Posts Tagged ‘Android’

Ok, before I even begin, let me put it right out there: I’ve been using Apple products since I first got my hands on one of those cute little Mac SEs in the late 80’s having given up my spanking, brand new Compaq 386 with 64kb of RAM and a dual 3.5 & 5.25 floppy drives to a post doc at MIT who traded me the Compaq, which he needed to finish his thesis, for his Mac. I never looked back. I will attempt to keep that bias in check in this post.

Tomorrow, Apple will formally release the iPad 2, a device that has seen extremely strong adoption in the healthcare sector and even one of the HIT industry’s leading spoke persons, John Halamka of Boston’s Beth Israel Deaconess Hospital (he’s also Harvard Med School’s CIO) spoke to the applicability of the iPad in the healthcare enterprise in the formal iPad 2 announcement last week.

The iPad 2 release is happening while most other touch tablet vendors including HP, RIM, Cisco and those building Android-based devices struggle to get their Gen 1 versions into the market. Of these other vendors, only Android-based devices are available today, including among others the Samsung Galaxy and the Motorola Xoom.

But it is not so much the new features in the iPad 2 (e.g., lighter weight, faster processor, two cameras, etc.) that will continue to make the iPad the go to device for physicians and healthcare enterprises, it is the process by which Apple vets and approves Apps that are available in the App Store. Apple imposes what at times for many App developers is an arduous and at times capricious approach to approving Apps. This approval process is in stark contrast of the one for Android, which is based on an open, free market model letting the market decide as to which Apps will succeed and which will not.

Virtually any patriotic, flag-waving American will say Hoorah, the free market rules. Of course a lot of App developers are saying the same thing and have riled against the Apple process since the first iPhone release back in 2007. But the free market, even here in America is truly not free. We have put laws and regulations in place, be they environmental, public health, etc. to protect the broader public good. Apple has done much the same for its App Store insuring that those Apps which are approved are unlikely to cause harm, which on a mobile device is usually the release of personal information such as passwords, credit card information, etc.

Unfortunately, the same can not be said for the Android OS and its marketplace of Apps. There have been numerous reported cases of malware Apps in the Android Market that most often are not removed until after thousands of users have had their personal information compromised. The latest occurred a little over a week ago when Google removed 21 malware Apps from the marketplace and then proceeded to remove about 30 more.

In the healthcare enterprise market, where very sensitive patient information is gathered and shared for improving the quality and efficiency of care delivered, touch tablets are seen as an ideal form factor for the ever on the move clinician who is looking to access the latest patient information at the point-of-care. Therefore, as clinicians increasingly demand access to such information via their touch tablet device, healthcare IT executives will increasingly seek to insure that the devices used are truly secure. Google’s continuing struggles to keep its Android Market free of malware will prevent devices using this OS from seeing greater adoption in the healthcare enterprise. This will allow Apple to continue to put distance between itself and other touch tablet competitors in this increasingly lucrative market.

Jared Sinclair, an ICU nurse in Nashville TN, has a similar view on the topic,


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Introductory Remarks: Chilmark Research is pleased to welcome a new addition to our staff, Cora Sharma.  Cora will be leading our research efforts in the mobile health app market (mHealth) and below is her first post on the subject.  Cora has a great background having received a BSc in Computer Science, worked in the software sector for several years and recently graduated from MIT’s Sloan School of Business. While at Sloan, Cora did an internship with McKesson where she found her calling, HIT and the desire to become an analyst.  She’s a great addition to Chilmark Research and I’m confident she’ll produce some excellent research. – Stay tuned.

The concept of mobility in healthcare is nothing new to providers, vendors, and to Chilmark Research alike.  The current media and investor buzz surrounding mHealth stems from the belief that: 1) mobile technology has finally matured to a point where age-old healthcare processes can finally be revamped; and 2) mobile technology has not only matured but has actually been adopted en-mass by physicians and shows no signs of abating.

