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iPad Lifecycle Versus Other Tablets

Posted on February 13, 2014 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

Every once in a while I like to put my old IT hat back on (I am @techguy on Twitter after all) and look at some of the more physical IT aspects of EMR and healthcare IT. I still get really excited about EMR Technology products and the evolution of these products.

I’ve long argued that most IT administrators would much rather have a set of Windows 8 tablets in their environment over a bunch of iPads or Android tablets. The biggest reasons for this was because of the security and management of these devices. Most hospital and healthcare IT administrators are comfortable securing a Windows based device and they aren’t as comfortable with new tablets like the iPad or Android tablets. Plus, the tools for managing and imaging Windows based tablets is so much more developed than those of the iPad or Android (although, I think both of these are catching up pretty quickly).

While I think both of these arguments are reasonable, I heard two new arguments for why an organization might want to stick with Windows 8 tablets instead of moving to iPads and Androids.

The first reason is that the lifecycle of a Windows 8 machine is much longer than an iPad or Android tablet. A Windows 8 tablet that you bought 5 years ago could still easily be supported by an IT shop and will work with your various software systems. A 3 year old iPad could very well not work with your EHR software and Apple has already stopped supporting O/S upgrades on the original iPads which poses similar HIPAA Compliance issues to Windows XP.

The whole release cycle with iPad and Android tablets is intent on replacing the previous versions. They don’t quite make them obsolete, but they’ve been releasing new versions every year with the intent for you to buy a new one every year. This stands in stark contrast to the Windows tablet approach.

Another reason many IT admins will likely lean towards Windows 8 tablets over iPads and Androids is that they’re just generally more rugged. Sure, you can make iPads and Androids more rugged with certain cases, but then you lose the look and feel of having an iPad in your hand and nicely in your pocket.

This point is accentuated even more when you look at devices like the new Toughpad tablets from Panasonic. They’ve finally got the processing power in these machines to match that of a desktop so they can run any software you want. Plus, they are crazy durable. I saw them at CES last month and a journalist from India was slamming it on the ground and stepping on it and the thing kept ticking without a problem. I don’t need to explain to any of you why durability matters in healthcare where you’re always carrying around multiple items and drops are common.

Of course, the reality is that it’s “sexy” to carry around an iPad while you work. Software vendors are going to continue developing for the iPad and doctors are going to want to be carrying an iPad around with them. IT staff are likely going to have to support iPads and other tablets in their environment. However, when it’s left to the IT staff, you can be sure that the majority of them will be pushing for the more rugged, easier to secure, easier to manage, and longer lifecycle Windows 8 tablets. Unless of course, they’re ordering an iPad for their own “test” environment.

These 5 Innovative Companies Are Cause for Health IT Hope

Posted on October 1, 2013 I Written By

James Ritchie is a freelance writer with a focus on health care. His experience includes eight years as a staff writer with the Cincinnati Business Courier, part of the American City Business Journals network. Twitter @HCwriterJames.

When the topic is health IT, it’s easy to get caught up in discussing the major EMR players.

And because of Meaningful Use, there’s a tendency for everyone to do the same things — even if they go about it in different ways. Whether you’re a giant like Epic, an upstart like Kareo or a specialty firm like the gastroenterology-focused gMed, you’re likely making sure, for example, that your customers will be able to exchange structured care summaries with other providers and with patients.

But there’s still plenty of innovation in health IT, much of it with little or no connection to MU2 or other federal requirements. Startups all over the country are trying to improve lives through more efficient collection and use of data.

