Apple has been in the news with some amazing ups and down recently:
• Surpassing Exxon Mobile to be the largest U.S. company in market cap. For those of you wise enough to avoid the perils of Wall Street, “market cap” = market capitalization, or share price times number of shares, which in Apple & Exxon’s case is around $350B these days.
• The sad passing of Steve Jobs, which got more media coverage than the “occupy” movement, eliciting sad condolences from even his major rival, Bill Gates, as well as every pundit in the IT world.
So what’s up with Apple in the healthcare space? The company’s road in this industry has been about as interesting a series of ups and downs over the years as you’ll find. Here’s a sampling below, based on my personal experiences as a 25 year+ user of the Mac OS (bought my first “SE” in 1986), as well as being deeply involved with hundreds of hospital clients over the years:
1970s – in the distant beginnings of PCs in the mid ’70s, Jobs & Wozniak’s Apple was one of the earliest and most successful micros, which were used mainly in homes rather than businesses or hospitals. The total paucity of software left Apples, Altairs, etc., mainly for hobbyists and gamers.
Early 1980s – in the late ‘70s, Apples finally started popping up in the workplace, thanks to breakthrough software like VisiCalc, a pioneering spreadsheet developed specifically for the Apple II. This hardware/software combination became the darling of many hospital users, and a 1981 study by Dorenfest & Associates (precursor to HIMSS Analytics) gave Apple over 50% of the hospital market, followed by Radio Shack’s “TRS-80,” Texas Instrument’s “99-4A,” Commodore, etc. However, the introduction of the IBM PC in 1981 led to the usual lemming-like purchase of Big Blue hardware, and by 1984, Dorenfest’s next survey found IBM with a 60% lead in market share, versus Apple’s 20%. This lead has grown ever since to where, today, Apple has just about disappeared on hospital desktops in favor of ubiquitous “Wintel” machines.
Late 1980s – when we started our HIS consulting firm back then, we encountered nothing but IBM PCs in clients with but one exception: the Hospital for Joint Diseases (now part of NYU), which had dozens of Apple’s Macintoshes throughout their departments. I remember finding a virus on one of them and helping their IT Director acquire SAM (Symantec AntiVirus for Macintosh) to clean the mess up… Throughout the ’80s and ’90s, IBM PCs and their clones totally displaced “dumb” CRTs in hospital after hospital, all running Microsoft Windows as their GUI, with not a Mac in site.
1990s – I never saw a Mac in a hospital for over 10 years until the late ’90s, when a super-sharp IT Director named Dave Witten at St. John’s Hospital in Jackson, WY, showed me several Macs he was using as servers running the Pick OS for his A4 system (formerly Skip Shipee’s “MSA”). Other than Dave’s, I never saw a Mac in literally hundreds of hospitals we worked at ever since. Only an occasional iMac in a physician or attorney’s office for personal use…
2000s – Finally, just a few years ago, Job’s iPhone and iPad broke the Microsoft device barrier, and hospital users on nurse stations and administration were no exception. In the past few years, for example, HIS vendors like Opus and IntraNexus (both recently acquired by NextGen) proudly demo’d how they could take a physician or CIO’s iPhone and, within minutes, load an app that put their EHR on the screen via a Web browser. Granted the screen was tiny, but the iPad is now curing that problem!
So where’s Apple heading in the HIS industry? I believe the iPad and its inevitable cheaper and more powerful successors will force most HIS vendors to create apps enabling their EHRs to be viewed on such devices. After all, just how many PCs can one squeeze on a nurse station to give RNs access to eMARs and physicians to CPOE? I remember visiting Beth Israel Deaconess Medical Center a few years back and hearing EMR pioneer CIO John Halamka, M.D., describe how he was commandeering patient rooms to fill with PCs so clinicians would not have to wait in line at crowded nurse stations. “iDevices” will totally cure that physical access problem, and woe betide the HIS vendor that does not keep up with the Joneses and make their EHR PDA friendly.
What about Macs? Well, they’re doing fine in the personal market, with a share of about 10% in the third quarter of 2011, in 3rd place behind HP and Dell with 26% and 22% respectively. Will they ever penetrate the huge desktop device market in hospitals? I doubt it, as Microsoft’s monopoly on the Windows OS generates too many billions of easy recurring revenue for Balmer and Company to ever allow Apple a foot in that door. Rather, it will be in the pockets of clinicians where Apple will finally take a bite of the healthcare IT (apple) pie.