Doctors Love Smartphones, but are GaGa over the iPad
Recent reports from SpyGlass Consulting and Manhattan Research show that the vast majority of physicians already use smartphones. Pamela Dolan at the AMA has a nice commentary on these latest numbers. Chilmark Research’s recent talks with industry folks shows that the iPad is also gaining significant traction with physicians.  At a recent conference in Denver where Chilmark Research attended and spoke, the CIO of Catholic Health Initiative (CHI) sees providing their doctors with mobile apps (in CHI’s case on the iPad) as critical to the success of complying with meaningful use requirements.

mHealth Apps in Acute Care
Given that physicians have now ‘gone mobile’, does this imply that they will no longer be satisfied with computers-on-wheels (COWs), demanding mobile access to every piece of data buried in Health Information Systems (HIS)?   If yes, providing doctors with mobile access to patient and hospital data could be just the perk needed to attract more affiliated physicians, satisfy existing ones and ultimately drive the adoption and use of HIT by clinicians.

Here is a brief look at the mHealth acute care vendor landscape:

  • Pure play inpatient mobile solutions companies like PatientKeeper and MedAptus have built their businesses on providing clinicians with mobile apps, each having started with charge capture and quality measures.  PatientKeeper expanded into CPOE with a limited roll-out that is scheduled to go GA in 2011. As the mHealth market continues to gain momentum, it will be interesting to follow the fate of these two companies.
  • The big boys of HIS (Cerner, Eclipsys/Allscripts, Epic, GE Healthcare, McKesson, MEDITECH, Siemens) all have mHealth stories, albeit weak ones that revolve mostly around mobile browser access to their core EHR.  Early this year Epic released the Haiku app to Apple’s AppStore, resulting in some fanfare from the tech community.   Also, the Citrix Receiver app makes it possible to run Windows-based apps like McKesson and Cerner securely on the iPhone/iPad and Android, though with obvious usability issues associated with being a non-native app.
  • Potential entrants/disruptors from outside the industry face a battle with the big boys, who seem to want to reduce mobility to an extra feature on their systems.  Diversinet is making a play in secure doctor-doctor and doctor-patient communications for the enterprise. The company has made extensive investments to the tune of some $80M spent over the last decade developing IP in encryption and identity management.

mHealth Apps in Ambulatory
There are a multitude of physician content and productivity apps in the AppStore, from anatomical diagrams to medical calculators to ICD-9 lookup and arguably the most successful category, medical content apps.

Mobile medical content companies such as Epocrates and Medscape have had a presence on physicians’ phones/PDAs for years.   We are closely following Epocrates’ expansion into the SaaS EHR market.  If mobile EHR access is a truly compelling value proposition for ambulatory physicians (we aren’t convinced it is), then Epocrates may be able to leverage the brand’s mobile association and large, existing installed base to stand out from the 400+ competing EHR vendors.

A number of ambulatory EHR vendors (AllScripts, eClinicalWorks, Greenway and NextGen) have recently introduced their own EHR mobile apps, most built for Apple’s mobile OS. Currently, it appears that little is on offer from EHR vendors for Google’s Android mobile OS, though that may change as Android becomes an increasingly compelling alternative to Apple.

Onward Ho!
Dipping our research fingers into the mHealth market, Chilmark Research is launching a new initiative that will culminate in the report: Enterprise Adoption of mHealth apps: Trends, Issues and Challenges. Over the course of the next couple of months (target release date is in advance of NIH’s mHealth Summit in DC) we will interview executives from the major HIS vendors, best-of-breed vendors, tech entrants, and leading Hospitals/IDNs. Through both primary and secondary research we will answer such questions as:

  • What top mobile apps are currently being adopted in the enterprise?
  • What are the priority unmet needs among leading Hospitals/IDNs?
  • What challenges are currently hindering adoption of mHealth apps in the enterprise?

In the meantime we will be posting every other week specifically to give updates on our mHealth research.  Onward Ho!

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Yesterday, with much fanfare, Steve Jobs took the stage at Apple’s annual developer conference and announced the pending release of the next iteration of the iPhone. While there has been plenty of press regarding this release, both before (and Apple’s Dark Lord tactics) and after, Job’s presentation also highlighted a number of facts and figures worthy of quoting here as Chilmark Research sees Apple’s portfolio increasingly being a leading indicator of future innovations and subsequent adoption in not only the consumer market, but the healthcare sector as well.

