New healthcare applications are being developed everyday for the iPhone and Blackberry – from EMR-related apps to prenatal care to chronic disease management.   Online articles and discussions have focused on the new Apple iPad as well, and its usefulness among nurses and other healthcare professionals. 

Some technology pundits question whether the Apple iPad will truly be able to run Windows-based applications from long-time rival Microsoft.   Others wonder if the iPad will fully support web-based applications.   Some healthcare applications are Windows and web-based, so that’s a valid concern.  And there are those that are thinking about how the iPad will work in doctors’ and nurses’ hands in demanding healthcare environments. 

It is my belief that the Apple iPad will handle all three scenarios very well.  Here’s why:

• Will the iPad run Windows-based applications?  That’s one of the biggest objections.  In truth, the iPad is the killer ‘thin client’ device that runs anything, including Windows.   As a thin client, it can run Citrix virtualization software, for example, that enables the device to run any version of Windows so that existing off the shelf applications can be used.  Load the iPad with the Citrix app – it goes back to a server that pushes out Windows 7, Vista, etc. 

• Will the iPad fully support some web-based applications?   –  The short answer is that it will.  Apple’s Safari web browser handles advanced web standards and is leading the way on the newest web standards like (HTML 5/CSS 3) – which means that dedicated, secure healthcare applications need to leverage the best in class available standards, and clearly the iPad is going to be able to facilitate that.  Right now Apple devices don’t run Flash, for example, an application heavily used for gaming and other presentations.  But whether or not Flash will be widely used in healthcare facilities is debatable for now.  Most professional apps are all standards-based, so no immediate access to Flash isn’t a big concern for now.  As more patients begin to use online healthcare applications to communicate with their providers, the demand for using mobile devices will only grow among healthcare providers as well.

• Can the iPad withstand a rugged healthcare environment in which it might get dropped and has to withstand cleaning every day to ward off germs?   Healthcare environments are incredibly demanding and mobile, so devices need to be sturdy and tether-free.   Hospital devices are carried around, occasionally dropped, and healthcare facilities have strict antibacterial and cleaning requirements for all devices.  Devices also need to be intuitive and not impede doctors’ and nurses’ natural workflow and processes.  The iPad is wireless, it can be recharged quickly, cleaned easily, and protected properly like any other mobile device, the iPad can withstand the rigors of the frenetic healthcare environment.  And, if someone is exceptionally rough on it or the device is broken, the good news is that it can be easily replaced within days and the new one can be put back into service without missing a beat.  

Mobile devices like iPhones and Blackberries are becoming ubiquitous and more workers will start to demand the freedom and usability these devices offer.    And with so many people already using smart phones and other mobile devices, the training curve will be low to boot. 

I think this is a situation where some people are focused on what the iPad might not be, rather than all that it is.   Healthcare professionals have long dreamed for a rugged, thin client, inexpensive and easy to maintain system that keeps them in touch with patients and healthcare operations.  The dream is now a reality with devices like the iPad.  I believe it’s a matter of another year or so before the iPad reaches widespread use in healthcare environments.

I read any story on healthcare reform with interest because the complexities and cost of reform will be significant.  One hopes that the benefits will be significant too, but that remains to be seen as reform is implemented.  I am also firmly convinced that technology will continue to change and improve the quality of care, while reducing the cost of care.  This combination is desperately needed, and integration will help us better manage change.

As mentioned in a recent Healthcare IT News article, “three forces are driving the transformation of the healthcare industry: regulatory reform is changing the industry structure, technology is creating a revolution in healthcare delivery and personalized medicine is disrupting the practice of medicine.”

Data is at the center of all of this change.  Reform will cause the healthcare industry to view patient data differently, and will require new connections that haven’t occurred in the past.  New, innovative connections between patient and doctor, and provider and insurer are already happening.  Where there are data and connections – there needs to be better integration.  Integration technology works behind the scenes and is critical to “make stuff happen” and to enable people or communities to connect with one another. 

These three transformational forces have caused healthcare providers to become even more concerned with coordinating and synchronizing results for their patients, for staffs and partners.  If everyone has one comprehensive view of patient data, for example, better care happens naturally with better communication and connectivity.  Mistakes are reduced, redundant tests are no longer needed, and entries of information go away.  In short, everyone’s on the same page.  I argue that this coordinated view is possible with better integration, and that integration doesn’t have to be difficult.  Incremental approaches to comprehensive integration can happen today. 

Integration provides connections between various disparate systems and applications to provide this single view of data.  Today, integration isn’t just about tracking and reporting on past events.  Real-time integration is about routing data based on the content of the data, applying rules to the data, causing things to happen based on the flow and content of information and how others react to the data.  On top of this dynamic mix of data and rules is a real-time view of data and the impact that data is having or showing on the enterprise.  Do I have enough inventory, staff, and information to make the right decisions?  If not, where do I go to get the information I need?    This one view of data helps organizations improve care, lower risk and increase revenue. 

