How the iPad mini can transform mobile healthcare

How the iPad mini can transform mobile healthcare

Summary: Our resident health blogger, Denise Amrich RN, had the opportunity to talk with two mobile health experts about how the iPad mini could transform healthcare.

TOPICS: Health

Late last month, Apple debuted the iPad Mini. In that short time, the healthcare community is already buzzing about how this new tablet will affect the industry. Physicians traditionally like using Apple devices and have for some time now used iPhones and iPads in practice. With the introduction of a lighter, smaller hybrid between the two, it’s very likely that this tablet could accelerate mobile adoption in the healthcare setting, leading to faster, more efficient and improved physician-patient encounters and care.

In this Q&A, I asked two mobile health experts to weigh in about how the iPad mini could transform healthcare. David Collins, senior director of mHIMSS, the globally-focused mobile initiative offered by HIMSS offers his insights and opinions on the integration of mobile in tablets in healthcare. Dr. Ferdinand Velasco, chief health information officer from Texas Health Resources also shares his predictions for why doctors might prefer a smaller tablet device.

I'm thrilled to have the opportunity to go in-depth with these two healthcare professionals.

1. Please tell us about yourself and your background.

My name is David Collins. I'm senior director, mHIMSS, leading HIMSS effort covering the application of mobile technologies to healthcare. Past roles with HIMSS have included oversight of the Davies Awards of Excellence, identifying best practices in leveraging electronic health records for value, as well as the patient safety/quality initiatives of HIMSS.

I'm Ferdinand Velasco, M.D., vice president, chief health information officer at Texas Health Resources. I lead the system's clinical decision support, medical and nursing informatics, business intelligence and data analytics functions across the continuum of care, including the system-wide electronic health record and also responsible for Texas Health's mobile health strategy.

2. Why the iPad mini vs. the full-size iPad or the iPod touch?

David Collins: The iPad mini offers the ideal amount of real estate. The iPod touch is too small. The full-size iPad is not convenient, (i.e., it is too large to comfortably fit in standard lab-coat pocket).

Dr. Velasco: Form factor. Unlike the full-size iPad, the mini fits into pocket of the doctor's white coat. Its larger screen size relative to the iPhone and iPod touch makes it easier to read, manipulate, and use for data entry.

3. Why the iPad mini vs. less expensive and more flexible Android devices?

David Collins: I would assume two things: 1) The greater number of available apps; 2) The ideal screen real-estate size.

Dr. Velasco: Consistency (one OS platform across all devices), ease of use, quality of health-related applications (more rigorous QA via App Store) and security (less malware than Android devices).

4. Are you concerned about having to take off glove protection so the capacitive screens can react to finger touches?

Dr. Velasco: No. The iPad (or any computing device) is typically not used when performing procedures requiring gloves.

5. How do you recommend proactively dealing with any other potential contagion issues regarding these devices which are carried from room to room and can't be washed with soap and water the way we wash our hands?

Dr. Velasco: The key isn't the device – it's the hands of clinicians handling them. The best protection against contamination is to adhere to conscientious hand hygiene practices before and after patient contact.

6. Please explain what you think the main benefits of using tablets would be, and then, specifically, iOS-based tablets.

David Collins: Tablets provide the flexibility of "instant on", lightweight mobility, and numerous features including camera and video, as well as easy access to social media, email and the Web – not to mention an outstanding pixel display to view images.

Dr. Velasco: The main benefits of tablets are portability and the intuitive user interface. Unlike the laptops (even ultrabooks), tablets are less intrusive in physician-patient interactions. They're also less expensive and can be used for all of the consumer functions that make them popular for general use. The advantages of the iOS tablets include consistency, ease of use, quality of health-related applications and security.

7. What is preventing adoption of these tablets into mainstream physician's offices?

David Collins: This is likely a result of three things: 1) becoming familiar with the technology itself, although very intuitive, 2) integration into the existing IT infrastructure, and 3) privacy and security concerns.

Dr. Velasco: From my perspective, it’s a lack of application support from healthcare software vendors.

8. What will it take to help encourage physicians to bring in these devices?

David Collins: Peer use of the devices can help increase adoption and alleviate many of the concerns that slow down adoption – such as getting comfortable with the technology, integration into existing IT infrastructures and concerns around privacy and security.

Dr. Velasco: Very few physicians need "encouragement" to adopt these devices. Many already have them and are eager to expand their use in clinical practice. What's needed is more support from healthcare software vendors.

