Libraries Loaning iPads

This morning I posted on the article, “Don’t have an iPad, go to the medical library and borrow one.”  There are lots of medical libraries loaning iPads out to their patrons and this post was a way to highlight to physicians some of the ways libraries are helping them get connected using iPads.

In my research I discovered that there are A LOT of medical libraries doing this, too many to list in the actual article.  So in order to have a more comprehensive list of libraries loaning iPads I thought it would be a good idea to create a comprehensive list of libraries who loan them and post it on the iMedicalApps forum. So if you library loans iPads, list it on the forum with your basic rules and some of the popular apps loaded. Remember keep it short and sweet with not to much library geek jargon, we want it to be easy for docs and medical professionals to scan through and look at it.

Interested in the geeky library details?  Don’t worry, I will posting in the next few days the librarian version of the iMedicalApps article.  This will have the information that librarians interested in starting their own iPad loaning project will want to know about.


Webcast: Leveraging Mobile Technologies for Health Sciences Libraries

Interested in learning more about how mobile technologies can be used in the medical library? If so, register for the Medical Library Association (MLA) continuing education webcast Leveraging Mobile Technologies for Health Sciences Libraries on Wednesday, April 18, 2012 1:00-2:30 (central time)

More information about the webcast (from

Program Goals:
The goal of this webcast is to familiarize information professionals with current practical applications of mobile technologies in clinical and curricular support settings.  Topics will highlight innovative uses of mobile technologies, address technology challenges, and provide best practice guidance for applying in viewers local environments.  

Program Objectives

  • Define how mobile technologies can be used in clinical settings
  • Define how mobile technologies can be integrated into curricula
  • Identify challenges faced when using mobile technologies in different settings
  • Explain challenges faced in clinical and curricular settings that mobile technologies can help solve
  • Demonstrate how mobile technologies can be used in your own setting
  • Plan how to work with vendors and IT support to enable use of mobile technologies
  • Identify opportunities for library resources via mobile technologies in multiple settings
  • Compare different mobile technologies and choose which might be appropriate for your own setting

Go to the MLA Webcast site to learn more about presenters Colleen Cuddy, Heather Holmes, Molly Knapp, Kimberley Barker, and Alisha Miles.

There are two ways to register for this webcast, individual or site.  Individual Earlybird Registration Fee: $75 (nonmember, $150.00).  Earlybird Site Registration is $395 (nonmember $495). 

Keep your eyes and ears open for sites near you that have registered for the program. 

For example:

For more information about the webinar or to register go to:



Upgrading iPads

I read an interesting article on the Cult of Mac the other day about upgrading from the iPad2 to the iPad3.  The short answer is don’t bother.  When the new iPad came out some people were disappointed that there wasn’t as big of a technology jump from the iPad2 to the iPad3.  Similar to when the iPhone4S was released, people claimed the iPad3 was a failure for Apple because it didn’t make the iPad2 obsolete.

What I found interesting about  this article is the author, Buster Heine, compares the iPad to the laptop and computer industry. 

“People wishing for product obsolescence with every new iPad are being naive. This isn’t the way technology works, and it would piss people off if it was. We would be outraged if our brand new $1200 iMacs were rendered obsolete within a year by a newer model, yet for some reason many people seem disappointed that Apple hasn’t enacted planned obsolescence for the iPad.”

People  tend to upgrade their phones about every 21 months, but Heines says that most people purchase a main computer and use it for 2-4 years or longer.  According to Heine, the iPad is “leading the charge into the Post-PC Revolution,” and will one day replace your desktop.  The iPad is not a big iPhone it is more of a portable Mac. Therefore, he reasons iPad buying habits should be more reflective of computer buying habits not cellphone buying habits. 

Over the years the Mac has changed relatively little from year to year, but over multiple years the difference between an 2007 Mac and 2012 Mac is noticable.  Heine speculates the iPad will show the same type incremental growth as the Mac.  “The new iPad is only marginally better than the iPad2, just like last year’s iMacs were marginally better than the year before. You shouldn’t feel the need to upgrade, and you never should need to upgrade your iPad every year. The iPad has been magical the entire time, and the iPad you own will continue to stay relevant for 2-3 years. That’s the way it should be.”


