X-rays and iPads: The network healthcare evolution

At the rate technology has changed everything else in our lives, by now we should have the equivalent of tricorders in our smartphones—instant access to our health statistics collected by sensors in our clothes and pulled into our individual health history in the cloud. We should be able to Skype our physician, text our pharmacist, and get both a blood sugar measurement and an MRI at Starbucks while waiting for a grande latte.

Except for the MRI part, all of that is doable today. Thanks to the big stick provided by the Affordable Care Act in the US, some healthcare organizations are pushing more aggressive use of network bandwidth and cloud technology:

Monitoring patients’ health more proactively with networked devices, ranging from wirelessly networked medicine bottle lids to worn or embedded sensors that report back on vital signs;Coordinating care with the help of analytic tools in the cloud and a wealth of individual and collective patient data; andConnecting physicians directly with patients over PCs or mobile devices for between-appointment follow-ups.

 

Those things can’t be pulled off without cloud technology, whether it’s hosted internally in a health organization’s data center or elsewhere. But ask any random sampling of physicians, technologists, and health industry observers. They’ll tell you technology isn't restraining the next big paradigm shift in health care. The bandwidth is willing.

“It’s less about the technology holding the industry back, and more about the reimbursement model for healthcare,” says Kenneth Kleinberg, senior director of research and insights at The Advisory Board Company, a global healthcare research, technology, and consulting firm. “Quality hasn't been rewarded, physicians don’t have incentives to share data, and patients are freaked out about privacy. Healthcare isn't a system—it’s a bunch of individual entities looking out for themselves. Just adding more bandwidth to a broken system doesn't work.”

Real technological change in health care requires changing the “work culture” of health organizations and people’s confidence in health IT systems, says Harry Kim, senior director of Hewlett-Packard’s healthcare group. But other complex (and heavily regulated) businesses have embraced change long ago. Citing ATMs, Kim says, “If we can trust our money to a machine, we can do it with healthcare.”

That’s why health organizations are looking outside of their industry for inspiration. “The companies bringing the biggest changes to medicine today are companies like Cisco, EMC, Apple, and Microsoft,” says Dr. Elliot Fishman, Director of Diagnostic Imaging and Body CT at Johns Hopkins Medical Center. Technology from the consumer sector (such as mobile devices and apps, cloud computing, and even gaming) is seeping into the healthcare field and being seized upon by care providers to improve the connection between physician, patient, and data.

To get an idea of how bandwidth can change medicine, we talked to people on the front lines of medical technology at two of the most well-known hospital systems in the US: Johns Hopkins and the University of Maryland Medical Center. We also caught up with technology and digital health service providers. What we got was a snapshot of organizations that are already working to transform medical care with networked technology, while trying to overcome organizational inertia to make it happen.

The first wave of change that healthcare organizations have dealt with (or are still dealing with) is what Kim calls the “digitization of sick care.” Nearly 80 percent of healthcare is dealing with chronic illness. To improve care for patients with chronic health problems, health providers need to be able to effectively monitor and capture the right data from them, pull it back into electronic medical records, and make it available to both patients and physicians to act upon.

The problem is that many health record systems weren't built to handle those tasks. Healthcare systems have had electronic health records for decades; the problem is the systems lack standardization. These carry with them the sorts of software and schema hangovers that plague every data integration project.

“At Hopkins, it started a long time ago with a longitudinal patient record that pulled in from all our systems,” says Stephanie L. Reel, Vice Provost of Johns Hopkins University, Vice President of Information Services at Johns Hopkins Medicine, and CIO for both the university and hospital. The system acts as a repository for information from all of the hospital systems’ various health systems.

“But in spite of the fact that I think we've done a good job over the last 25 years, we've now realized we didn't,” Reel says. The effort required to get all of the data normalized from each of the systems was “too expensive, cumbersome, and not always possible.”

So Hopkins is replacing its homegrown system with one from Epic, a hosted system with a single, patient-centric database. Reel says that when it’s implemented, the system will “give each patient control over his or her own records.” Patients finally gain complete access. Since it’s a single integrated system, all of an individual's data is there for each caregiver—their allergies, test results, medications, etc. Epic's portal can even be accessed through mobile apps for Apple iOS and Android devices.
Epic's Canto electronic medical record app for iPad.

