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Is this the Apple of the Physician's Eye?

January 26, 2010
by Joe Marion
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If you are an Apple computer fan, the hype has reached a frenzy around the anticipated launch of the iTablet on January 27th. Rumors suggest it will be another killer product from Apple and that it will serve all kinds of roles such as a “Kindle killer” to a laptop replacement. If it’s as good as the hype says it is, could it also be the key to legitimizing electronic health records?

Think of all the applications that exist for the iPhone, including medical applications. It seems the biggest limitation is the size of the iPhone device. If all the speculation is correct, the iTablet might just be the right form factor to accelerate medical applications – particularly if it can do everything an iPhone can do, and more!

Could the iTablet be the device that finally makes electronic health records a reality? Think of how it could act as the data input device of choice. Besides Wi-Fi connectivity, the iPhone as a phone also supports 3G wireless connectivity. The iTablet is rumored to also be able to support 3G. If so, the possibilities are endless. The small office practice that doesn’t have, or doesn’t want to support a WI-FI setup could simply use it via 3G for data entry practically anywhere. And, with all the applications available, there are most likely medical journals and reference materials available as well – all for just $1.99.

OK. Lest you think “I’m an Apple” (pun on Microsoft’s latest advertising for Windows 7 – I’m a PC), let’s look at the flip side of the equation. Granted, via Wi-Fi, this could be a slick data entry device, but unless AT&T quadruples overnight, I doubt the current support infrastructure could handle such an increased load. You know, there’s a map for that (as the Verizon dig goes). And that brings me to what I see as the biggest issue with the notion of wireless connectivity for such a device – carrier limitation. As long as Apple continues to be tied to the coattails of AT&T, I don’t see the opportunity for many iTablet applications, since they will probably be similarly encumbered by AT&T restrictions.

This reminds me of the early days of Speech Recognition application, when large companies such as IBM jumped on the marketing bandwagon with specialized medical applications such as IBM MedSpeak/Radiology. That is until they discovered that the market could be sized in the thousands as opposed to the hundreds of thousands of units, and they quickly exited the market.

The fact is medical applications pale in comparison to general consumer applications. Most market opportunities will never be large enough to be sustained on their own. This makes it difficult for vendors to consider niche opportunities for commercial devices when they are tightly regulated in an open market. If Apple were to realize this, they would open up the iPhone and iTablet to niche applications without going through carrier restrictions.

Palm is a flailing company, but it has seen fit to open up its latest internet-based smart phone devices to multiple carriers (, including Sprint and Verizon. Perhaps the Palm Pre will finally get some traction against the iPhone (yes, I’m a satisfied Palm Pre customer!).

To comment on my cynicism of the $1.99 application from the iStore, while this is a great moneymaker for Apple in the consumer market, again, it may not be a moneymaker for medical applications. On the other hand, if the device were open and had access to multiple vendor’s application stores, this could represent a whole new business opportunity for medical applications vendors! While it may not be practical to charge for each medical application, there may be opportunities for “pay as you need them” specialized applications.

To summarize:

1. One can only hope that the iTablet is unlike the iPhone in that it is an open device. I fear this is not the case, and while it may be generally available for applications such as medical, it will be restricted by the same constraints as the iPhone.

2. If Apple is smart, they will recognize the medical possibilities, and allow the device to be directly integrated with medical applications, such that medical application providers can bundle the iTablet with their application and resell it. With the floodgates about to open on HiTech/Meaningful Use, this would be an astute strategic move.

3. This all could be for naught if the iTablet doesn’t live up to expectations and is just another tablet PC device. I’m betting that Apple won’t let this happen!

4. Could there be a whole new market opportunity for the iStore of medical applications?

As usual, your comments are welcome.



see the blogpost "EMR? We have an iPhone App for that•
Posted on: 1.21.2010 9:40:18 AM Posted by Pete Rivera" and it's comments.

