iPad & Next-Gen Tablets: A Clinical Viewpoint

Simple shifts in user interface technology and interaction style can make a huge difference in long term for IT, web applications, and software design. The GUI has been in constant use in consumer software since the 1980’s Mac, with early 90’s Windows 3.0 mainstreaming the GUI. While numerous interaction designers have foretold the death of the GUI, they really haven’t had much to replace it with.

A decade ago it was voice, which I never bothered to even respond to. Voice will always have limitations, as it places too heavy a cognitive burden of vocal precision and thinking on the human speaker. We would have to transform our literate, objectified culture to an interpretive, oral culture to use voice UIs effectively.

The GUI as we know it took a decade to research, another to establish, and another to mainstream. The gestural touch UIs will probably last as long.

Why is this important for healthcare interaction design? First, we might recognize that design technology does not drive adoption. If we innovate a better device or interface than the status quo, usability and universal adoption do not necessarily follow. Consider this from an activity systems view. People have jobs to do with IT, with their motivated outcome (work product) as a critical goal of any collection of interactions.  They must buy, install, learn, and integrate hardware and software to fulfill these outcomes. Changes cost, time and cognitive burden.

Every interaction involves trade-offs between platform, access, bandwidth response, application complexity, data entry and data (content) interaction, and the expected output. If any of these fail, the whole system fails. All of these functions are enabled by sub-cognitive operations that are committed to repertoire. Learning new interaction modes requires the inter-actor to rethink how work is done. Sub-cognitive operations are now tedious actions, followed step by step. Multitasking becomes impossible while learning or using the new techniques. The (clinical) activity itself may be affected by the change.

Clinicians are thought to be conservative IT adopters (on the whole) because they don’t pick up every new device, and there is this mistaken notion that they are savvy IT users, because they are smart professionals who work in high-tech locations. My research with specialists and residents shows that more senior docs actually use smartphones less than ever, not more than ever, at least for clinical IT. Yes, there’s interest and better apps will make a difference. But on the whole, doctors use the phones to talk, and the hospital computers to look things up. Residents love smartphones when they are learning things, but once they have learned their procedures and are doing the work, there is less time to search, and less need to use the smartphone for lookups.  I mean, you try scanning an EMR record on an iPhone!

So that brings us to the iPad.

A recent contributor from iMedicalApps in KevinMD (recommended) explains Why healthcare may not embrace the iPad. After reading the piece you may come to the conclusion that the early survey research is sketchy and it is too early to make the case either way. The study they base this on is:

According to the Software Advice survey, the medical community wants a tablet, with a third of respondents saying that they are likely to purchase a tablet. For over half of respondents, the primary factor that would guide their purchasing decision would be ease of use, with a fifth identifying software as their guiding factor. Why do they want it? Over 75% of respondents identified diagnostics management (ordering/tracking tests), medical reference, clinical decision support, prescribing, imaging, and notes as tasks they would like to perform on their tablet. As you read this, an obvious question arises – these are all things the iPad could probably do well, so where does the survey go wrong for the iPad?

The survey also explores the must-have features for a tablet, with over 50% identifying Wi-Fi, durability, lightweight, availability of medical software, and fingerprint access as essential features. Fewer respondents also identified dictation capabilities, RFID reader, camera, and barcode scanning as must-have features. While the iPad clearly does fares well with regards to some of these criteria (weight, Wi-Fi, usability), it lacks most of these identified must-have features. And these are certainly features that many, including us at iMedicalApps, have discussed as notable deficits when it comes to the iPad in healthcare.

They note this was a small survey (175) with only half clinicians. What’s missing here is context. “Apps” are not enough. The tablet must fit the style of practice. must be fully compatible with the institutional network (not just “wifi”), and must support, or at least not conflict, with mission critical IT such as EMR, order entry, test and imaging. It must fit in the white lab coat or smock pocket. It must seamlessly synch (not iTunes). It must take calls and show voicemails.

Eventually there will be a tablet that will integrate with the institutional infrastructure, But by then, there may be an open-architecture tablet that follows the iPad, is designed as a clean-surface device, with voice and remote gestures. The ubiquitous touch device presents problems in an environment where users where latex gloves or must be careful about persistent touches on a mobile device that transports between hospital locations. There may be real clinical reasons the Apple iPad is not adopted in healthcare, and the issues raised in the survey don’t yet touch on these. What do you think?

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