 

But on top of that, the data will also be used to mine information on how well different courses of care worked for patients. This should help tailor care based on patients' own conditions and the outcomes of people with similar cases. “You can look at a population base that has benefited from treatment,” Reel said. “We can learn from our own cases, but also if done appropriately, can learn from interventions elsewhere. This gives us the opportunity to do personalized medicine—based on previous cases, we can be able to predict when patient will benefit from one type of intervention or another—or, from their genetic makeup, might be able to decide if treatment won’t help.”

Physicians aren’t waiting for their central IT departments to achieve the nirvana of centralized healthcare data. They’re finding their own ways to get access to the information they need, when they need it—pushing health providers to build Web portals and other applications that give them access to medical records anywhere. One of the most visible signs of change is the adoption of the iPad and other mobile devices by physicians.

Thanks to more reliable and more widely available wireless bandwidth, the iPad has become an essential tool for clinicians. Last October, the Department of Veterans Affairs moved to open up its network so that doctors could use their own mobile devices. While other health systems have been slow to officially adopt the iPad and other devices, John Kornak, Director of Telehealth at the University of Maryland Medical Center says, “A BYOD (bring your own device) mentality is starting to take shape among physicians, and more mobile apps are starting to find their way into use.”

Kornak says that there is a strong push from doctors to find mobile apps that make it easier and more seamless for them to connect to health data such as charts and radiology images. “Physicians are telling us if we don’t have [the apps they need], we need to have a development partner and build it ourselves. They're really urging us to not focus on what the standards are—we need to be open to any devices on market, and keep them in mind when building solutions.”

One of the most obvious applications for the high-resolution screen of the latest iPad is displaying medical imagery. By pulling up images from CT scans and MRI scans on their iPads, Hopkins’ Dr. Fishman says surgeons now use the iPad to explain procedures to patients more effectively. “Doctors can look at their cases in real time. Now my clinicians are looking at the information I generate as it’s created. They can pull down CT slices in 2 seconds. It’s very fast and interactive. They can bring the image to the bedside or in the office.”

That mobility and ease of access pays off in another way: time. “When you speak to surgeons at Hopkins,” says Fishman, “they say that they save about an hour of time each day from using the iPad. And that’s a big deal—instead of going home when their kids are asleep, they get home when their kids are awake.” Fishman says he’s been at the beach and on airplanes and has been able to look at radiology images for consults.
That power doesn’t just come from the digitization of raw information, though. It only works, Fishman says, when the networking piece becomes transparent. “The end-user experience has to be that it just happens," he says, "not typing 20 codes in for access and hoping that it works.”

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Prototype iPad with 2 dock connectors sells for $10,200

If you walk into an Apple Store today someone will happily sell you a third-generation iPad, or even an iPad 2 if they happen to have some left in stock. But the first-generation iPad is dead and buried. There really is no reason to desire one unless you happen to be a developer who wants to test on the old/original hardware.

So why has someone just paid $10,200 for a first-gen iPad that isn’t fully-functional?

The main reason is due to the fact this model never got released. It’s a prototype unit that Apple manufactured with not one, but two dock connectors. Everything else remains the same as the final, shipped iPad in terms of hardware configuration, but that second dock connector is totally unique. It shows Apple was experimenting to see if they needed a second connector for docking the tablet in landscape mode.

Ultimately the second port was rejected and Apple went with a simpler design. Apparently all prototypes are disabled when they are no longer of use to the company, but somehow this prototype unit managed to leave the safety of Apple’s campus and got refurbished. It runs Apple’s testing suite known as SwitchBoard, but the touchscreen does not work for input.

Paying $10,200 for this device certainly secures the buyer a collector’s item and a piece of Apple history. However, I can’t see it being a good investment and doubt it will increase in value as the years roll by. I’d hazard a guess this prototype has been bought by a huge Apple fan rather than someone thinking they can make even more money from it in the future.