9. Are you worried about theft, particularly since so many medical records can be stored on something so small?

Dr. Velasco: This is a legitimate concern, but is not restricted to tablets. The potential for theft underscores the need to have the technical features (e.g., secure mobile device management) and good processes (i.e., not storing unencrypted patient health information on the device) in place.

10. Where should my readers look for more information? For my readers who are in IT health, are there any industry resources you can recommend?

David Collins: has great content in both its news and blogs sections and is a good resource for technical information related to mobile health IT.

11. Is there anything I didn't ask, that you'd like to tell our audience?

David Collins: The mHealth Summit next week (December 3-5 2012) is all about the use of mobile technology. During the Summit, mHIMSS will be releasing the mHIMSS Roadmap, which will encompass the current and future state of mobile technology, including: Privacy and Security, Standards and Interoperability, ROI/Payment, Technology, New Care Models, and Policy.

Dr. Velasco: With mobile devices like the tablets and smartphones, we are entering a new era in clinical computing – one in which the technology finally supports the mobility of physicians and patients. This will help to generate and accelerate adoption of information technology in healthcare in general.

12. Finally, have you considered how a Windows 8 tablet with touch and updating tiles would help you your healthcare environment, especially since it integrates nicely into existing facility IT infrastructure?

David Collins: My gut is telling me that the integration might not be as simple as we think. I'm sure that Windows 8 could lead to a more streamlined approach; however, there are many other pieces of the puzzle to integrate between the core electronic health record and the existing legacy systems (multiple other software platforms running other applications throughout the enterprise health system).

Dr. Velasco: We plan to work with Microsoft to look into the applicability of Windows 8 Tablets in the clinical setting. It will take time for health IT software developers to update their applications to fully take advantage of the new Windows operating system. In the meantime, we expect to be able to leverage "backwards" compatibility with earlier versions of Windows.

My thanks go out to both professionals. Lots of food for thought.

Topic: Health


Denise Amrich is a Registered Nurse, the health care advisor for the U.S. Strategic Perspective Institute, and a mentor for the Virtual Campus at Florida's Brevard Community College.

Nothing in this article is meant to be a substitute for medical advice, and shouldn't be considered as such. If you are in need of medical help, please see your doctor.

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  • The biggest problem in healthcare going forward

    is how to convince Doctors to work for 1/3 less than they are getting now, so they can cover the currently uninsured as they come on board with the (as promised) no increase in spending.
    Tony Burzio
    • You do realize that this article ...

      ... has nothing to do the with Obamacare??
      • In a sense it does

        where is the money for these iPad mini's going to come from?
        William Farrel
      • Do you realize that since the case can

        be made that every aspect of human behavior has an associated healthcare costs that EVERYTHING is now part of Obamacare. And don't think they won't try it. That was the reason liberals wanted this bill passed. Trust me, it has absolutely nothing to do with making sure you get health insurance. It's about making sure you are a serf asking a government panel for permission for your grandmother to get a pacemaker.
    • "how to convince Doctors to work for 1/3 less than they are getting now..."

      Just a thought - how much would you trust a doctor who's working for minimum wage? And notice that there's been a huge lack of primary care providers/family doctors, who are typically the lowest-paid subset of providers in medicine.

      Yes, you can chop the salaries. Question is, if you were a young person looking into future careers, would you then choose one that doesn't pay well and can render you bankrupt with just one lawsuit?
  • I'd have to query

    The following to statement regarding iPad Mini V Android tablets.
    1) The greater number of available apps; 2) The ideal screen real-estate size.
    The first one is a dead fan giveaway, how many apps would a unit like that have for the job it needs to do? Not many I'd suspect, and the second is more down to personal choice.
    • and a follow up

      Just what does the number of apps have to do with it's use in healthcare?
      • He means

        ... healthcare apps.
  • Umm

    Did you say cameras in video while referring to going from room to room with with patients? I think I will pass on that hospital thanks!

    Oh and the iPad mini smeared fonts are not something I want to trust a doctors diagnosis with!
  • PlayBook has better screen

    And better hardware all around and a far superior OS, but keep drinking the Appke koolaid shall we?
    • Blackberry Playbook?

      Are they still making those?
  • Will this...

    stop every doctor and nurse from re-asking the same questions over and over and over and over again? Maybe that just happens in Canada... but man is it ever annoying!! Really makes you lose confidence in the system when I have to repeat myself 5 times to 5 different people... in the same day!
    • Repetition is helpful...