Here’s a sampling of startups and specific innovations:

  • HealthLandscape. This Cincinnati-based firm markets a mapping application that lets you input data from a variety of sources. The idea is to better understand health information by visualizing it. The company is a subsidiary of the nonprofit Health Foundation of Greater Cincinnati, which worked with the American Association of Family Physicians and the Robert Graham Center to develop the platform.
  • SwiftPayMD. This iPhone and iPad app from Atlanta-based Iconic Data allows physicians to note diagnostic and billing codes by voice right after seeing a patient. I have to admit, when I stopped to think about it, I was surprised that doctors couldn’t already do this. The major selling point: It helps practices to get paid as much as two weeks sooner.
  • Vivify Health. Based in Plano, Texas, this startup has created a cloud-based platform for monitoring and testing patients remotely. Its system works with just about any consumer mobile device to provide customized care plans, coaching, educational videos and interactive video conferencing. In a press release, Vivify Health said it’s helping hospitals, home health agencies, payers and others to reduce readmissions, manage chronic diseases and improve care transitions. It received funding this year from Ascension Health Ventures and Heritage Group.
  • Drchrono. This Mountain View, Calif.-based company bills its flagship product as “the original mobile EHR built for the iPad.” It was part of the Y Combinator, a Mountain View-based seed accelerator, in 2011. Drchrono in 2012 raised $2.8 million in funding led by venture capitalist Yuri Milner.
  • Doc Halo. This firm, based in Cincinnati, makes possible HIPAA-secure texting. (If this list seems slightly Cincinnati-centric, it’s because I worked in the city for eight years and know the market better than I know others.) Many doctors use regular text messaging to discuss patient information, but they shouldn’t. Doc Halo’s mobile app system uses several levels of encryption.

These are just a few projects that I thought were cool. Based on what they’re doing, there’s plenty to be hopeful about in health IT. There are, of course, many other firms equally worthy of mention. And there are now accelerator programs all over the country specifically for health IT startups.

I often get the feeling that the federal government’s involvement is taking the joy out of health IT. That’s not the case, but amid the push to meet MU2 requirements, you might have to look a little harder to find it.

And with these startups, here it is.

Disclosure: gMed and DrChrono are both advertisers on this site.

EMR-Switching Physicians Demand Mobile EMR Apps

Posted on June 3, 2013 I Written By

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.

We already know that many physicians are considering dumping their current EMR, with up to one fifth telling research firm Black Book Rankings that they were considering a switch in 2013. Now,  Black Book says that it’s found a focus for the switch:  that physicians are looking for new EMRs to offer integrated mobile applications as front ends.

Seldom do you see as unanimous a decision as doctors seem to have made in this case. One hundred percent of practices responding to Black Book’s follow-up poll on EMR systems told the researchers that they expect vendors to allow access to patient data wherever physicians are providing or reviewing care, according to the firm’s managing partner Doug Brown.

Not surprisingly, vendors are responding to the upsurge in demand, which has certainly been building for a while. As part of the current survey, 122 vendors told Black Book that they plan to launch fully-functional mobile access and/or iPad-native versions of their EMR products by the end of this year, while another 135 say they have mobile apps on their near-term product roadmap.

Demand for core patient care functionality in mobile EMRs outpaces physicians’ interest in other types of mobile functionality by a considerable margin.

According to Black Book researchers, 8 percent of office-based physicians use a mobile device for electronic prescribing, accessing records, ordering tests or viewing result.  But 83 percent said they would jump on mobile EMR functions to update patient charts, check labs and order medications if their currrent EMR made them available.

When asked what  mobile EMR feature problems need to be addressed, current users of both virtualized and native iPad applications saw the same flaws as being the most important. Ninety-five percent of both groups said that the small screen of a smartphone was the biggest mobile EMR feature problem. Eighty-eight percent said difficulties with easy of movement within the chart was an issue, 83 percent said they wanted a simplified version of the EMR on their mobile screen and 71 percent wanted to see screens optimized for touch use.

For more info on EMR Switching check out this whitepaper called Making the Switch: Replacing Your EHR for More Money and More Control.

The Health IT Tablet Shift and Some Hope for Windows 8

Posted on March 20, 2013 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

One of the most amazing shifts that we’ve seen in healthcare is the acceptance of the tablet form factor. I’ve been fascinated with tablets since they first came out. The idea was always great, but in implementation the idea always fell apart. Many a sales rep told me how the tablet was going to be huge for healthcare. Yet, everyone that I know that got one of the really early tablets stopped using it.

Of course, the tablets that I’m referring to our the pre-iPad tablets. As one Hospital CTO told me at HIMSS, “the iPad changed tablets.