Over 2M sold since its release 2 short months ago.
8.5K native iPad apps now available.
35M apps downloaded => ~17 apps/iPad.
5M books downloaded

Some analysts are now projecting that 8M iPads will be sold by end of 2010; would not be at all surprised if that number is exceeded.  On a recent trip to Martha’s Vineyard, while taking the ferry over, I saw two, separate elderly people (had to be at least 80+ years old) using iPads.  This product is a hit and its popularity will drive continuing developer interest to build out new apps for the iPad.  Having spoken to a number of healthcare workers though, the utility of the iPad in the healthcare setting has yet to be determined as many still question the ruggedness and ability to disinfect an iPad. Really do not see this as a big hurdle to overcome as such has been the case for many previous computing platforms and the iPad comes in such a compelling form factor, it really is hard to resist for numerous applications including bedside patient education, that the healthcare sector will be an important market for the iPad.

Over 5B apps downloaded.
A whooping 225K apps are now available.
15K apps/wk are submitted to Apple for approval (95% are accepted within a week).
Top 3 reasons for apps being rejected:

  1. Does not function as advertised.
  2. Uses private APIs.
  3. App is buggy and crashes.

By end of June’10, over 100M devices using the iOS (iPhone, iTouch, iPad) will have been sold.

The AppStore has created a completely new model for app development and delivery that has been highly successful for Apple in driving sales for its ever expanding portfolio of devices.  Google is a distant second with the Android OS and the Android store of some 30K apps. In healthcare, with a few notable exceptions (e.g., ADAM, Epocrates, iTriage, LiveStrong, WebMD, etc.) most of the mHealth apps in the AppStore are pretty simplistic, what Chilmark refers to as mHealth 1.0 apps (for more info, mobihealthnews has a nice little report on mHealth apps).  But what Chilmark is more interested in is seeing how the concept of an AppStore-like environment (platform) will allow for the development of a wide range of mix and match clinical apps, which some have begun referring to as “Clinical Groupware.” Big question here though is how will meaningful use be achieved through use of a certified EHR if the certified EHR is actually a collection a disparate apps running on an iPhone or iPad?

The New iPhone:
For healthcare, a couple of new features are notable (beyond multi-tasking which was announced earlier this year as part of new OS4.0).

  • New “retinal” display that Apple claims will provide unmatched resolution.  This will be particularly valuable in reviewing images.
  • Video camera on both sides of iPhone combined with video conferencing app, FaceTime.  This could be particularly useful for telehealth applications wherein a remote clinician (say a nurse) is providing at home care, notices a new rash on a patient and confers with doctor at clinic or hospital, in real-time on what appropriate action (bring them in, apply slave, order Rx) should be taken.

Apple is clearly in the driver’s seat today setting the standards and benchmarks by which others will follow.  How these developments may impact the healthcare sector is something we will continue to monitor closely.

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iTriage is a slick iPhone app that we first took a look at back in April.  A couple of weeks back we had a chance to meet with the CEO, Dr. Peter Hudson (yes, he’s an ER doc who still practices medicine) who was in Boston to attend a conference.  During that meeting, Peter gave us a brief update on progress to date, including their recent announcement with HCA to become a premier listing service for South Florida.  Following is what we learned.

Since its launch in April 2009, iTriage has maintained an enviable position as one of the top downloaded apps in the iPhone AppStore, currently in the top 10% of all apps downloaded.  When one thinks about all the 35,000+ apps currently available and some 1 billion apps downloaded to date, that is pretty impressive for a small company.  Clearly, they must be doing something right.  That being said though, if they are such a popular app, why don’t they at least show up on the AppStore Health & Wellness or Medical sections in the list of top paid apps? Curious.