      ... simply because it's a check on the system. Just think - if we're pushing electronic medical records - what software system has EVER been 100% bug-free?

      Simply put, even if a system has 99.999% accuracy, that's still represents a potentially fatal problem with 30,000 people in the US... And if there's a field that should have an absolute ZERO tolerance for error, arguably it's Medicine.
  • Just a contrarian thought to the iPad Mini in healthcare

    1) even with hand washing, decontamination of devices is still an issue. Humans are never 100% reliable even in the best of circumstances, and a way to decontaminate the device should be in place if it is to be in common usage. All the contact surfaces of patient-care devices - including keyboards, mice and screen covers - are "washable" where I work.

    2) I personally find typing on glass to be problematic... and those that grew up with computers are just as likely to be touch-typers on a keyboard vs. being comfortable or efficient typing on a virtual keyboard. I have a colleague who uses an iPad, and he winds up using a bluetooth keyboard to type in his notes... which renders the "fits in a pocket" upside of the Mini somewhat moot.

    3) "lack of apps" is a poor excuse for not deploying a particular medical informatics device. Simply put, if it's a patient-care device, it may even be better off being "locked down" as a dumb thin client. Just ask yourself, is it really relevant to have "Words With Friends", "Instagram", "Twitter", or "Temple Run" when the device you're using is supposed to document and manage a patient's condition? Most major apps I'm familiar with that handle medical information are already multi-platform, and for those that are not, there is always a client solution such as Citrix. Which leads me to -

    4) Social media and mobile games are already distracting enough - do we need this additional risk when managing sick people? And why is the access to social media considered a plus? Do we really want our healthcare providers tweeting about an "interesting case" when they leave the exam room? I'd think it's just inviting a HIPAA disaster.
    • Nicely said.

      My primary care physician has terminals in all rooms and uses a digital recorder for instances where it makes sense.

      Contamination is an issue.
    • The answer would be ...

      ... recording (using ipad, too) where needed, then transcribing later (maybe with Siri, if it ever gets reliable enough).

      I'd think glass is easier to clean than a physical keyboard.

      Windows 8 may be better option eventually, once it is out of beta and the UI is improved. Current UI and gestures are too finicky for some users and require more mental load - not something you want your doctor to be hassled with.
  • Oh, and one more thing...

    5) as was mentioned, mobile device security is a legitimate issue. Password security has been recently revealed to be a huge issue - and heathcare agencies should have a way to remote-wipe devices that are lost or stolen without going through a third party (in this case, Apple) to do it. In some cases, a thin-client solution that doesn't store protected patient information on the device might actually be more beneficial.

    And for full disclosure, I work in healthcare and I personally use a MacBook Air. And yes, I have FileVault enabled at minimum and I've cleaned it with alcohol (though I have found some cases don't take well to alcohol, either).
  • Device Agnostics

    The "Future" in this regard is not in apps. I do work for an insurance company and work on their software, extranet and intranet.

    There is a thing called "HIPA" or Health Insurance Portability and Accountability Act. Complying with this through Apples app store is pure nightmare.

    The best way to provide the functionality across multiple devices and ensure compliance is with intranets or extranets using html 5 and ssl. This way any device, whether it be a desktop, laptop or tablet can have secure access to the information required. Through the use of media queries different devices can interact with the information in the most efficient and appropriate way for that device.

    Currently I am very interested in the Galaxy note line. Pen (with fast handwriting recognition and the ability to annotate and draw), voice recognition (for physician notes) etc. When the 7 inch note comes out I believe we will have a perfect solution for our mobile operators.

    As evidence of the uptake on the note series, check out American Airlines (

    I believe the days of having to download app after app to your device is on the wain. Most app functionality can be replaced with web technology. True, html 5 and javascript is more resource intensive than a native app but with modern devices this is not nearly as much of an issue. Talk to any IT person and you would get a shudder reference securing multiple apps that the user may have downloaded.

    As for cost:

    Chrome books can be had for only a couple hundred dollars as in room devices.
    Any tablet can do the web. Even a Kindle will do the trick if a staff member wanted to use one.
    Entering data directly and avoiding the transcription process saves time, money and more importantly ERRORS!

    I am currently building a solution using ASP.NET MVC 4, HTML 5, Web.API, and the new Federated Identity to support field workers using the device of their choice.

    A little more than 2 cents worth.

    • Better than ipad, yes

      For handwriting and drawing the Galaxy Note seems a better choice. It's certainly not the iPad's strong suit.