I never really thought of it that way, but it makes sense.

Turning Online Books on Their Ear

If books had ears then Inkling, a company that makes textbooks interactive for the iPad, would be turning them on their ear.  Currently most of us are familiar with ebooks through AccessMedicine, MDConsult, StatRef, and even Unbound Medicine.  These types of ebooks tend to be a little bit more than the book in a readable (often PDF) style that can be easily read online.  Sometimes there are more graphics, links to online resources, movies or sound files that are embedded in the text, but they pretty much still function like the text. 

Recently iMedicalApps posted about Inkling’s webinar on their ebooks. I have included the Inkline webinar in this blog post, please note you may have to watch it at home like I did if your hospital blocks Vimeo.  

 Inkling Medical Webinar from Inkling on Vimeo.

The webinar goes into a rather long history of how traditional textbooks are boring, printed, linear, and not interactive.  But hey that was the best technology we had at the time…I can only imaging the conversations when we moved from scrolls to books. I found the most interesting parts to be the demo of Inkling books.  They looked at Harrison’s and Netter’s and showed the difference between their books and regular online books.  Some of the difference are the ability to take and share notes with others globally, removing labels for medical images, and linking to multimedia.  My explanation is not doing it justice so it is best if you watch the webinar.  Librarian, Nadine Dexter, also discussed how her institution is using Inkling books for the new medical school. 

Inkling books are available for individual sale as well as institutional sales.  They also will sell just the chapters to books.  So if your medical school curriculum only needs students to read a couple of chapters within a book, they (or the institution) only have to buy those chapters which is cheaper than the entire book.  They already have relationships with McGraw Hill, Wolters Kluwer, Elsevier, etc. so it isn’t like iBooks where we are waiting for something medical to happen.

The webinar is only 30 minutes and they did a good job of answering the questions people had but  it was directed to a lot of different health care people (not just librarians), so some questions that librarians often think about weren’t asked or answered during that time.  Some of the questions that I thought of while watching the webinar were about perpetual access, licensing, how does it work with Blackboard and other course management systems.  If a library bought a book what is the best way for them to distribute it their institutional employees.   In terms of library purchases, is it something that is “check-out-able” and is unavailable while somebody is using it (similar to public library Kindle books) or can any number of institutional users use it at any time? 

I have been saving up to purchase an iPad 3 when they come out and I am looking forward to testing all sorts of online books (Inkling included) to see how they measure up.  I am just glad I found this webinar because it looks like Inkling is nice addition to the already small field of medical ebooks and even small field of those willing to work with institutions.

How Do Librarians Use iPads

This week (and part of next) I am in jury duty.  Thankfully the jury pool room has free wifi so I have been able to keep up with the online world a bit (If my laptop battery lasts, there are precious few electrical outlets). 

This morning I received an email from another librarian asking me how I use an iPad as a librarian.  Well, I don’t have an iPad.  I am saving up for one when the iPad 3 comes out.  So a lot of the ways I would use an iPad are still just guesses for me. 

So I posted the question on the iMedicalApps forum, “How Do Librarians Use iPads.”  My hope is that librarians with iPads will answer how they use their iPad in the job and how it is a better tool or solves a need that previous tools (laptops, desktops, smartphones, etc.) didn’t.

Hospitals Slow on Tablet Implementation

I saw this article, “Hospitals slow on tablet implementation,” last week and posted it right away on my Facebook account with the intention of blogging about it the next day.  Sigh… that was before round two (or is it three now) of sick kids. 

Several things flitted through my mind when I first read the title:

  • Wow, Apple’s Tim Cook was a little off on his estimate that 80% of top hospitals were testing the iPad.
  • Ok, looks like my hospital and I are not in the minority as it sometimes felt.
  • Yep, same ol’ same ol’. By the time we adopt the new technology it is out of date

But after those thoughts and others left I began to wonder what is the real hold up. It can’t be that 99% of all hospitals have the same draconian IT policies. (Although my conspiracy theory friends might disagree.) Why does it seem that U.S. hospital have such wonderful advance cutting edge technologies for diagnosing and treating diseases, but when it comes to computer infrastructure, hospitals cannot keep up with technology. 

