

      The evolution of healthcare isn’t over.

      Grand narrative claims about the future of healthcare that are tied to the launch of a single product such as we’ve seen in anticipation of the iPad 2, let alone a class of device such as a tablet, are going to look as daft as Francis Fukuyama proclaiming that history was a done deal.

      There’s a lesson in the crazy back-peddling said author has done more recently too, perhaps 🙂

  3. Hello Andrew,

    Thank you for the thought-provoking article. I hope we hear more from those in the medical field! Personally, the best choice for any individual is the device that simplifies workflow. I have to admit, for me as a creative individual, this has been Apple. However, the medical field is behind on adopting technology that improves work flow. For example, from one of my clients who is a SaS provider with a free service to physicians, I learned that some practices get more than 10 boxes of payment/remittance “paper” a week. The healthcare industry could save more than a $100 billion by adopting “electronic” over “paper” payments and remittances alone.

    Any device that makes it “simple” will win with adoption. But, it will be the app developers who will make the difference. This is not a client, but an interesting app for iPad I came across today–Dr. Chrono Singularity Hub, , provides a nice overview with Dr. Chrono’s many detailed videos. Although designed for the iPad, it can also interface with an Android device. 😉

    I cheer anything that makes it easy for my doctor to move into the 21st century, so long as he chooses something!

    • Hi Angela

      Thanks for your thoughtful commentary and usual masterful synopsis of the argument.

      Again, yes, those all sound like things that are earnestly to be desired. If the iPad hastens their arrival, I may even buy one myself.

      I think we may be a few upgrades away from that, though 😉

      Oh, and thanks for the share. You always bring flowers.

  4. The iPad isn’t transforming medicine.

    The iPad is just making it easier for us to work with data, and ultimately to work with, and for, patients.

    It’s a needed element in the workflows of providers and patients. That’s all.

    “That’s all”, btw, isn’t necessarily “nothing”. Sometimes all you need to change directions is a “that’s all.”

  5. Your title “agnostic” got me curious but as I read through I didn’t see any reference to “web apps”- the true agnosticator. We’ve been lulled into the conveniences of downloadable native apps that only divide mobile healthcare utilization.
    Are we really blaming iPadx for the shortsightedness and herd mentality of EMR vendors? One of the most trumpeted examples of iPadx in healthcare are those apps that show doctors interacting with patients viewing CT scans. But that was being delivered entirely on the web back in 2002 at RSNA. The web alone does wonders, not just the iPadx. The iPadx brings touch. That’s it. But as you point out, so do other devices. Can healthcare vendors realize this?
    2011 is not the year of the iPad2, it’s the year of the data interactivity device. That’s something no one company deserves to own.

    • Hi Faisal

      Thanks for dropping by.

      I concur entirely, and perhaps the reason I didn’t focus on the situatedness of apps is a consequence of my own expectation that apps will be where I want to use them rather than tied to a particular device.

      In fact, as a consequence of the fact that I use Mac, PC and Android devices every day it is a precondition for my taking up any given app that it is not native to particular OS.

      I think you offer more grist to the mill that grinds down any notion that the iPad in isolation has the potential to ‘revolutionize healthcare’, the sort of overheated category claim that prompted me to write this post in the first place.

  6. As a footnote, iPadx has always had the ever so capable Safari browser running HTML5. But for vendors, native apps get more press coverage than web apps.

  7. Nice article and i agree with Faisal – webapps (not native) are under rated and i think will be developed much more in the future designed for the iPad. I dont fully agree with little arrogant Apple philosophy but i have to admit they are a truly innovative company and they are changing tech landscape as we speak.

    • Thanks Pawel

      We all ask a lot of Apple. They have an opportunity to realize a commitment to social good as well as creating exceptional revenues for themselves.

      No-one is asking them to do this for free.

      Everyone should be asking them to do more in terms of not imposing draconian restrictions on how their products are used.

  8. Andrew great post and good debate

    When people mention the word “revolution” it concerns me. I do like my iPad. As Alex says earlier the is a difference than having a smart phone. However my (and my families) access to information has certainly changed.
    There are two points that I want to make.

