Sunday, January 23, 2011

iPad EMR's?

Since I authored the articles on radiology apps for the iPad, I've been contacted by various other medical iPad supporters. Austin Merritt, COO of Software Advice, a site dedicated to "free advice for software buyers" comments on the availability of EMR apps for the iPad. Are Vendors ready?
The answer to that question is a surprisingly resounding “No!” The medical software industry is far from supporting the iPad on a meaningful scale. Buyers would think that vendors eager to grow market share would quickly adopt new, flashy technologies, but software vendors are surprisingly slow to react. Electronic health records vendors need to get on board or face the prospect of losing market share to faster-moving competitors.

There is no doubt that buyer demand for the iPad is surging. A past Software Advice poll (below) found that nearly 35% of healthcare providers were “very likely” to purchase a tablet PC in the next year. Don’t forget that the iPad enjoys 87% market share of the tablet PC market. That’s a lot of potential customers looking for iPad EHRs.
Merritt cites the two companies that have so far built EMR's for the iPad from the "ground up," Nimble and Dr. Chrono. Of the two, Dr. Chrono seems a little more robust, with capabilities including image viewing, something close to my heart. Of course, these programs, and in fact the various iPad/iPhone/laptop apps and applications are essentially portals into the database, be it in the cloud or elsewhere. As Nimble puts it:
Nimble connects directly to the ClearPractice cloud via a secure internet connection so no data is stored on the device, making it both secure and HIPAA compliant. Because the ClearPractice servers do all the heavy lifting, the system is blazing fast, whether connected to a wireless or 3G network.
And therein lies the thought process behind most everything iPad. If you look at them critically, most apps are not much more than stylized portals to the web, i.e., they are thin clients.  Nimble's claim to fame is its interface:
Taking a typical point-and-click EMR system and moving it to the iPad environment often means fumbling fingers and a less than optimal workflow. In contrast, Nimble is a native iPad application, designed and built to be used specifically on an iPad and takes full advantage of the intuitive iPad user experience. Because Nimble is native to the iPad environment, we were able to rethink the EMR experience and remove all the common impediments of traditional EMR systems that slow down and frustrate busy doctors.
And here is a screenshot of this simple view:

But is it really desireable for the system to be completely iPad-based? Well, probably not. Keyboard entry of data on the screen would be tedious. Of course, there are Bluetooth keyboard attachments, which would help some:

Since there are only a few iPad-based EMR's, Merritt asks:
So where are the 300+ other EHR software companies? They have iPad apps “in the works,” but not ready yet. This really comes as no surprise. The medical software industry is notoriously slow to adopt new technologies. Have you ever seen your doctor’s office running a system that looks like it is from the 80s? We hear from these practices every day. Plenty of software vendors are still selling outdated, DOS-based systems with Windows interfaces (we will withhold names to protect the innocent).

As a result of this slow movement, we expect a number of newer software companies to quickly gain popularity and seize market share from vendors who are slow to move. Interestingly, a number of garage-based startups are already poised for growth: medical iPhone and iPad app developers.

Blogger John from EMR and HIPAA answers:
I’d have to argue the opposite. I think that almost all the EMR vendors that I see have an iPad strategy. Nothing wrong with a web based version for the iPad either. In fact, watch for the web to win out on the iPad eventually. At HIMSS I’m sure that one of the most common conversations will be EHR vendors iPad approach.

Also remember that even nimble, which you mention, is only parts of the EHR and not the full EHR software. I wrote about that.  I think that many more EHR vendors will adopt this type of approach to iPad EMR.
I tend to agree. I'm sure this is a foolish observation for all but the least-savvy on such things, but it does bear stating: The iPad is a wonderful window through which to view data, images, etc. It is convenient, portable, and dare I say, even cute. Obviously, it cannot stand alone as an EMR, and I have my doubts as to using it as the sole point of entry. Certainly, it will be a very nice adjunct to a "real" or a "larger" or whatever system, a nice addition to the physician's office. Can something like Nimble satisfy "Meaningful Use"? I'm thinking not, but then no one really knows what "Meaningful Use" is anyway...


AV said...

I got the iphone a few months ago and was impressed with all the apps Apple had to offer. I got a PHR for myself and it was free but the only thing the company offered was a card. I would rather go for a PHR that comes in flash drive and get automatic reminders, and I think that whether it's an app or Medefile, or any other PHR company that it is beneficial to both patients and EHR's. I recently got the iPad as well and I would love to see more EHR apps available on it.

John Lynn said...

I think all of meaningful use could be met using an iPad. Just it wouldn't likely make sense to use it that way. As you observe, it's great for viewing information and even fine for certain functions (ie. ePrescribing or order entry) but it's not so good for documenting. At least until we reach the point that the documentation is actually just recording the whole visit's audio and video. Chew on that for a little bit.

Anonymous said...

We are working hard to make drchrono the best mobile EMR on the market.

Thank you for this great article!

Daniel, cofounder drchrono