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iPad: Right Time, But Not Quite Primetime — Part I

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iPad: Right Time, But Not Quite Primetime – Part I
Do 11 concurrent evolutions equal one revolution?
Implications of a recently released mobile tablet

- Link to Part II here
- Link to Part III here

Does the arrival of Apple's iPad really cause any revolutionary changes in the HCIT scene? Announced in January and available for about a month, the iPad has been associated with a lot of hype and speculation, including Healthcare Informatics and other HCIT blogs.

In just 28 days, Apple sold one million iPads, whose owners had downloaded 12 million applications and 1.5 million e-books by the end of April. It took the original iPhone 74 days to hit 1 million. iPad has achieved celebrity status, having appeared on every major news program, The Daily Show, SNL, and of course the requisite visit to Oprah. And now, the iPad is appearing at a Starbucks and in a hospital near you!

It's an interesting product, but does it have any special significance in the era of striving to demonstrate Meaningful Use at hospitals? After a few weeks of both personal use and observation of its use by others, I think it brings 11 unique implications worth paying attention to as critical opportunities.

In this, the first of a three-part look at the iPad, we’ll explore the first four of my 11 implications.

1. Pure mobile device play. The iPad can serve as a carry-able PC desktop, in the same sense that Citrix allows any Web browser to launch an interactive connection to a desktop. Within a few minutes of unpacking it, I had the iPad connected wirelessly to a PC running Windows XP, using VNC. I launched an existing, remotely-accessible EMR that requires no locally installed software. It worked immediately.

After a little experimentation, I found that a considerably easier, faster and more functional option existed using the Remote Desktop capability in Windows XP (and Windows 7), which also goes by the names RDC (Remote Desktop Connection) and uses RDP (Remote Desktop Protocol). In the parlance of iPhones, "there's an App for that" thin-client terminal server computing. In fact, several, some of which are free. Remotely controlling a PC desktop all works - left mouse, right mouse, mouse-over hover, automatic reconnection to dropped sessions without data loss. And, of course, the legendary zoom, pinch stuff and a clear, bright display completely preserving the 1024x768 VGA on a more than adequate 9.7 inch display. Is any of that that even evolutionary, much less revolutionary? Absolutely not.

2. Docs have iPhones. Here's where the iPad starts to get very interesting. Lots of docs have iPhones. Their perception is that they're already trained and familiar with the operation and utility of the iPad. There's a halo effect, whereby they assume that there's a very small learning curve to becoming fluent on an EMR that's accessible "iPhone style." It may be more of a false psychological comfort, but it sure beats the opposition, the irrational heightened anxiety when they first see EMRs that appear intensely foreign. This makes the iPad clearly a win for physician adoption.

3. "There's an App for that." The iPhone (and iPod Touch) really did benefit from a user interaction model that was designed for the smaller screen, multi-touch interface, and unique "patterns" that the iPhone supported.

A pattern (also known as Design Pattern) is a reference to the programming model on the iPhone that encourages apps to start and exit immediately, with no branding splash screens, seamless Web access, and an awareness of the CrazyBusy, mobile lifestyle of its users.

This is a distinction from an older desktop model typical of PC software applications, such as Microsoft Office applications like Word, with massive menu options and related navigation, ribbons, application "chrome" (unused screen space), and often sluggish responsiveness. Do we want to move that forward to mobile, Web-enabled computing?

This raises the issue of whether iPhone Apps are appropriate and ideal for the iPad. My experience so far suggests that there's plenty of room for existing mature desktop apps, as well as clever enhancements to iPhone apps, and something much more usable than either - fully threaded workflow.

Does the arrival of Apple's iPad really cause any revolutionary changes in the HCIT scene? Announced in January and available for about a month, the iPad has been associated with a lot of hype and speculation, including Healthcare Informatics and other HCIT blogs.



See Bobbie's post on using the iPad in Board Of Directors meetings, here:

Killer App Posted on: 10.26.2010 9:57:33 AM Posted by Bobbie Byrne, M.D.

Six months, cultural change, and some experimentation later, this organization is going paperless in the boardroom.

Joe, I'm a little confused. Is the Ipad a substitute for a laptop?

You're not alone in being confused about what an iPad is and who it's for. In thinking about your question, I decided to use a triangle, circle and hexagon to answer your question directly, the shapes representing people with distinctly different needs.

For people whose principle use of a laptop (or desktop computer) is email, web browsing, and perhaps something else minor (e.g. playing solitaire or light photo, music, or word processing), they can use an iPad as a laptop replacement.  There are plenty of believable reports of responsible observers who are going on business trips with only their iPad, leaving their laptop at home and not missing it.  They're also able to work at home and at the office with only an iPad.  I'm calling them Triangles; they have roughly three, well-contained needs that the iPad serves well.

There are lots of other people for whom the answer is clearly, "No, the iPad cannot replace their laptop and never will."  These "Circles" who may be reading this blog post now, also have Outlook open for their enterprise email, with both an inbox and calendar window.  They often have big monitors (greater than 21 inch diagnol) and often more than one monitor.  When they're creating or editing a Powerpoint slide deck, all of these other programs are running.  The Circle person is jumping between windows related to the task at hand, as well as touching other tasks.  They also have one or more instant message clients running, including MicroSoft Office Communicator, Skype, and OOVOO.  For the circles, no amount of clever software enhancements on the iPad will overcome the screen size, processor performance constraints, etc.

Then, there are the Hexagons.  These folks started off in life-before-iPads as circles, not as triangles.  They appreciate the iPad typically as an extremely mobile utility.  They also have enough discretionary income and other attributes that are elaborated in Parts 2 and 3 of this series, that they have chosen to be early majority buyers.  (They are not, incidently, early adopters.  The establishment of the iPhone and it's operating system over its first three generations has made the iPad a whole product with proven technologies at launch.)  For the Hexagons, iPad is a third or fourth, web-connected, personal device in their lives.  It doesn't replace a laptop; it does step in a fulfill all of the needed utility for some asks that the laptop can also do.  Hence, Yes and No, it replaces but doesn't replace their need for a laptop, or "Neither/Both" in the graphic.

The billion dollar question for HCIT, which we will explore further in Parts 2 and 3, is what is the shapes of your physicians, both independent and dependent on your hospital's mobile device strategy. 

From what I've observed one month out, you already have a few physician Hexagons at your hospital.  Your hospitalists may be extremely well served by facilitating them becoming hexagons. 

Your independent consultants, if they already are Triangles will be happiest connecting to your EMR triangle-style.  It will assure that they will have a device when they need it, and one that they're already carrying for triangle reasons. 

The Circles may be happiest with the traditional Workstation-on-Wheels and related computer station approaches in common use today.

Thanks for asking your insightful question.