    1. We are still in the infancy of the use of this new media and these tools?
    I hear that when TV was invented the theatres were concerned tht people would stay at home to watch theatre at home. I guess TV has developed and theatre still maintains it’s exclusivity in an art form.
    I am still concerned that we are still fumbling around at whether the patient experience is really changing because of the iPad. I’m not just taking about the in office experience but the whole journey for patients. Has the iPhone changed those fundamental questions – what’s going to happen doctor, how can I best make sense of this condition now that you have diagnosed it? Where can I get further support. I have every hope that the innovation that apple bring in the iPad may spur new ways and may inadvertently spark other innovations.

    2. Closed business models.
    I can remember Apple back in 1982 – I had a holiday job setting up apple iis and demonstrating them to educationalists. Their computers were always high priced and highly functional. Much study has been made about Apple in various business schools. I do vacillate between what the ‘right’ business model here and hence agree at I am also agnostic! There was an interesting comment in today’s observer comparing apple with a religion, where the objective of following was eternal life. The parallel in health that we must remember is that the patient wants are.

    In sum Apple is showing leadership in innovation – agree. I agree with Phil that patient experience will improve with the increased use of these mobile tools.

  9. Hi Andrew, all

    We could debate the business model of Apple, the locked-down nature of iOS and the Apple app store and compare that to the Android offerings – a relevant discussion considering that 2011 is the year that Android v3.0 (Honeycomb) hits us (see along with HP and its Palm-based Web OS (plus the BlackBerry Playbook).

    However, I think the gargantuan amount of press that the iPad has generated has actually offered a dis-service to the potential of tablets in general. I have read through these posts, and I think what needs stressing is that this conversation is not about iOS, Android, WebOS, BB or anything Microsoft is cooking up for entry into the tablet marketplace next year. It’s not about the debate between the benefits of native apps or web apps – it’s about the potential for the form factor and emerging technology to act as a conduit to better health.

    • Yes the ‘conduit’, nicely put. The conduit you mention is what the debate is about. Who controls it. Will it stay open. And can it stay open. Healthcare IT being a vertical and not the entire pie means we aren’t by ourselves going to change Android, Nokia, Microsoft, Apple or HP tablet strategy. They’re going to build what they’re going to build. What we *can* change are vendors and software developers. Get them to build on the choice of ‘conduit’ we’d like to see utilized.

  10. I’m sorry Andrew but I would have to say that I see your post as just a good old Apple-bashing in disguise. I hear similar statements from many late-adopters and those that just hate Steve Job’s way of doing business.

    The iPhone has already revolutionized health care and the iPad has and will do the same not by way of its improved graphics or processor speed (although those win too), but simply by way of it’s marketability and ease of use; the fact that physicians WILL pick it up and use it during their clinical encounters has completely changed the game and it will only evolve from here. There are no unicorns involved in that and the other companies will continue to play catch-up with Apple. I wish for the day that Google can find a 10/10 design to put Android in but that day hasn’t come yet.

    • Hi MS

      Please consider sharing your name next time. No-one round here bites 🙂

      Far from being an ‘Apple basher’, I am old enough not just to have looked at pictures of the Apple ][, but to have actually used it to do work on in my school’s geography department.

      I have every reason to believe you when you say that the iPad may be revolutionizing your experience of medical education, and that’s great.

      I see many interesting experiments taking place using tablet and mobile technologies.

      I hear a lot of hyperbole.

      I do not perceive a revolution.

      New technologies may hasten the flow of information, and provide new and more convenient conduits through which it may pass between end users (if the manufacturers of said devices don’t choke that information off)

      However, technologies alone do nothing to resolve long-standing, deep-seated, and firmly-rooted failures of design and delivery in healthcare.

      An iPad is never going to resolve these contradictions, even if we had it in our power to arm every healthcare professional at every point of care in every country in the world with one in order to see how little changed.

      However, you and your future peers may be able to forge such changes. We’re looking to you to see beyond the technology and be radical in the way that you approach the unholy mess that the generations before you have made of the architecture of healthcare.

      If we all get dazzled by the shiny, we doom ourselves to making the same mistakes yet again.

      We’ve had the tragedy of healthcare’s historic failures; let’s hope we can avoid the farce.

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