It’s so true. Now there isn’t even a discussion of whether the tablet is the right form factor for healthcare. The only question I heard asked at HIMSS was if a vendor had a tablet version of their application. In fact, I’m trying to remember if I saw a demo of any product at HIMSS that wasn’t on a tablet. Certainly all of the EHR Interface Improvements that I saw at HIMSS were all demonstrated on a tablet.

As an extension of the idea of tablets place in healthcare, I was also interested in the healthcare CTO who suggested to me that it’s possible that the Windows 8 tablet could be the platform for their health systems mobile approach. Instead of creating one iPad app that had to integrate all of their health system applications, he saw a possibility that the Windows 8 tablet could be the base for a whole suite of individual applications that were deployed by the health system.

I could tell that this wasn’t a forgone conclusion, but I could see that this was one path that he was considering seriously when it came to how they’d approach mobile. I’m sure that many have counted out Microsoft in the tablet race. However, I think healthcare might be once place where the Windows 8 tablet takes hold.

When you think about the security needs of healthcare, many hospital IT professionals are familiar with windows security and so they’ll likely be more comfortable with Windows 8. Now we’ll just have to see if Windows 8 and the applications on top of it can deliver the iPad experience that changed tablets as we know them.

Will Windows 8 Kill Physician iPad EHR Requirement?

Posted on October 16, 2012 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

Yesterday at the Digital Health Conference I had the chance to catch up with George Cuthbert from Medent. He’d emailed me a few months back about the potential benefit of Windows 8 in the EHR world and the deep integration of Win 8 that they’d been working on to leverage the unique abilities of Windows 8 for their EHR users.

I admit that since I’ve become more of a health IT blogger and less of a techguy, I haven’t kept close track of all that was happening with Windows 8. I knew that it was designed to incorporate touch as a major focal point of the new Operating System and I knew that it was Microsoft’s attempt to integrate the best of touch together with the advantages of data input using a keyboard and mouse.

Based on the short demo that George did for me of Win 8 and the Medent EHR, it has some real promise. In fact, as the title suggests, I think that if an EHR vendor does it right this could solve the issues that so many EHR vendors have of trying to create an iPad EHR application.

This may sound a little outlandish and certainly many doctors have a special love affair with Apple products. However, I think that most doctors don’t care if it’s an iPad or Windows 8. They just want the iPad like touch interface which allows them to smoothly consume data from their EHR. The Fujitsu model that George showed me has the potential to do just that. In fact, it was quite beautiful how seamlessly you could go from the tablet to a laptop workstation and back.

The biggest challenge that most EHR software will have with this idea is that their EHR isn’t built for touch. Just because Windows 8 makes touch possible doesn’t mean that it will be a good experience to use that way. That’s true for iPad as well and is the major reason why Citrix access to your EHR on your iPad isn’t a great solution. Touch requires a very different interface. George and Medent realize this and you could see the thought and effort they’ve been putting in to transform their interface into a touch optimized experience.

Obviously, I think we’ll still see plenty of iPad in healthcare and iPad EHR. However, I have a feeling that many in healthcare will be just as happy with the Windows 8 touch implementation.

BIDMC’s Encryption Program Tames BYOD Security Fears

Posted on August 14, 2012 I Written By

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.

Beth Israel Deaconess Medical Center has begun what it calls an “aggressive” campaign to make sure every mobile device in use by its staff and students is encrypted. This is interesting in light of John’s recent post about encrypting devices to meet HIPAA.  The following update comes from the GeekDoctor blog maintained by Halamka, a resource worth reading in its own right.

The initiative, spearheaded by the indefatigable CIO John Halamka, MD, MS, is massive in scope, affecting as it does 18,000 faculty members and 3,000 doctors, plus a large student population. Costly and time-consuming though it may be, I think it’s an object lesson in what needs to be done to make “bring your own device” a safe and sustainable part of hospital computing.

“It is no longer sufficient to rely on policy alone to secure personal mobile devices,” Halamka said. “Institutions must educate their staff, assist them with encryption, and in some cases purchase software/hardware for personal users to ensure compliance with Federal and State regulations.”

