iPads Have Much Potential, But Significant Challenges Remain

Drex DeFord, SVP & CIO, Seattle Children's Hospital

Who knew that an article entitled, “iPads in Healthcare:  Not So Fast” — including quotes from my trusted CTO, Wes Wright — would cause such a stir.  I’ve seen tweets, facebook posts, comments on Linked-In, and rebroadcasts of portions of the article in other articles.  Most of the stuff I’ve read has been negative-ish about Wes’ comments.

Then Anthony called and asked me to comment on our “bad experience with iPads.”

Here’s what I think:  First, you should read the original article and consider carefully what Wes actually says:

1. Legacy applications often don’t work well on iPads.  For the most part, they’re NOT built to run on iPads.  So the interface is indeed clunky.  The iPad isn’t a mouse, keyboard, and 21-inch monitor, and that’s what many of the original apps are built to use.  This is a little bit of a “duh” moment for me, but it needs to be said out-loud, because the iPad isn’t the cure-all solution or the “perfect carry-around device” — at least not yet.  There’s a lot of work to be done to make that a reality.  I’ll talk more about that later.

2. Docs love iPads.  To this one, I have to say, almost all of us love iPads.  I love mine.  I took one of the first iPads we purchased at Children’s to test capabilities – accessing legacy apps, using Citrix Receiver to get to my VDI desktop, reading email.  What I found out, though, was that I loved it for all the non-work reasons most:  it was my bank, a decent note-taking device, my yoga instructor, and it let me remote control my DVR via the Internet when I forgot to set up a recording.  Once I realized that most of the things I loved the iPad for didn’t really have to do with “work stuff,” I gave it back to the test pool and bought my own personal iPad.  Yes, we all love our iPads, but I was quick to realize that legacy apps don’t work well on iPads, as I said, yet.  Wes said that out loud.   For Apple-loyalists, this was heresy.  (for the record, I drive a Macbook Pro too)

3. We should be at least a little worried about iCloud.  The new offering from Apple is very cool.  But I worry all the time about data-leakage in all forms, from all sources.  An important part of my job is to protect patient data.  iCloud may be, potentially, another threat to that charge.  If you’re not thinking about what data lives on an iPad, and then syncs up to the iCloud, or what data might be vulnerable when an iPad is lost or stolen, maybe it’s time to consider the unpleasant possibilities.

This next part is from me:  Since I agree that 1, 2, and 3 are generally true, then I hope you’ll understand our view that there’s a lot of work to be done bridging legacy apps (built for PCs) to the iPad form-factor, and making sure the data sent to, and used on, iPads is secure.  There’s a hundred different ways to do this, and all of those require time, planning and resources – in a severely resource-constrained environment.

Specific to our EMR, we’re working with Cerner on how the EHR bridge from legacy to iPad might work for Children’s.  You should know that I have some criteria for how this should work, because I don’t really want the patient information to reside on a portable device long-term (see #3), so we have to be thoughtful about our solution.

Building bridges from other legacy apps to the iPad will be challenging, and ultimately somebody has to pay for that bridge to be built.  I work at a small Children’s hospital, and I don’t have a large iPad development staff (honestly, I don’t have even a single FTE budgeted for iPad development; I’m betting that’s a common situation).  Every legacy vendor working on an iPad bridge for their product is taking a slightly different approach, leaving the customer organization to figure out how to integrate and protect data (but that’s not any different than what we’ve lived with for years).

Here’s a wish:  similar to a “Virtual Desktop” infrastructure, I need a “Virtual iPad” infrastructure – something that allows us to run and serve-up those vendor built legacy-to-iPad apps in a secure way.  So when the Internet connection to the users’ iPad ends, so does the access to patient-information.  No data resides on the physical iPad.  Oh, and I’d like one of those for the dozens of versions of Android too … while I’m wishing.

The bottom line is that iPads are great devices.  Very cool.  I love mine.  But it’s not a magic-bullet.  It’s doesn’t automatically solve the issues outlined above with its coolness alone.  It’s a form factor we should seriously consider integrating into our “information delivery system,” especially given its consumer-based popularity.  But adding the iPad to the inventory, and doing it well, isn’t as easy as some have made it seem.

And, in a nutshell, that’s what Wes said.