Guest Post: iPad or Android? Maybe We Need Both

This post is written by Brian Martin, MD.

Brian Martin is a physician informaticist – a software engineer who went to medical school, spent most of his career designing clinical software, and now spends his time helping physicians select technologies that improve their personal lives, their clinical practice, and the health of their patients.

I was asked today about whether iPad or Android-based devices will become the device of choice for practicing physicians. My answer? It could be that both have their place.

The issue isn’t whether someone will create the perfect iPad or Android tablet. Technological barriers, security issues, hackers, HIPAA, encryption, voice recognition, handwriting recognition are all technology problems. Easily solvable, especially with all the under-employed rocket scientists looking for work.

The hard work is to develop an elegant solution to the user experience that lies at the crossroads between technology and the physician’s workflow. And different situations may call for different devices.

If the doc is seeing patients in an outpatient setting or rounding on inpatients, then it’ll be the iPad. If the doc is away from the office or hospital, on personal time, then it’ll be the fits-in-your-pocket mobile device – an iPhone or Android device. It’s all about the user experience, how the technology fits into the doc’s workflow, and how the technology impacts the patient’s experience of the face-to-face physician visit.

For many, and perhaps the majority of physicians, being a doc isn’t a 40 hour-per-week job that you leave at the office. Not a chance. Clinical excellence is more than a full-time commitment, and for many, it’s a 24×7 commitment. Sure, you can go out to a nice restaurant, play a round of golf, a set of tennis, but…

When you are away from the office or hospital, and one of your patients needs your attention, do you really want to interrupt your personal life to drive to the office?

Or if you’re on a dinner date with your spouse/partner/date, and the lab calls to say that one of your patients has a wacked-out finding that you need to make an immediate treatment decision on, do you cancel your date and head back to the office? I wouldn’t want to. But if I’ve got 3,000 patients in my practice, I don’t have a choice, simply because I’m not going to rely on sheer memory power, no matter how highly I might think of myself (snicker if you will), to remember what diagnoses and allergies this patient has, what medications I’ve prescribed and why, and what the last test results were. Nope. No one’s that good.

But what if I could excuse myself for 5 minutes, step outside, pull this patient’s summary EMR up on my iPhone, make a diagnostic and treatment decision, select and submit one of my standard order sets, transmit a prescription to the pharmacy, then call the patient and tell him to stop taking one of his medications and go to his pharmacy to pick up the medications I just prescribed? Fantastic! I don’t cancel my date and ruin what was developing into a seriously romantic evening, my patient is properly managed, and life is good.

Have you ever seen a doctor walk into the doctor’s lounge in the hospital, then call the nursing station with his/her patient orders just to avoid entering data into the hospital’s EMR? I have. I’ve also watched my primary-care physician, who is not a touch typist, try to maintain eye contact with me while his eyes flitted rapidly between the keyboard and monitor.

And why can’t he maintain eye contact? Because his employer mandated that all physicians do their own clinical data entry, including progress notes, lab and medication orders, referrals, etc. Sure, that’ll get the employer to HIMSS Level 6, but at what cost? Or imagine a psychiatrist constantly switching his/her attention between the patient and a computer monitor during a psychotherapy session… And if that patient has paranoid/delusional traits?

I have yet to see an EMR with a keyboard/mouse/monitor (KMM) interface that does not interfere with the physician/patient experience. What we need is a technology that enhances the clinical experience FOR THE PATIENT. Docs know how to use traditional paper charts and pens for taking notes and looking up information during a face-to-face patient consultation, while keeping their focus on the patient. The iPad is the closest we have to a replacement for the pen and paper chart. Creating iPad, iPhone and Android interfaces to existing EMRs can be a first step.

The hard work is to develop an elegant solution to the user experience that lies at the crossroads between technology and the physician’s workflow. And different situations may call for different devices.

So. If you are a C-level health systems exec who is being pitched to make a “me-too” decision to spend mega bucks on an enterprise-wide KMM-interface EMR built using 1960s-era software (MUMPS is the COBOL of medicine), spend some time walking around and visiting docs in your community who use EMRs. Ask them if they’ll let you watch how they interact with their patients and their EMR. Pay attention to the user experience, and ask them about some of the scenarios I’ve described above. Then watch a three-year-old use an iPad.

About the author

Anne Zieger

Anne Zieger

Anne Zieger is a healthcare journalist who has written about the industry for 30 years. Her work has appeared in all of the leading healthcare industry publications, and she's served as editor in chief of several healthcare B2B sites.

4 Comments

  • Great post!! The fact that MUMPS is an “antique” code should have just a few people concerned considering the billions being spent on it.

    You may be onto something…following docs around to see their experience in addition to the patient reaction. 🙂

    Some of us saw the impact of the Apple product when our kids were 18 months old, 20 years ago. Android or IPad? Let’s see who can come up with the best product.

  • Yes it’s all about the software. That said, Apple’s human interface guidelines have really set the standard for how software should work on a mobile device. In outpatient settings there will have to be some BYOD (bring your own device), but hospitals will eventually have to deliver the right tools for the job, and so far there is no comparison.

  • Thanks for helping to bring these issue to light. The number one selling EHR today is built on 1960 MUMPS software. Most of these system purchased today for billions of $$ will have to be replaced in the next few years. CIMO need to educate themselves. As for the i-stuff or Android; decision need to be made based on the eco-system not on the User Interface. Native software for Apps is the rage today because it is good for the manufactures, this will soon change. Cloud is the answer.

    Jeff Brandt
    Co-author of HIMSS “mHealth: From Smartphones to Smart Systems”

  • I’m no fan of Apple and their arrogance, but the ipad is very popular and is a good product; the pad of choice for so many. And as mentioned, Android is very popular and must also be supported, especially for smart phones.

    As to Mumps, that it is old is not automatically bad, but I’m not comfortable with things I’ve read about the database methodology that I understand the vendor in question uses; hierarchical. Relational databases make far more sense today and are much easier to support. As to buying that system, any exec who buys a system because it’s popular, without regard to the quality of its interface, or its integration into the hospital, is clearly in the wrong line of work, IMHO.

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