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Apple Patents Hint of & iPen Stylus for iPad, iPhone

Apple has filed new patent applications for a stylus, dubbed the iPen, which will work with the company's iOS devices.

The U.S. Patent and Trademark Office published the applications on Thursday, which detail plans for a new stylus being designed by Apple for its touchscreen devices.

Apple's patent application drawings for an iPhone stylus

Patently Apple reports that one of Apple's new patent filings shows that the company is thinking of creating a stylus that uses haptics, a technology that Apple has filed patents for before. The advanced haptics in the iPen would allow the user to feel brush strokes, line thicknesses and more.

"An input device capable of generating haptic feedback may help a user navigate content displayed on the display screen, and may further serve to enhance content of various applications by creating a more appealing and realistic user interface," reads the patent's background description. "Haptic feedback may be any tactile feedback. Examples include forces, vibrations, and/or motions that may be sensed by the user."

Apple's patent applications for an iPad stylus

"Haptic feedback may confirm the user's selection of a particular item, such as a virtual icon or a button, or may be provided when the user's iPen is positioned over a selectable item," says Patently Apple in its report. "The iPen may also provide a haptic output when the device is over, near or passes the boundary of a window or application shown on a display, or when the device is over, near or passes a graphic item having a particular texture."

Haptics in the stylus could also be used in gaming, says Apple. When playing a multiplayer game, the actions of one user could cause another user's pen to emit particular haptic output. 

Apple's invention could be configured to interface with a touch-based user interface device such as a touchscreen, says the patent summary. The tip of the device could be pointed, blunt, or configured as a ball that rolls along the touchscreen surface.

Apple describes that the stylus could have orientation sensors that can detect when the iPen rotates allowing thinner or thicker lines, darker or lighter marks, for example. The sensors could also be used to change the volume of the touchscreen device, for example.

Apple has also designed the iPen to have a mini-speaker built-in, which will give the user audio feedback.

Patently Apple explains that the iPen could be used in conjunction with Apple's own new graphics editing program, which may be similar to Autodesk's Sketchbook for example.

A second stylus patent filed for by Apple describes an optical pen that uses a camera, for example, to determine the movement and location of the stylus in relation to a touchscreen. This device could have a pointed tip for precision input to improve writing on an iPad, for example.

Both patents were originally filed by Apple in November 2010.

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Yahoo Axis Shines on iPad, an Afterthought on Desktop

It's been a while, but Yahoo just made some noise again in the search business. With the release of Axis, a new search app and add-on for both iOS and desktop browsers, Yahoo aims to make browsing the Web a more visual and convenient experience. And it succeeds -- at least on the iPad. 

This is surprising, since on iOS Axis is essentially running a skin over top of Safari -- similar to what the Atomic browser does. In Yahoo's case, though, it's a powerful skin, filled with features you won't find on Apple's browser, such as easy toggling between regular and image searches, and instant syncing of bookmarks and tabs between desktop, iPhone and iPad.

At the same time, the app isn't cluttered. It's nice and minimalist, combining the search and address bar into a single field similar to how Chrome works (seriously, why don't all browsers do this?). And your bookmarks conveniently appear in every new tab you open, letting you instantly tap to go somewhere familiar. However, it doesn't put your most recent bookmarks first, which is a bit annoying.

One of the major thrusts of Axis is that it makes search more visual. It delivers pretty well on this promise, displaying a strip of site preview thumbnail images whenever you input a search term.

This is quite handy even if the sites themselves aren't particularly visual. For example, for most subjects, a Wikipedia entry is one of the first to appear. While Wikipedia pages tend to be mostly text, they're instantly recognizable, even as a thumbnail. The thumbnails tap out after you swipe through the first 20 or so, though, getting replaced with basic text summaries.

The most powerful feature of Axis, though, could be its near-flawless device syncing. Open a page on your iPad, and you can pick up right from there on your iPad or any major desktop browser (via an add-on or extension). All your bookmarks are synced, too -- Yahoo even conveniently names one of your folders "Read Later."