So I began to look around the web to find out if anybody commented on Sarah Jackson’s post at Fierce Mobile Healthcare as to why so few hospital have done fully functional tablet systems.

Both Jenny Gold of Kaiser Health News and iMedicalApps approach the problem from the app side of things.  Gold’s article blames the EMR companies that often don’t have apps for their software, thereby forcing hospitals to use third party apps like Citrix or VMware which can be clunky and slow.  Satish Misra at iMedicalApps points out that even apps created by EMR companies like Epic, Centricity, and Allscripts require make their EMR apps read only making it a necessity for doctors to log on to a separate computer to make notes in the chart.  To add to the “fun” many of these EMR companies like Epic and Allscripts require separate licensing for their mobile platforms.  (Hmm that little caveat sounds familiar to librarians.)  So what you have is all these hospitals who have spend LOTS of time and money getting themselves and EMR product and now enters a game changing product that was never envisioned 5 years ago when many hospitals were well into their EMR planning and implementation. 

While EMR integration is important there are many doctors who are using the iPad without that ability.  They are using them in the exam room, ER, Surgery, and especially in radiology.  According to Robert McMillan of Wired, Apple has a secret plan to steal your doctor’s heart.  His name is Afshad Mistri.  (Although I am not sure how secret he can be when Wired does a big article on him and he is organizing invitation only conferences for medical professionals.)  His goal (and Apple’s) is to get the iPad in the hands doctors.  McMillan reports that it was Mistri who launched the special iTunes room for healthcare in September, and promoted it to a select group of healthcare app developers.  Apple has to be careful promoting the iPad in hospitals.  Step too far one way and the FDA will want to regulate it as a medical device, but don’t step at all and you don’t get it in the hands of doctors.   The Wired article is a very interesting read and highly recommend it because it does a good job of illustrating just how Apple, a consumer oriented company not a company usually interested in businesses, is delicately trying to work its way into healthcare, specifically hospitals. 

As much as Apple has secret fingers in the pie, trying to hook docs to the iPad, don’t forget that there are still signal issues within most hospitals.  This is a big barrier to implementation.  You can have all the best apps and EMR integration but if you are in a deadzone, you have an expensive brick.  Ravi Nerella posted in the iMedicalApps forum, “We had issues with reception throughout our hospital (the ED was a dead zone) until one of the major cellphone carriers was allowed to place a tower or repeater (whatever it is they needed) and now we have great reception (for the specific carrier only of course) that also forced us to go with the specific carrier to provide us service.” 

Just from a quick look through the Internet it seems that there is a host of reasons why 99% of the hospitals don’t have fully functional tablet systems. But from my perspective it seems to basically comes down to money (doesn’t everything).  It takes some serious cash to license the app (3rd party or from the EMR company), some apps aren’t even fully functional so you aren’t saving on hardware costs by chucking the PCs.   It also costs a lot of money to support the product and write hospital specific apps.  Additionally they have to spend money on the infrastructure, making dead zones viable.  If something wasn’t put in the budget and it is that costly to implement, it is going to take quite a while (years maybe?) to implement.  The iPad is less than 2 years old.  It wasn’t even a glimmer in budget lines back then.   The speed of personal day to day technology has outpaced hospital budget planning processes.  Quite simply, hospitals are giant cruise ships that can’t turn on a dime when the iceberg of new technology comes into sight.  Let’s just hope most hospitals are not the Titanic.

iPads in the Hospital

Yesterday we all thought the new iPhone 5 was supposed to debut, but Apple had other plans and decided to release the iPhone 4S.  As with almost all of Apple’s announcements people were all a buzz and were bummed when there was no iPhone 5.  As a result Apple’s stocks slipped a bit due to our high expectations for an iPhone 5. 

During the announcement Tim Cook made a statement that caused my ears to perk up and completely directed my attention away from the iPhone.  Cook said, “Over 80 percent of the top hospitals in the US are now testing or piloting iPad.”  Wow! That is a lot of hospitals using or soon to be using iPads. 

