I saw this article, “Hospitals slow on tablet implementation,” last week and posted it right away on my Facebook account with the intention of blogging about it the next day. Sigh… that was before round two (or is it three now) of sick kids.
Several things flitted through my mind when I first read the title:
- Wow, Apple’s Tim Cook was a little off on his estimate that 80% of top hospitals were testing the iPad.
- Ok, looks like my hospital and I are not in the minority as it sometimes felt.
- Yep, same ol’ same ol’. By the time we adopt the new technology it is out of date
But after those thoughts and others left I began to wonder what is the real hold up. It can’t be that 99% of all hospitals have the same draconian IT policies. (Although my conspiracy theory friends might disagree.) Why does it seem that U.S. hospital have such wonderful advance cutting edge technologies for diagnosing and treating diseases, but when it comes to computer infrastructure, hospitals cannot keep up with technology.
So I began to look around the web to find out if anybody commented on Sarah Jackson’s post at Fierce Mobile Healthcare as to why so few hospital have done fully functional tablet systems.
Both Jenny Gold of Kaiser Health News and iMedicalApps approach the problem from the app side of things. Gold’s article blames the EMR companies that often don’t have apps for their software, thereby forcing hospitals to use third party apps like Citrix or VMware which can be clunky and slow. Satish Misra at iMedicalApps points out that even apps created by EMR companies like Epic, Centricity, and Allscripts require make their EMR apps read only making it a necessity for doctors to log on to a separate computer to make notes in the chart. To add to the “fun” many of these EMR companies like Epic and Allscripts require separate licensing for their mobile platforms. (Hmm that little caveat sounds familiar to librarians.) So what you have is all these hospitals who have spend LOTS of time and money getting themselves and EMR product and now enters a game changing product that was never envisioned 5 years ago when many hospitals were well into their EMR planning and implementation.
While EMR integration is important there are many doctors who are using the iPad without that ability. They are using them in the exam room, ER, Surgery, and especially in radiology. According to Robert McMillan of Wired, Apple has a secret plan to steal your doctor’s heart. His name is Afshad Mistri. (Although I am not sure how secret he can be when Wired does a big article on him and he is organizing invitation only conferences for medical professionals.) His goal (and Apple’s) is to get the iPad in the hands doctors. McMillan reports that it was Mistri who launched the special iTunes room for healthcare in September, and promoted it to a select group of healthcare app developers. Apple has to be careful promoting the iPad in hospitals. Step too far one way and the FDA will want to regulate it as a medical device, but don’t step at all and you don’t get it in the hands of doctors. The Wired article is a very interesting read and highly recommend it because it does a good job of illustrating just how Apple, a consumer oriented company not a company usually interested in businesses, is delicately trying to work its way into healthcare, specifically hospitals.
As much as Apple has secret fingers in the pie, trying to hook docs to the iPad, don’t forget that there are still signal issues within most hospitals. This is a big barrier to implementation. You can have all the best apps and EMR integration but if you are in a deadzone, you have an expensive brick. Ravi Nerella posted in the iMedicalApps forum, “We had issues with reception throughout our hospital (the ED was a dead zone) until one of the major cellphone carriers was allowed to place a tower or repeater (whatever it is they needed) and now we have great reception (for the specific carrier only of course) that also forced us to go with the specific carrier to provide us service.”
Just from a quick look through the Internet it seems that there is a host of reasons why 99% of the hospitals don’t have fully functional tablet systems. But from my perspective it seems to basically comes down to money (doesn’t everything). It takes some serious cash to license the app (3rd party or from the EMR company), some apps aren’t even fully functional so you aren’t saving on hardware costs by chucking the PCs. It also costs a lot of money to support the product and write hospital specific apps. Additionally they have to spend money on the infrastructure, making dead zones viable. If something wasn’t put in the budget and it is that costly to implement, it is going to take quite a while (years maybe?) to implement. The iPad is less than 2 years old. It wasn’t even a glimmer in budget lines back then. The speed of personal day to day technology has outpaced hospital budget planning processes. Quite simply, hospitals are giant cruise ships that can’t turn on a dime when the iceberg of new technology comes into sight. Let’s just hope most hospitals are not the Titanic.