The time to revisit integration is now.  Connected and synchronized healthcare data combined with the ability to manage it in real-time, will help healthcare organizations face reform, connect new technologies to old, and handle the future of healthcare, whether care happens in a hospital, clinic or at home. 

Technology has always made the seemingly impossible possible, and integration technology is no different.  In fact, while it’s addressing the “impossible,” integration technology also protects the investments you’ve already made and helps you adapt to reform and other mandates.  Integration technology is back in the limelight as the critical application to pull it all together, and the healthcare industry only stands to benefit from better integration.

With today being tax day in the U.S., many of us are focused on what we have paid in taxes, and what we get for our contributions. As our budget balloons to levels that some in both the White House and the Congressional Budget Office call unsustainable, many are thinking about how the country can lower healthcare costs (and therefore lower our collective tax burden). The question is how do we work to control the expansion of the U.S. budget while keeping a high level of care for patients? One answer is telemedicine.

Telemedicine offers a way for patients to use today’s technology to communicate with their doctors. Existing telemedicine communication tools include simple interfaces like phone, e-mail and fax. Newer tools include self-service healthcare websites and live video conferencing such as Skype or Google Wave. Telemedicine also includes home health, web-based medical decision support to self-diagnose, online PDR (physician desk reference), and direct interaction with remote medical resources via electronic collaboration tools. Armed with this technology and better information, patients take a more active role in their health. Care effectively shifts from a passive to a more proactive healthcare model.

Don’t forget that telemedicine isn’t about the technology, however. Technology is the enabling tool that allows patients to play a more active part in their healthcare. Telemedicine moves some patient care from traditional settings such as hospitals and clinics to that of the patient’s own home or location, saving us time and trips to the doctor. Today we are already using telemedicine tools such as phone, fax and email. But new more interactive self-service tools are being created all the time to help patients communicate with their healthcare providers easily and quickly, making us better informed and more in charge of our healthcare. Doctors use telemedicine to have access to the latest medical information available, and use aggregated data and baselines of care from a large collective of patients with the same health issue. This gives our doctors better information so they can provide us with the best care plans.

As access to telemedicine tools becomes more ubiquitous, patients will be able to communicate with their doctors on their iPhones, for example, no matter where either party may be located. In essence, telemedicine represents a patient revolution. It is on the path to becoming the leading way patients communicate with their doctors and doctors communicate with other healthcare providers to provide us with better care. Telemedicine holds promise for producing huge time and cost savings and improving care and outcome for patients. We can all benefit in the adoption of telemedicine, by the reduction in costs (which should help control the overall healthcare budget).

While telemedicine helps make patient care more convenient, effective and inexpensive, it cannot cure how we feel about paying taxes, unfortunately. But we can take solace in the fact that as telemedicine is adopted and becomes more common, it will help reduce healthcare costs, which should help reduce taxes for everyone.

Florida joins the rest of the nation in dealing with an epidemic of abuse of prescription narcotics and other controlled substances.  The issue is that although the abuse is illegal, these drugs are being acquired through legal means, unfortunately (written prescriptions are legal – dishonest people are providing them to others illegally).  Many stories exist that give examples of how ‘pill mills’ are nothing more than legalized drug dealing, and the widespread abuse of these drugs can devastate individual families and the community as a whole.  Though long overdue, recent legislation in Florida attempts to crack down on pill mills.  But there is the issue of lack of funding and enforcement.

The ‘fix’ to stop people from getting their ‘fix’
So, how can Florida and other states fight the pill mills for a small cost with a big benefit? It’s simple.  The state can require all controlled substances to be issued only via electronic prescription (e-Rx) through the SureScripts network, even for transactions not requiring insurance benefit checks.  When honest doctors and pharmacists have the ability to see and check controlled substance scripts against other scripts, abuse can be identified and reported immediately.  Plus these doctors and pharmacists have the added benefit of quickly checking drug interactions and drug allergy checks for their patients’ safety.

The state benefits too, because once e-prescriptions are mandated, Florida can partner with SureScripts to provide the overall patient-narcotic database that it currently does not have the funding to build.

Issues
There are some roadblocks that must be resolved, but they are worth a discussion.  First, this will not happen without cost.  Providers will have to purchase an e-prescribe software solution, but incentives already exist from the federal government to help offset those costs.   And second, the rule to allow electronic prescription of controlled substances must be adopted, which should happen soon.  If you can believe it, until now, paper-based controls and processes were considered more secure than electronic means.

More than ‘just say no’
There are huge benefits to e-prescriptions.  Most importantly, legitimate providers will give better, safer care to their patients.  And fewer illegal prescriptions are a good thing for any community.  First things first, however.  Support and momentum need to build for controlled substances to be transmitted securely via e-prescribe.  I have lots of reasons to support e-prescribing in my business, but in this instance, public health and safety is the most important one.  For me, e-prescribing has been a long time coming, and I fully support this initiative — kill the pill mills and have a few side benefits to boot.