While Android still is the dominant phone (43% of the market vs. Apple’s 28%), Apple is the dominant tablet device with 74% of the tablet shipments.  What does this mean for hospitals that are not looking at iPads?  If the vast majority of institutions are going to be using iPads then I would assume the vast majority of medical programs will be developed for the iPad first, leaving other tablet devices for later (if at all). 

Perhaps Cook’s statement was hype or overexaggerated.  I have seen no independent verification of the statistic.  But if you look at the fact that Yale is providing iPads to medical students, Harvard is creating apps for medical students to use on both iOS and Android, and the Mayo Clinic doctors use the iPad to access patient information, dictate notes, etc., it is clear top medical schools and hospitals are definitely using the devices.  So, you’ve got to wonder if those not considering the device are doing themselves an IT disservice. 

I would love to have an iPad. I get more and more questions about apps and other medical resources from doctors who use their own iPad without insitutional support (they can’t use it to get on the Intranet to access resources).  I help them the best that I can.  Right now I am not buying my own iPad because I have no clear direction as to what device (if any) my insitution will support.  Since they don’t support Outlook for iPhone or Android, I am not holding my breath for the iPad.

Apple Makes Finding Medical Apps for Professional A Little Easier

According mobihealthnews, Apple quietly launched a new section on the AppStore directed just towards healthcare professionals.  The section which was referred to as an “iTunes Room for Healthcare,” has apps for both the iPhone and iPad intended specifically for healthcare professionals. (There appears to be about a dozen apps that are also for consumer use.) 

Not only will this section be dedicated to apps for healthcare professionals but it will also internal categorization as well.  There are six categories for the medical apps: reference, educational, EMR and patient monitoring, imaging, point of care, and personal care (for consumers).  Mobihealthnews thinks that the “personal care” apps may have been included “as a means to help care providers recommend popular health apps to their patients.” 

Finally!!!!!  That medical/health section had a lot of junk apps that people had to sift through to find good stuff, it is nice to see this professional section come about. My only question is how/who is adding and vetting the apps?  I hope it isn’t a free for all where app developers can just add their app if they feel like (meaning we could return to problem of chaff out numbering the wheat) but I would like it to be open enough that something that was good but accidentally left out or something newly created could be easily added.

Should Hospitals Buy iPads or Let Doctors Use Their Personal Device?

Does your hospital allow iPads or tablet devices?  How about smartphones?  Nope don’t feel too bad, a lot of hospitals (including mine) still haven’t thought of  personal devices as necessary medical devices.  The personal information device (iPad, tablets, smartphones) represent a watershed event where doctors are able to access medical information on the go.  They aren’t tied down to a computer or laptop.  It will be interesting to see how small and large hospitals deal with this watershed event.  It has been interesting to see what hospitals (well known and not so well known) have made the progressive leap and what hospitals (well known and not so well known) have not. 

There are two schools of thought (three if you count a no adoption policy).  One is the hospital buys one specific device and supports it.  The other school of thought is to allow physicians to user their personal devices.  

FierceMobileHealthcare looked at two institutions that implemented mobile device policies, one hospital bought the device and the other allowed doctors to use their own device(s).  Both institutions are trying to provide doctors with a way to use mobile technology at the bedside, but each have their own reasons for the path they chose. 

Hospital buys the device:

Dale Potter, CIO of 1,300-bed Ottawa Hospital in Ontario, Canada implemented an iPad roll out which was described by FierceMobileHealthcare as “arguably the largest roll out of hospital-owned tablets in the northern hemisphere.”

Dale’s hospital bought 2,000 iPads, has 1800 iPad 2’s on order, and may buy even more  in the year.  Dale believes hospital ownership was important and the way to go for moving his hospital forward to be “recognized as a top 10 health center in North America.”

