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Posts Tagged ‘Apple’

A Tribute

When I was at MIT, a postdoc heard I had just picked up a brand spanking new Compaq 386 with dual 5.25″ and 3.5″ floppy drives. He wanted my computer bad for he needed it to do some robotics programming. This being my brand new computer with all the bells and whistles, I was very reluctant, besides, I had my own work to do on the computer, what was I to use instead?  He assured me that he only needed my computer for a month and that I could use his brand spanking new Macintosh SE in the meantime. I relinquished, we made the trade and I fell in love. When he came back a month later to trade back computers, I told him no, I was going to keep his and he could have mine. This was 1987.

I never looked back.

Since then, I have always owned an Apple computing product. My reasons are many but the primary ones are:

Design aesthetics combined with functionality rule. I am extremely sensitive to design aesthetics, have always hung out with artists and one time pondered becoming an architect. When I visit a city and have some extra time, I go to the local galleries. Steve Jobs was also extremely sensitive to aesthetics and that extreme sensitivity led to what I believe have been the most beautifully designed devices that we have ever had the pleasure to behold. But they are not just beautiful, they also work beautifully with everything stripped out of them but the bear essentials. Certainly a lesson here for HIT vendors and their bloated, ugly, nearly unusable software.

Supporting a renegade. Apple has almost always been a bit of a renegade in the computing world bucking traditions. This renegade spirit which descends directly from Jobs is something I have always admired and was willing to support. Yes, Apple products sometimes cost a tad more but you are not buying just a product, you are supporting a movement. It is that renegade spirit I hope to bring to the HIT market in founding Chilmark Research. This industry is in serious need of some shock treatment, and through our research and analysis, we plan to be right there throwing the switch.

Systems rather than parts. While some may whine over the proprietary nature of Apple’s complete hardware/software systems design approach, one cannot argue against its ability to provide an unmatched user experience. Yes, I’m an IT analyst and yes, I can get my way around almost any OS but seriously folks, do I really want to or would I rather just open up my computer and get to work? Thinking back on those days with that Compaq and dealing with DOS and then using the Macintosh SE with its integrated system, is it any wonder I switched? It appears that many a provider thinks much the same way I do for just look at the rapid adoption and use of the iPad (adoption now over 35% of all providers) in the last year and a half since introduction.

Supporting innovation. Simply put, without Jobs, we all would probably still be dealing with FUGLY computers and a DOS operating system. Jobs and his company single handedly made computers actually fun to use and become not just a tool for business, but a consumer product.

Our country, our industry has lost the greatest visionary of our time in the consumer electronics market. He will be sorely missed but as he stated in his Stanford commencement address, death is a necessary part of life for without it, nothing would advance. Steve, I will miss your vision and hope that the many you have mentored over the years, including myself, will be able to carry your vision forward.

Lastly, one of my favorite quotes of his that I always try to keep front of mind and live by:

Growing old is mandatory.
Growing up is optional.

Stay hungry.
Stay foolish

– Steve Jobs

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CNBC Takes a Look at iPad Adoption

Chilmark Research was contacted earlier this week by CNBC, via Twitter, regarding a story they were doing on iPad adoption in healthcare. Always nice to see a well done story on the topic (hat’s off to CNBC producer Ruth Coxeter and reporter Bertha Coombs). Of course, seeing Chilmark Research prominently quoted sure puts a smile on our collective faces. (Note: The 22% iPad adoption number quoted in the CNBC story came from our recent mHealth Report in the Enterprise Report which was published in November 2010.)

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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.

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

 

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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.

iPad:
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.

AppStore:
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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There have been a lot of discussions on the Net regarding the potential impact of the iPad in the healthcare sector.  At this point, there is very little agreement with some pointing to the ubiquitous nature of the iPhone in healthcare as a foreshadowing of the iPad’s future impact, while others point to the modest uptake of tablet computing platforms as a precursor for minimal impact.

Our 2 cents worth…

We believe the iPad will see the biggest impact in two areas: medical education and patient-clinician communication.

The iPad’s rich user interface, native support for eReading, strong graphics (color) capabilities, ability to use various medical calculators (there are a slew of them already in the AppStore) and numerous other medical apps (most of these are iPhone apps and will need to be updated to take full advantage of the iPad’s larger 9″ screen) provides an incredibly rich ecosystem/learning environment for medical students.  Nothing else comes close – a slam-dunk for Apple.

That rich, graphical user interface, it’s inherent e-reader capabilities and portability also lends itself as possibly the best patient education platform yet created to foster patient-clinician interaction.  At bedside, a clinician has the ability to review with a patient a given treatment, say a surgical procedure, prior to the operation showing rich anatomical details (e.g., a patient’s 64 slice color enhanced 3D CAT scan), potential risks, etc. Heck, one could even show a video clip of the procedure right there on the iPad.  Now that is cool and sure beats the common approach today, some long lecture that oft-times is difficult to follow.

Beyond those two compelling use cases, other uses in healthcare for the iPad include its use by nurses and hospitalists to provide bedside care, tap multiple apps (hopefully multi-tasking will come in OS v4.0 to be announced on April 8th), in an intuitive environment.  As to how the iPad may extend beyond these limited boundaries for support of say charge capture and CPOE remains to be seen but in the immortal words of many an Apple iPhone advertisement:

There is an app for that.

And based on some of our initial conversations with mHealth app developers, many are already working on just these types of applications for the iPad, which they hope to bring to market within next several months.