Halamka and his team already began training staff regarding smart phone devices connecting with the Exchange e-mail system using ActiveSync. Under the new regime, those devices must now have password protection.

Next, the Information Systems team is beginning the massive task of encrypting all mobile devices. They’re starting with company-owned laptops and iPad-type tablets, but expect to move out into encrypting other tablets later.

While the process is understandably complex, broadly speaking the IS department is going to take every device currently owned by the institution and give it a complete going over for malware and vulnerabilities, make sure the configuration meets security standards, then fully encrypt it to meet HIPAA/HITECH safe harbor criteria.

The next phase of the program will extend the checkup and encryption process to any personally owned computers and tablets used to access BIDMC data. I’ll be interested to see if people get squeamish about that. There’s a big difference, emotionally, between letting IS strip your work device naked and sharing your personal iPad.  But clearly, if BYOD is to have a future, initiatives like this will need to go on at hospitals across the nation.

EMR Landmine, Mobile EMR Access, and Patient Advocates

Posted on August 5, 2012 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

While it seems that many people are coming out with distaste for the Olympics, I am still on the side of enjoying the Olympics thoroughly. I’ve watched as much of the coverage as possible. What can I say, I’m a sucker for pretty much any sporting event. I hope everyone else has been getting as much joy out of the Olympics as I have gotten, but I digress.

As you know, each week I take a quick look at some interesting tweets that have been posted around the EMR, EHR and Healthcare IT twittersphere. Plus, I’ll add a little commentary that will hopefully start some interesting conversations and help you as a reader.


What a perfect way to describe the issue: an EHR Landmine. Jane Shuman is exactly right too. In fact, a local doctor recently told me the same thing. The challenge of checking and re-checking patient information from a previous patient visit is a huge problem waiting to happen. I think the doctor I talked to said that EMR perpetuates mistakes. It’s so true. I wonder what other EMR landmines are out there.


My readers agree with Melissa. As long as the iPad is a native iPad app and not just some remote desktop access to EMR software that isn’t optimized for a tablet environment.


You have to love Regina Holliday. A tireless patient advocate. Years down the road I hope that Regina will be able to stop her patient advocacy. Not because she gets tired of doing it, but because we embrace the patient in healthcare.

Needed iPad Feature for Healthcare IT and EHR

Posted on July 6, 2012 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

As most of you know, in my pre-blogger life I was a tech guy. In healthcare I did top to bottom IT support at a health and counseling center. I dealt with everything from servers to networking to desktop support to project management and everything in between. It was a great job since I was never bored and always had a variety of things to do. Not to go into my entire career history, but just to say that it’s with good reason that I’m @techguy on Twitter. I love tech and always will.

When I think back to my tech support days, I remember one time where we had an influx of cash as part of a big move into a new building. With that move we ordered ~100 new desktop and laptop computers. You can imagine the logistics of deploying this many devices all at once. We had to take over what use to be a conference room in order to make it happen.

One of the keys for myself and my student worker to be able to deploy all of these devices quickly and effectively was desktop imaging software. We installed one computer with all of the necessary applications and other security configurations. Then, we copied that computer to all of the other computers. It made for a wonderfully consistent experience for everyone and made support so much easier. Plus, if and when someone had issues with their desktop computer I’d just restore it back to the original install point.

None of this information will be all that exciting for those tech people reading this blog post. However, most that read this site aren’t that technical and so hopefully it gives some perspective to those readers.

The point of telling this background is that I think it’s one of the major weaknesses of the iPad. Can you reinstall the iPad after use? Can you restore it back to it’s original install point? Sure, if you’re in a solo physician practice or small group then maybe this doesn’t matter as much. However, if you’re in a hospital or large group practice these types of features can be really important to your IT people.

I’ve argued since nearly the beginning of the iPad that the big issue for the iPad in healthcare is the lack of enterprise features. The features described above are just a few simple examples of enterprise features that I’m not sure the iPad will ever support. Sure we’ll still see the iPad in healthcare. We already do see it, but we’ll never see the ubiquitous adoption of iPad in healthcare without these features.

