Apple’s Fuzzy Healthcare Number

On October 4 Apple’s CEO said: “Over 80% of the top hospitals in the US are now testing, or piloting, the iPad.” This statement is a little misleading.

Firstly, he said “testing or piloting.” What is the number of hospitals that are actually buying and deploying iPads to use with their core clinical applications? I bet that number is less than 1%.

What exactly defines a “top hospital in the US?” Are those the ones that answered Apple’s calls? I have an Apple sales executive (Rachelle, who is a super nice woman) that periodically calls on me to keep track of what we are doing. When she last called I toled her we had a pilot taking place to test connecting employee owned devices (including iPads) to our Exchange Server so our employees can get email and appointments.

That’s it, just a pilot. No roll-out. No committment. Furthermore, it is just for Exchange connectivity. Still, I presume this means that our 15 hospitals are in that 80%.

But, the picture behind Cook is two men, with lab coats and stethescopes, staring into an iPad. This might give the world the impression that 80% of the hospitals have doctors and nurses accessing electronic patient records on an iPad.

Not yet.

My organization is not going to deploy the current generation of Windows client applications on iPads, just because they are cool. When core vendors produce native iPad apps (or properly formatted web apps) that will be the right time to look at radical device changes. And don’t talk to me about Citrix. Citrix on the iPad’s relatively tiny screen is a terrible user experience and not worth the cost to make a radical change to our device support model.

Doing Something Different (Go Brewers!)

I have been writing this blog for 8+ years. This is the first time I recall going completely off topic. I want to talk about baseball. Tonight all of us in Wisconsin are celebrating the Brewers advancing to the National League Championship Series.

There was a play in the top of the 9th inning that drives me crazy. The Diamondbacks had runners at the corners with 2 outs.  The Brewers Betancourt scooped up a slow bouncer and raced to 2nd base, ariving a split second before a sliding Justin Upton.

Why does Upton slide into second base? I would argue that sliding slowed Upton down enough to allow him to be forced out. What if instead, he were to run through 2nd base to avoid the force? Sure he would be tagged out before he could reach 3rd base. But the runner at third would have already crossed the plate before he could be tagged. I am gad that didn’t happen because that run would have likely eliminated the Brewers.

If a runner is forced out for the final out another runner crossing the plate will not score, even if the runner crosses home before the force out. If the runner is tagged out after reaching the base, then it becomes a matter of what happened first – the final out or the runner touching home plate. Because the runner at third usually has a bigger lead, they typically can cross home plate at the same time the force out occurs. Even if Upton were immediately tagged after running through second, the Diamondabacks would have scored the winning run.

Maybe someone will post a comment telling me why I am wrong. Maybe there is a rule that requires the runner to slide. But I think Upton slid because, for over 100 years, every player in the same situation has slid.

Is there something in your IT operation that you do because it has always been done that way? Is there a simple but unconventional change that you can make to get a better results?

Maybe this post wasn’t off topic after all.

The short list of great American inventors

Alexander Graham Bell (March 3, 1847 – August 2, 1922)
Thomas Alva Edison (February 11, 1847 – October 18, 1931)
Henry Ford (July 30, 1863 – April 7, 1947)
Steven Jobs (February 24, 1955 – October 5, 2011)

These people radically changed the lives of every American alive in their lifetime. It was awesome for me.

SaaS and the Enterprise

I hate desktop software. Every new application is a potential conflict with mission critical software. Then you have the effort of installing and updating. It is a terrible model for the enterprise. Wherever possible I am looking for Software as a Service (SaaS) option.

Adobe has a potentially great service in their CreatePDF SaaS offering (once they add the ability to manipuate PDFs online). The need to create and manipulate PDFs is wide-spread in my organization, but I don’t want to take on the burden of installing Acrobat or some similar app on hundreds of desktops.

Unfortunately Adobe is rolling CreatePDF as a consumer offering. A separate credit card for each use is not a model that works for the enterprise. People like me would be lining up for this service if there were a front-end where our Provisioning team could easily add and remove users and we could receive a quarterly invoice based on the number of users.

I think Adobe is missing the boat. DropBox is another cool app that does not have an enterprise model ( seems like a good enterprise alternative).

Bring Your Own Device in Healthcare?

The NY Times has a good article on the increasing popularity of Bring Your Own Device (BYOD) policies. This is appealing to many employees, and interesting to me. I want to further empower our tech savvy employees. But, I don’t think it won’t work in our environment at this time.

It is probably no mistake that the company cited in the article is Citrix Systems. I am sure that they have had a corporate IT purchasing policy for years that restricted purchased applications to those that work well in their Citrix environment. I think an environment where are applications are served via Citrix is a key requirement for a BYOD policy. All that is required is the IT to make sure that the Citrix client is running on the employee’s device. This leads me to…

Reason #1 that BYOD doesn’t work in a typical healthcare environment: Most applications don’t run well on a Citrix.

At Ministry Health Care and Affinity Health System we have literally hundreds of apps that we cannot deliver on Citrix. In fact so many, that we don’t try to deliver apps via thin client technologies unless there is a specific need to do so. Because most of our client applications run locally on the employee’s PC, we need to tightly control that environment to avoid conflicts and other things that keep people from doing their job.

It is probably reasonable to assume that the employees at Citrix Systems are more technologically savvy than the average employee base. Consequently the IT department at Citrix Systems doesn’t have to worry about the devices being in a usable state. That is not the case for our employee base, while we have many IT savvy employees many others, especially our caregivers, spend more time thinking patient care than computers. Many need a lot of help with basic PC support.

Reason #2 that BYOD doesn’t work in a typical healthcare environment: Many of our users require a lot of support from IT just to make sure their computers are in a working condition. IT cannot efficiently support hundreds of different device models.

I have seen it all, from browsers with a dozen installed toolbars to deleted system files. I would love to allow users to install their own software and customize their computers, but history has proven that there are far too many disruptions to the work environment when a liberal desktop management approach is used.

The story also quotes that Citrix Systems has reduced its device cost by 20%. But I am sure that doesn’t include the multi-year investment in Citrix software and servers required to deliver the applications to the desktops. That is hundreds of thousands of dollars and a significant new support requirement for organizations like ours.

In the future we might be able to offer such a policy to a certain group of users (managers and analysts). But there would be a lot of work in developing a plan to move that model and right now there this does not arise to the level of the most strategically important issue for Ministry to tackle. Needs like improved clinical information systems come first.