Doctors driving IT development with their mobile technology choices
■ Their adoption of smartphones and tablet computers has resulted in demand for systems in which they can use them.
When physicians at Albany (N.Y.) Medical Center started adopting smartphones a few years ago, they almost immediately looked for ways to use them in their clinical lives.
Doctors liked being able to access their patients' records and clinical tools anytime, from any place, so they pressured the hospital to give them access.
With an estimated 81% of physicians using smartphones (up from 72% in 2010), according to a survey of 2,041 physicians released May 4 by Manhattan Research, Albany Medical Center was not alone in feeling pressure from physicians to allow them mobile access. Hospitals and health information technology vendors are realizing that the way to sell physicians on health information technology is to make it mobile. Instead of hospitals and vendors telling physicians to adapt to their preferred ways of using technology, physicians are gaining the power to sway hospitals and vendors to their preferred way of using it.
Tech-savvy physicians have long been fans of mobile technology, even before it became as user-friendly as it is today. Many physicians adopted the Palm Pilot when it was the new device on the market.
The BlackBerry was the first smartphone to reach widespread adoption rates in health care, with many hospitals buying them in bulk and handing them out to physicians. But the mobile devices available today have something to offer even the least tech-savvy physicians, mainly ease of use, which is why the market penetration has gone so deep.
Manhattan Research found that while there are three smartphone leaders -- Research in Motion's BlackBerry, devices using Google's Android platform and Apple's iPhone -- physicians are showing a clear preference for Apple products for the first time. That bias toward Apple has extended to the tablet market as well because of the iPad. Manhattan's survey found 75% of physicians owning at least one Apple product.
"Physicians just really love the ease of use of the [Apple iPad]," said Meredith Ressi, president of Manhattan Research. "It's intuitive, and they know it's not going to give them a bunch of technology headaches." Thirty percent of doctors are using iPads to access electronic medical records, view radiology images and communicate with patients, according to Manhattan. An additional 28% of doctors plan to buy an iPad within the next six months.
Albany Medical Center has discovered a similar trend among its physicians.
As a direct result of physician demand, the hospital made provisions to allow them to use their own mobile devices to access the hospital's IT system.
Administrators knew anecdotally that many physicians preferred Apple products, but a recent project helped shed some light on their use.
Eighteen physicians in the group were given an iPhone, iPad and BlackBerry to use and compare over three months. There was a clear preference for the iPad for accessing email, patient records and applications, and the iPhone was the preferred device for phone calls. Albany said despite the limited number of doctors, this survey was indicative of physician use of mobile devices.
iPad in health care
Joel Anderson, co-founder and president of ClearPractice, one of the first EMR vendors to develop an iPad-specific EMR system, said even though he knew the iPhone had a large physician user base, he was a little skeptical that the iPad would take hold.
Before it was even launched, there were some who predicted the iPad would transform the way health care thinks about technology. One of those people was Tom Doerr, MD, the primary investor for ClearPractice and a friend of Apple founder Steve Jobs.
"Honestly, we [myself and others in leadership positions at ClearPractice] were a little skeptical," Anderson said. "In the past, doctors haven't adopted any technology at a rapid pace."
As it turned out, Dr. Doerr and Jobs were right about physicians' willingness to adopt the iPad, Anderson said. ClearPractice's iPad-based EMR was released in October 2010.
He said he doesn't know why the iPad has continued its lead, despite most every other technology vendor coming out with a competing product, many of which are built using the Google Android operating platform. If and when demand for an Android-based EMR hits, Anderson said the company is prepared to develop a product to meet the demand.
Gregg Malkary, founder and managing director of the Spyglass Consulting Group, a mobile computing marketing research firm in Menlo Park, Calif., said on the surface it looks as if vendors in the ambulatory EMR market have made provisions to accommodate physicians who want to use mobile devices. But their efforts have mostly focused on giving physicians remote access to existing EMR systems, not developing remote EMR systems.
Ressi said most vendors are working on "something" to make their EMRs accessible through the iPad. Allscripts, for example, has created an "Allscripts Remote" app that will allow remote access to their office-based EMR. But very few have developed iPad EMR applications.
Malkary said in most cases it's too expensive for EMR vendors to develop an iPad EMR system. But providing access through a remote program is "low-hanging fruit" that many have gone after simply because it's become a requirement for them to offer basic capabilities on the iPad.
Connections may be made easier for physicians using cloud-based EMRs. Cloud-based systems are cheaper for physicians to implement because they don't require expensive servers and hardware -- data are stored on remote servers maintained by someone else. For smartphone or tablet-carrying physicians, their EMRs can be accessed wherever they have an Internet connection.
The American Medical Association has launched a complete cloud-based platform, through its Amagine brand, that will allow physicians to access clinical tools with a single sign-on to a Web-based platform. Some of Amagine's technical partners, such as the drug reference tool Epocrates and the clinical decision support tool MD Consult, offer separate iPhone applications.
Anderson thinks physicians lose out by using the iPad for remote access to an office-based or even cloud-based EMR rather than using an EMR made for the iPad. But George "Buddy" Hickman, chief information officer at Albany Medical Center, said when the hospital made it possible for physicians to access its IT systems remotely through Citrix, which provides remote access to office-based servers and programs, it was "good enough" for most physicians.
Ressi said the user experience, in most cases, would be better with an app, but right now "it's not Web versus app that we're hearing. It's iPad and accessibility."