Because the devices are hospital owned, it allows them to have control over the apps and other software on the devices.  They completely relying on the App store or outside vendors either, the hospital hired 120 developers to create apps for the institution, including a mobile electronic health record and a dozen in-house apps.  Because the devices are hospital owned and they not only can control the apps and software but they have created a remote wipe, log-ins, and other security protocols.  Even though the iPad is $600, Dale says that the costs of buying each doctor an iPad is cheaper than buying the a PC or laptop and “significantly less than other medical instruments that physicians carry with them each day.”

Doctor’s choice:

Todd Richardson, CIO with Deaconess Health System, Evansville, Ind., lets physicians use their personal devices for work.  Richardson’s primary reason for this is the devices are constantly changing making it difficult to remain current financially and logistically (constantly updating new devices with OS updates, patches, etc.).
In addition to the financial issues, management and ownership of the devices can be difficult to deal with.  Todd states that maintaining the devices, providing sync and charging stations and keeping track of them is “a hassle he just doesn’t need.”  Additionally doctors are going to load their own apps and software on the devices regardless, so if it is their person device it makes it easier. 
Deaconess allows doctors to use personal devices because they use Citrix to access the EHR via a secured wireless SSID and physicians must register their device’s MAC address.   
It is an interesting debate, which method is right lies more with the culture of the institution and what the CIO feels will work best there.  At least these CIO’s are addressing the issue. 
Now how does this relate to medical libraries?  Well we probably don’t have much say, if any,  in what direction the CIO goes with.  But once the decision is made, librarians can get on board by supporting the devices.  That means helping with the selection of apps, looking at library and information apps, helping doctors use the apps or the device itself.  There are a few doctors who have come into my library asking about certain resources for their iPad or Android.  Currently my hospital has yet to adopt a mobile device policy so much of the stuff they ask are general questions of getting on the network, how to access a medical video on YouTube (hint: turn off wifi and use 3G), how to connect to full text articles, etc.   But even if you hospital has adopted a mobile technology policy, you will still get questions (especially on ebooks, ejournals, and what databases have apps), so it is important to know what is out there. 

Doctors Using iPads Biggest Headache for Hospital IT

Last Thursday I read a short little post from iMedicalApps, Hospital IT cite Doctors using iPad for work as their biggest headache, which led me to a slightly longer post on Forbes, Doctors Love the iPad. But What’s the Prescription for Tablet Security?  Basically, the iPad and smartphones have created a paradigm shift for hospital IT departments. 

Hospital IT departments must focus on data security and until recently that was primarly related to devices owned and maintained by the insitution.  Sure there were probably doctors who rounded with their laptops but the number of those were small compared the recent explosion of doctors making rounds with iPads, smartphones, and tablets. 

“As iPads spread virally throughout the healthcare industry, IT chiefs are left wondering if these new devices will compromise the security of their organizations. After all, it introduces a fundamental shift in the way we manage-or rather, relinquish managing-the endpoint. We are entering a world with more lightweight endpoint devices and more heterogeneous operating systems, and since these devices are often owned by the employee the IT team does not have control over the software running on these devices.” 

“Relinquish managing the endpoint,” perhaps it is just me but this reminds me a bit of libraries as online databases and ebooks and ejournals become more accessible to people.  Remember a time when you had to put the phone handset into the modem to get on to Medline?  Once librarians were the keepers? or maybe a better word should be the the finders of information.  People had to come to us for information, we managed the endpoint of information for patrons.  Now that information is easier to come by online and users are finding it themselves our role has/must evolve. 

Now we don’t have to deal with patient data or network security, but hosptial IT departments are experiencing some of the same control issues with access to information that we went through.   It will be interesting to see how they evolve.  For some IT departments it will be a bigger shift than for others.  How big of a shift not only depends on the culture of the department and the hospital network. The security system must be able to deal with mobile devices but so must hosptial applications including the older ones that every hospital seems to have and rely on in some way.  As  John Smith  commented on the Forbes post, some older Windows systems don’t work with these new devices.   On his own blog, John’s post Extending the Rudder goes into more depth about the security, mobile platforms, and thin computing.   

The horse is out of the barn folks, now let’s see which hospital IT departments evolve and which ones don’t.  Technology has forced many professions to evolve, including the ones born of technology.