Thursday, April 1, 2010

Geeking Out Over the iPad Revolution!

So, I didn't pre-order an iPad. I won't be standing in line in Augusta to get one. I do, however, agree with the camp that see this new offering from Apple as a whole new way of looking at HIS in medicine and more specifically, Primary Care.

As a family doc, there's nothing more precious than time (see my post on First-Order Retrievability below). With the advent of the Cellular Age and the movement of our business society first to Palm's original Pilot device, then to the "Crackberry" and now the Android and iPhone platforms, the speed at which we conduct business, and everyday life as an extension, became astronomically high. Gone are the days of the answering service/machine and the "While you were out..." pink memo pads. If we desire, we can be connected to anyone and everyone, nearly 24/7.

There's also something to be said for "always on" social media, like text messages, blogs, Facebook and Twitter. These services, though not secure, can be used to transmit small packets of information to and from multiple sources very efficiently.

That trend hasn't caught on widely in medicine, though there are a growing number of physicians that are recognizing the power of continuous access and "multimedia medicine" and applying it to the "Cellular Generation." Por ejemplo, there exist a burgeoning number of physicians who are now offering e-mail as an alternative in addition to phone triage. A simple, rapid way to present the signs and symptoms of illness obvious to the patient and allow the physician to assess the need for an E.R. visit versus a clinic visit at your leisure. Beyond being two-way asynchronous communication, it's also readily available thanks to our smartphones and PDAs.

Some physicians even go so far as to "see" patients, and more commonly consults from other physicians, by video chat! A novel idea, but with the increase in broadband service, an idea whose time has finally come. Video allows physicians to visualize the patient (potentially in 3-D) and speak in real-time. Still images can also be used for rapid triage, if the clarity and pixel densities are high enough. Audio of a child's cough could even be used to triage "croup" vs a run-of-the-mill viral upper respiratory infection. Microsoft even markets a still camera that records everything you do, all day long...

Add to that the decreasing price for storage, and what emerges is something that some may dream of and others fear. A medical record that contains all of the above (video, audio, stills), as well as audiovisual representations of the entire office visit. Why not? We spend hours a day (especially in primary care) "charting" as we call it. Writing out descriptions that often inadequately represent the symptoms and physical signs they represent. Don't get me started on eponyms. Instead, this new record could be a more complete, more accurate representation of a patient's medical history. Something that would be infinitely more useful for future generations of physicians than a handful of old paper that may or may not have accurate descriptors, often colored by perception.

All that to say, the iPad makes this more convenient. While this generation of the device has no camera, you can bet your Aunt Fanny the next one will. It does have a mic and the ability to view video. You can pull up streaming video from any webcam using multiple services and you can utilize any of the above social networking tools as well. I've even toyed with the idea of a text message server that could take messages from linked cell phones and deposit them directly into an EMR record for that patient. Near real-time monitoring of a patient's data like blood pressure or glucose. This would be easily accessed on the iPad.

Moreover, as a 6-year owner/user of tablet computers, this form factor isn't as bad as many of the technorati make it out to be. We are tactile creatures by nature and the user interface of the iPhone is popular for a reason. To be able to use nothing more than a finger to make selections is very familiar to even a one year old.

Without having an iPad on hand, I can't vouch for the completeness of these claims, but if the reviews hitting last night and today are any indication, we may just be entering that "brave new world."

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