How might the iPad change healthcare?

Mainly conceived as tools to support the consumption rather than the production of information, wireless ‘media tablets’ such as Apple's iPad provide a delivery and visualization medium for stored and online documents, images and video, as well as a portal to a vast array of downloadable ‘Apps’ serving a variety of purposes. They share characteristics with both mobile phones and laptop computers, but typically offer a larger and more intuitive interface than the former whilst being more portable and simpler to operate than the latter. Although e-health applications are not unique to wireless media tablets, there are unique reasons why they may be well placed to facilitate e-health. On a general level, these are technologies, which have attained almost unprecedented levels of diffusion and adoption since the iPad was launched in early 2010 (around 18 million units by the end of that year alone, Figure 1A). Apps are being developed to suit a range of operating systems, notably Apple's iOS, Google's Android and Blackberry's QNX.1–4 The controlled ecosystem that prevents non-authorized code to be run on the platform and the greater availability of controlled Apps for the iPad seems to secure Apple's dominant position for at least the next two years, although other providers are gaining market share (Figure 1B). The Apple Store so far contains around nine thousand examples of software in the ‘medicine’ category and fifteen thousands in the ‘wellness’ category.5 The ‘appidemiology’ of this market suggests that health maintenance is of interest to more users than illness management, arguably reflecting both the needs of an affluent user demographic and a more widespread desire for eHealth applications that support healthy lifestyles and wellbeing, although, as yet, it remains a luxury accessory, rather than a core technology.6,7 (Figure 2) Figure 1A Media tablet market forecasts: number of devices sold. (Source: adapted from Gartner: http://www.gartner.com/it/page.jsp?id=1626414) Figure 1B Media tablet market forecasts: market share. (Source: adapted from Gartner: http://www.gartner.com/it/page.jsp?id=1626414) Figure 2 iPad App for diagnosis of skin diseases. (Source: http://www.knowabouthealth.com/ipad-version-of-visualdx-mobile-app-released/5538/) Whereas the potential of iPads for supporting clinicians has been clear from an early stage,8–10 their use by consumers for health purposes was anticipated to a lesser degree and warrants further exploration. As such technologies become mainstream, we may soon face a situation in which patients and their physicians have the same mobile personal computing device, offering access to the same sets of information and tools for healthcare decision-making and leading to a more horizontal alignment of knowledge between the two. Greater synchronization across personal computing and media devices (e.g. iPad, iPhone, iPod, Apple TV) will increasingly enable users to interact with their eHealth applications in a flexible way and as part of a holistic ‘ecosystem’ for self-management that includes financial transactions, entertainment, gaming, social networking and video telephony. This also offers a cost-effective alternative to bespoke hardware devices for health; for example the iPad includes an option to connect biomonitoring devices via USB. (Figure 3) In addition, the emergence of Cloud Computing presents future opportunities for these devices to act as mobile platforms for personal information management and virtual desktop computing, whilst avoiding the need for mobile storage of software or data.11 Figure 3 A blood pressure monitoring device now available for the iPad. (Source: http://www.ihealth99.com/) We now offer a few examples in order to illustrate the various ways in which such technologies may support different actors in healthcare and to give a pointer to possible future scenarios. Table 1 describes a selection of medical Apps that have attracted particular attention in recent months. However it is important to note that there is, as yet, no consensus on methods for classifying the quality of medical Apps and sources claiming to highlight the ‘best’ medical Apps are largely based on popularity (numbers of downloads) and anecdotal user reviews, rather than formal evaluation of usability, utility or applicability.12 Table 1 Selection of medical Apps that have attracted particular attention in recent months.