I’m sure that some would suggest that by using a remote desktop application like Citrix you can achieve much of the enterprise features that I mention above and more. Things like security of data are much easier in Citrix. I’m just still skeptical that any remote desktop application can reach the type of iPad usability that a native iPad app can achieve.

I am interested to see how well the new Windows 8 platform will do. The idea of marrying the best of the tablet/iPad world with the best of the desktop world is an interesting idea. We’ll see if they’re able to walk that balance beam and provide that seamless experience across both sides of the aisle.

Laptops End Up With Kids, iPads Don’t

Posted on June 8, 2012 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

As I mentioned previously, I had the great opportunity to talk with Kaiser recently about their mobile initiatives at Health 2.0 Boston. It was a great chat with Brian Gardner, head of the Mobile Center of Excellence at Kaiser Permanente.

At one point in the conversation I asked Brian about Kaiser’s approach to devices. Did they allow physicians to bring their own device? Were they deploying their own devices and which devices did they use. Brian made a couple of comments that I found really intriguing.

First, he stated clearly that Kaiser issued all of their devices. They were looking at the BYOD (Bring Your Own Device) idea, but currently they didn’t support any BYOD options. Based on his response to this question I could tell that there were a lot of conversations about this topic happening at Kaiser. I got the feeling that they were likely getting quite a bit of pressure from their doctors to do something along these lines.

Brian then also provided what I find to be a really compelling observation. He commented that from their experience the laptops they issued to doctors always seemed to end up with their physician’s kids using them. I assume they could see this based upon the software the physician’s children installed on the laptop. Then, Brian observed that they hadn’t seen the same thing happening with the iPads they’d given out. He surmised that this was possibly because many of the doctors that got iPads saw it as a privilege and those doctors didn’t want to lose that privilege?

How intriguing no? Why is it that a laptop feels like a commodity and an iPad feels like a luxury item? One you don’t mind your children touching and the other is a luxury that your child shouldn’t touch.

I’d also extend this observation to say that working on a laptop feels like work. Using an iPad feels more like play. At least that’s the feeling I get. I imagine many doctors feel the same way. I wonder if that will change as the iPad starts to get more applications that really help you do work on it.

Mobile Health Moving The Network Edge Out Permanently

Posted on June 1, 2012 I Written By

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.

Managing devices at the edges of the network is not a new problem.  In fact, looked at one way, we’re still dealing with the same problems of sharing computing intelligence that the first gen of client-server developers did.

But in a world where mobile devices are expected to do such critical work, I believe we’re at a unique juncture. HIT leaders are going to have to figure out how to completely transform balance between smart/dumb clients and their relationship to applications.  In other words, they’re going to have to manage from the edge in as well as from the core outward from now on. Too strong a statement?  Hear me out and see what you think.

Since the 1960s, we’ve gone back and forth between expecting edge devices to be dumb conduits for computing results (the green screen) and super-smart computing devices which needed the network only to connect users to each other.

Now, here in health IT land, we’re trying to find a balance that generations of brilliant developers and engineers have struggled to achieve.  With the advent of relatively cheap, flexible WiFi networks and widespread use of 3G/4G devices on the road, we’ve got the network infrastructure nailed for the time being.

But what do we do with the pesky limitations of those oh-so-popular iPads, Android tablets and smartphones?  Short-term, the answer for many IT organizations is making EMRs accessible only via devices that can run a remote desktop.  This compromise works for some users and is detested by others.  This may be a decent technical solution, but it may not be a usable one.

According to one reader, the way to create this balance is to create a better virtual desktop:

Were I a present-day EHR vendor, I’d start designing interfaces that work well when accessed via touch-screen devices that are using remote-desktop software, in preparation for a future when it is standard practice for all clinical staff to carry around iPad-like devices.

I think he’s dead-on. These devices aren’t an add-on anymore, they’re a permanent part of the clinical workflow where a lot of important, nay, life and death work will get done.  Readers, are you aware of anyone who has created an iPad virtual desktop interface which feels workable to the clinicians you know?