The parent company’s (Healthagen) business model is to solicit providers, mostly large integrated delivery networks (IDNs) to become premier sponsors who pay an annual subscription fee (based on number of hospitals & clinics) to Healthagen to have their facility listed along with some brief marketing content, including the ability to upload videos, as to why one would want to go to their facility (typically ER) versus others. Thus, Healthagen is tapping into the marketing budgets of IDNs. With home offices in Colorado, Healthagen has done a good job of landing the big IDNs in Colorado including Centura Health.

On October 5th, HCA announced that they would become a premier sponsor as well for their facilities in South Florida.  What is particularly cool about this announcement is that in addition to the standard promotional marketing content that one may find in iTriage on a given HCA facility, HCA will also be providing real-time information on expected wait-times in ER, right there in the palm of your hand on your iPhone and in a recent upgrade of the software, a Blackberry as well.  (In November, they’ll release versions for Android and PalmPre.) This is all part of a larger push by HCA, which includes posting wait-times on billboards in this region to drive consumers seeking medical attention to their facilities as a significant percentage of those admitted to ER wind up being admitted for more extensive care.

Granted, someone having a heart attack will dial 911 and go to the nearest facility, or as in my recent case, choose a hospital known for excellent care based on a recommendation (the EMT that treated triaged me suggested I go to Brigham & Women’s as they have the physicians to treat nasty cuts, in my case a plastic surgeon stitched me up). But there may be other cases where someone who is feeling ill and cannot get an appointment with their primary care physician or are on travel, may find this feature useful.

Now, if I can only get something like a change:healthcare feature embedded into iTriage for costing information, a medication checker like PharmaSURVEYOR or DoubleCheckMD (who knows, maybe that new med I was prescribed is causing all the grief) to evaluate current meds I am on and while we are at it, a more user friendly mobile interface (yes, they do have an avatar on the Web) then we really would have one powerful app to support consumer-driven healthcare.

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blackbFollowing on the hugely successful iPhone AppStore and the more recent Google Android Market, Research In Motion (RIM) intends to launch its own Application Storefront for the BlackBerry in March.  ZDnet interviewed the folks at RIM on their plans, which was published today, following RIM’s announcement Monday of accepting submissions from 3rd party developers.

Late last week, also came across this interesting newsletter from RIM where it appears that they are “priming the pump” for the future Application Storefront with a focus on managing/tracking health & wellness on one’s BlackBerry.

The iPhone has a commanding lead in the smartphone app market with over 10K apps today and nearly 500 dedicated to health & wellness.  Momentum at the AppStore shows no sign of slowing.  Android’s market is growing, albeit slowly despite its “open platform” approach.

Blackberry and its future Application Storefront will certainly see some success, after all there are some 21M active BlackBerry users.  The big question is: Can the folks at RIM, who appear to be behind the 8-ball move out front and start gaining mind-share among consumers and 3rd party developers?

For developers RIM is providing a distribution model that is more attractive than Apple, and maybe less draconian.  For BlackBerry app developers the revenue split will be 80/20, whereas Apple is getting 10% more with their 70/30 split.  For consumers, if RIM can foster and encourage developers to create more engaging and interesting apps in market sub-sectors, e.g. health & wellness, that could create a significant area of differentiation.

Outside of gaming, where there really are some pretty amazing apps for the iPhone, apps in sub-sectors such as health & wellness are what one could call iPhone 1.0 apps characterized by:

  • Simplistic interfaces
  • Me too apps (really how many different BMI or pregnancy calculators do we need in the AppStore)
  • Only modestly engaging and useful

To date, Apple and its 3rd party developers have done little to change that.  Even the WebMD app when first introduced was pretty poor.

If RIM is able to open its Application Storefront doors with a selection of applications that take moble computing to the next level, they may indeed succeed in gaining mind-share and begin to influence the market.  If, however, they open up those doors and show just more of the same, it is unlikely that they will ever catch-up and will just have to distantly follow in Apple’s footsteps.

(Full disclosure: On Feb 1st my T-mobile contract runs out, I sell my BlackBerry Pearl on Craigslist and hove to the Apple store I go.)

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iphone-hedLast week the Washington Post published an article on the fervor surrounding the iPhone and the slew of independent developers that are making boat-loads of money by creating apps for the iPhone.  As the article correctly points out, Apple’s goal is not so much to make money from selling these apps, but to become the de facto platform for all things mobile.