I think we're all blurring different issues. Yes, there are overlapping aspects that makes this blurring all too easy. My take:

a. The form factor may actually be a genuine break through. The grand experiment is about to begin to test that. Or, more aptly, it will start in March when the device ships. I had a Toshbia Tablet PC in 1994, running windows. It was an optional-tethered keyboard approach. It worked but was heavy, had battery life of 3 hours, was expensive, and it was pre-Internet browser era. Thanks Thomas Friedman for reminding us in "The World is Flat" that Netscape went public in 1995, and was only one of ten flatteners.

b. The consumerization force leads to other break-throughs:

i. costs goes down with volume.
ii. competition drives price down and choices (with innovations) up (behold Google's Android, the Palm Pre Magic, Noika's march toward tablets, etc.).
iii. even without iPhone apps, the presence of a decent browser makes this an open platform. You don't need to go through the iTunes store to sell or buy web accessible functionality.
iv. existing iPhone apps include Citrix and open-source VNC clients that means that hospitals, clinics and individual professionals can access any existing PC's desktop (any app), subject to lockdown of those devices and networks.

c. New patterns! This is seldom discussed by non-programers but platforms like the iPhone use a new user interaction model, called a pattern. Apps are designed to load or wake-up quickly and, similarly, get out of the way (i.e. close) quickly. The best apps have rare or no splash screens.  This allows cooperating modules (see EHR modules in ONC documents and blog post title on this site). If you use an iPhone today, you're probably switching between apps and don't even realize that you're doing it. For example, click a link to a phone number and you're in the phone app, click a link to a link in a Twitter client and you're moved to a browser, etc. Compared to desktop experience with Windows 7, Mac OSX, or Linux, this restores the "Snap Factor" (speed) experience to end-users.

d. Culturally, the massive proliferation of smartphones to the community, largely non-techies, has been fascinating. It's these kinds of examples and societal expectation pressures that healthcare has previously not had on this scale.

In summary, for me, it's not that Apple is a great leader that's interesting. It's that the ecosystem has clearly pop'd over a tipping point, and Apple, unlike others, played all of the major dimensions, not just hardware or software. The consumer acceptance of the Kindle, the grocery shoppers use of hand-held barcode wands to speed shopping and reduce checker FTEs, and, for that matter, self-service in every other major area of our lives, that's the important trend.

There is one thing that Apple does deserve special credit for. They recognized that consumer devices is not a hardware play by itself. It's not a software play, and consumer-facing software, even by other software-only companies is relatively horrible.

It's not a distribution model play only, and distribution models like the iTunes/App/Movie/WN store are a highly profitable and enviable innovation. By the way, this is also called Publishing, as in the multi-billion dollar, cross-industry Publishing with it's advertising revenue model.

And, it's not a "market the heck out of it" only play, although making it culturally "cool" is an important, necessary ingredient. Back with the first iPod, Apple figured this out and executed. For more and deeper details, see the work of the writer Robert X Cringely. Here's a good starting point for your reading:

All of Cringely's 2010 prediction blog posts are worth reading, including his take on IBM, Google, Microsoft, the feature-phone (cf SmartPhone) manufactures, etc.  You'll find them all here.  Cringely gets approximately 300,000 unique pageviews per blog post, and dozens of comments.  HCI would be well served to make it's blogs more conversational.

So, Joe, I agree with your high level point. This event, if only as punctuation to a larger trend, is a big deal.  The product launch, the devices utility in healthcare and related lessons are important.

Now that the announcement of the iPad has been made, we know Apple at least for now is sticking only with AT&T and I agree that is limiting. However, from a very parochial perspective, we use PatientKeeper as our physician portal on top of MEDITECH and beta-tested the iPhone (and BlackBerry for that matter) interfaces for them. Almost all of our physicians went iPhone, switching from other Smartphones and even the BB. The user interface is simple, intuitive, and enhances their productivity while reducing training. So from my perspective, even if the iPad only improves on the iPhone by being bigger, that will likely be enough for many physicians to want one.

I'll keep you posted.