One thing is certain, from at least one data point we received this past weekend, there is strong, initial interest in the medical community as to what the iPad may facilitate.  Speaking to one of the technical folks at the local Apple store this past weekend we learned the following: Of the 1,000 iPads sold on Saturday (this store did sell-out), 700 were sold off the floor and 300 were reserved for business customers.  Of those “business customers” a significant share of those 300 iPads (north of 30%) were sold to local medical institutions.

One of those local healthcare institutions appears to be Beth Israel Deaconess Medical Center (BIDMC) where an ER doc has provided his own iPad review, based on actual use during a shift.  Particularly like his comment about using it for patient education.  Might the iPad truly bridge the information gap between patient and clinician?  One thing is for certain, it will make it much easier for patient and clinician to confer over a given diagnosis, results and creation of a treatment plan with supporting documentation/graphics.

Read into that what you may but one thing is for certain, there is significant interest in the healthcare sector to at least understand how the iPad may be used within the context of care delivery in a hospital.  It remains to be seen as to how end users will actually use these devices and what apps will be developed to serve this market (might Epocrates see stronger uptake for their EMR on the iPad vs. the iPhone?) that take advantage of the larger, 9″ screen, but based on what we have experienced with the iPhone, there are likely more than a few developers right now working on novel applications that clinicians will find valuable. Question is: Will they be valuable enough to augment the extra weight and volume of lugging the iPad versus a smartphone?

Only time will tell.

That being said, based on initial impressions of physicians, such as the one from BIDMC (see above) and our own limited experience in using the iPad this week, the iPad is pretty incredible and could usher in a whole new approach to healthcare IT (interfacing to and interacting with an EMR/EHR system) that may result in physicians adopting and using such technology, willingly.  Could we even go so far as to say that the iPad will be a bigger contributor to HIT adoption and use than the $40B in ARRA funding that the feds will spend over the next several years as part of the HITECH Act?

Again, only time will tell.

Appendix:

Some other perspectives on the iPad in healthcare:

Article in HealthLeaders with some interviews with med professionals buying an iPad at Apple store in SanDiego.

ComputerWorld article looking at various business sector (including healthcare) uses of iPad.

Post by iPhone iMedicalApps on some of the current challenges for those adopting an iPad for medical use (virtually all the problems listed will be resolved within next few months)

Another post, this time at iPhoneCTO looks at the iPad in the med space for workforce mgmt.

Well look at this!  Children’s Hospital here in Boston announced today (4/8/10) that it has received one of the recent HHS innovation grants to “…investigate, evaluate, and prototype approaches to achieving an “iPhone-like” health information technology platform model…”

Another ER doc writes a review of the iPad.

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While the Apple iPhone was first targeted at the general consumer, Apple has been taking the necessary steps to bring this device into the enterprise, directly competing with RIM’s Blackberry.  Unseating the Blackberry in many sectors, such as finance, may be near impossible but healthcare is another story.  Within healthcare, Palm, with its Treo was extremely popular as it was not only a communication device (cell, email, etc.) but also supported other apps such as the very popular Epocrates.  Palm lost its focus, sat on its laurels, the Treo became dated, barriers to entry lowered.  Enter the iPhone, its intuitive interface, a touch screen, an ever increasing number of medical apps and Palm is basically out in the healthcare.

The iPhone was first adopted by physicians independently of the organizations (hospitals) they worked for to do simple communication and access numerous apps that helped them in their day-to-day activities.  Seeing this adoption trend. some of the EMR vendors also started to get on-board offering iPhone access to their app (AllScripts introduced theirs at HIMSS’09). But this adoption, for the most part, remained separate from broader enterprise (hospital) initiatives as early versions of iPhone’s operating system (OS) were simply not enterprise ready.

But this is changing.

Apple’s iPhone OS, which has seen significant improvements since its introduction and now has robust enterprise features, including security ( HIPAA compliance), integration to the ever popular Microsoft Exchange Server (calendar, email, etc.), and an SDK to build apps for internal purposes.

To showcase the iPhone in enterprises, Apple now has a section of their website dedicated to showcasing customer deployments of the iPhone in an enterprise.  Of the 15 enterprise case studies presented, 20% of them are dedicated to the healthcare market; Mt. Sinai in Toronto, Memorial Hermann in Houston and Doylestown Hospital in Pennsylvania. Of all the enterprise verticals to profile, dedicating 20% of case studies to one market, healthcare, signals Apple’s intent to invest in this market.

Common threads in each story:

1) Security features of iPhone OS insure HIPAA compliance.

2) Ability to use Microsoft Exchange ActiveSync for email and calendaring features.

3) iPhone’s intuitive interface minimizes training requirements.

4) iPhone is readily portable and can deliver the right information at the right time to the right individual.

5) iPhone’s ecosystem of applications allows a hospital and its clinicians to tap a wide range of applications to customize the iPhone to their particular needs. Many of these apps are free thus not a drain on ever tight IT budgets.

As Hermann Memorial’s CIO, David Bradshaw stated:

Healthcare is a real-time business.

And as we’ve said before:

Health is mobile.

The combination of an ecosystem of relevant applications with enterprise connectivity in a secure, easy to use, mobile construct is the future of healthcare IT, at least for clinicians.  The next step is bridging the divide between clinician and consumer through the use of such technologies. We’re not there yet, but hopefully, Apple is working with a healthcare organization (or at least will uncover one) and present such a case study in the near future.

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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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