Apple won’t say how much money the App Store is taking in, nor will it say how many of the 300 million downloads were free apps and how many cost money (most apps are free; the others cost anywhere from a buck to $10). Apple gets a 30 percent cut of revenue generated by apps. But for Apple right now the money isn’t the point. The big thing is the race to become the dominant mobile-computing platform, the way IBM-standard PCs running Microsoft operating software — first DOS and then Windows — came to dominate personal computing in the 1980s and early 1990s.

Apple has a monsterous head-start on the competition.

Today, there are over 10,000 apps for the iPhone, nearly 450 just for health & wellness.  Taking a look at would be competitor Google and its Android platform and you’ll find a paltry 35 apps total, none by the way are targeting health & wellness.  Palm, which once had the physician market virtually to itself is all but dead.  Yes, Palm is releasing a new OS any day now but they have lost so much momentum and market cache that they will find it impossible to come back as no independent developer in their right mind will bother to develop an app for a dying platform.

What about Blackberry, Nokia (Symbian) and Windows Mobile?

These are three big players in the mobile market who will not give up easily and each has some pretty substantial resources to back them up.  Problem is, if you add Appple and Google to the mix, you end up with 5 potentially viable mobile platforms.  Can and will the market support that many? Unlikely.

In time there will be a shake-out that will result in at most, 3 mobile platforms, but that is at least 3 years down the road, unless of course there is an acquisition (e.g., Microsoft acquiring Blackberry).

So what is a developer to do?  Here is our 5 steps to mobile platform success:

  1. Talk to your customers and talk to your customers’ customers to understand how they are using mobile technology today and what mobile apps/platforms they are using today.
  2. Pay particular attention to those customers who are often away from their desks/offices for extended periods of time. Understand how they access information on the go and what information is most difficult, but critical to gain access to.
  3. Build platform flexibility into the app.  Assume your app will eventually be available on at least 2 if not 3 separate mobile platforms.  In the US, we recommend established developers to target the iPhone first. If you are new to the market, developing for Android first will provide early and important market visibility.  If you have a large presence outside the US, Nokia’s Symbian wil be on your radar.
  4. First and foremost, focus on simplicity of engaging/using the app.  Despite all their features, mobile devices have their limitations, thus the app must be extremely easy to use requiring a minimum number of clicks to perform any task.  Beyond simplicity, think radical and leverage the unique capabilities of mobile devices e.g., accelerometers, GPS, barcode scanners, etc.
  5. Iterate, iterate iterate.  Once you launch the mobile app, do not expect to just sit back and let the $$$ roll-in.  Get the product out into the market quickly and continually track usage patterns.  Update product on a frequent basis to reflect those usage patterns, creating added value. Mobile apps are extremely viral, iteration is key to a viral market infection.

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Doing the monthly drive-by of mobile health & wellness apps, what do we find…

Apple iPhone:

There are now nearly 400 health & wellness apps in the iTunes AppStore today.  While this is more than double the apps we found in early October, we are beginning to see some signs of slowing growth in new health & wellness apps for the iPhone.

Surprisingly, the popular drug app for physicians, Epocrates is no longer listed on the site.  Did contact customer service at Epocrates who gave a pretty lame excuse to the effect: Oh, there are just so many apps on iTunes, blah, blah, blah.  Quite surprised that they would pull their product from the site (most likely got tired of forking over 30% of every sale to Apple) as it was one of the most popular apps.  That being said, Epocrates is still offering an iPhone app that you can pick-up at their website, in fact, just got an email coupon a couple of days ago for Epocrates Essential for the iPhone.

The AppStore also has a new look (see below), greatly simplifying the task of finding what is most popular on the site.

Google Android:

Still waiting for the first health & wellness app to appear – Nothing Yet!

Can only assume that the Android customer base today, TMobile’s, is dominated by the young and immortal, which it is, who could really care less about such apps today.  With Google’s recent decision to provide an unlocked Android phone to the market, this may all begin to change.

iTunes AppStore

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