SEE ALSO: Google Search Just Got 1,000 Times Smarter

As I said, though, it's only near-flawless. You can only see the last tab you had open on whatever device you're picking up from. It also doesn't sync your search history (though it will pass along the last search you performed on the other device).

Social networkers will appreciate that Axis integrates Pinterest. Whatever page you're on, you can tap a virtual button to instantly switch over to the Pinterest iOS app and pin the page, although you'll need to switch back to Axis manually. It's a convenient addition that Safari doesn't have -- although Axis has no "Print" or "Add to Home Screen" options.

In all, though, the Axis experience on iOS is compelling, which is in contrast to the underwhelming desktop integration. To be fair, it would be expecting too much of Yahoo -- who doesn't make any kind of desktop browser -- to come up with something groundbreaking here, and Axis ends up being not much more than an impressive syncing tool.

There seemed to be technical difficulties with the pre-release Chrome extension, and I never got it to work. It did better on Firefox, though, but I was disappointed that I had to wait for pages to finish loading completely before I could use Axis.

Regaled to a small search box on the bottom of your browser, Axis is more of an unwanted intruder on the desktop, and its abilities didn't provide much in functionality that I couldn't get from any of the many add-ons in my browser. It's also more limited than the iOS version -- your Axis search history, for example, is nowhere to be found.

Axis is a worthy experiment, though, and I hope Yahoo quickly iterates its iOS app. It's quite simply one of the best browsers you can get for your iPad, and if it keeps improving and adding new abilities, it could help define how we consume the web on tablets. Just as long as Apple doesn't kill it.

What do you think of Axis? Check it out for yourself at the Axis site, and let us know in the comments.

The screen that greets you when you launch Axis on iPad.

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How iPad app Paper helped boost Cosmonaut stylus sales almost tenfold

Steve Jobs may have said “nobody wants a stylus” when unveiling the iPhone for the first time in a Macworld keynote in 2007, but five years later the smartphone and tablet accessory is enjoying a revival, with Apple’s iPad ironically leading the way.

Today, there are many styluses from which to choose from, ranging from thin metallic pens to dedicated tools from traditional drawing tablet makers, but one of the most popular styluses on the market at the moment is the Cosmonaut, created by Studio Neat.

The Cosmonaut started life as a modified dry erase marker, later evolving into a prototype that was successfully funded on Kickstarter, raising $134,236 from 6,192 backers (far surpassing its $50,000 goal).

The accessory has become a bestseller in its own right, but it enjoyed huge sales following the launches of popular smartphone and tablet applications including Zynga’s Draw Something and FiftyThree’s Paper.

Paper, a sketching and drawing app from the ex-Microsoft folks behind the Courier project, saw 1.5 million downloads in just two weeks with some 7 million pages of ideas created. Demand for the app translated into demand for a stylus, and the Cosmonaut seemed to be the stylus that everyone wanted.

It also helped that the launch of Paper coincided with a promotion that Studio Neat was running on the 5by5 network at the time.

Studio Neat’s Dan Provost explains:

It’s hard to pinpoint exactly what was driving the sales, because we had an awesome coincidence where the week that Paper was launched, we were running a sponsorship promotion on the 5by5 network.
That ended up being really good timing where an app perfect for the Cosmonaut was released.
We had a really good spike, it was easily five to even ten times as much as were typically seeing a day. It was a significant boost.

Not all sales were as a result of the iPad and the new apps (it is available for any touchscreen device), but they did have a pretty big impact on sales of the stylus.

Provost says that the since Draw Something and Paper launched, “there’s been a shift in public awareness that a stylus could make apps better, helping the Cosmonaut to perform better than any of our other products.”

We also spoke with Provost about the inspiration behind the Cosmonaut, his company’s experience of raising funds on Kickstarter and what it has planned in the future.

The interview will be published in the coming days.

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iPhone, IPad Become Apple of Cyber Criminals' Eye

Apple devices--ever more popular in the workplace--are about to become more popular with cyber criminals.

That is one of a number of findings in security vendor Zscaler's Q1 State of the Web Report that should be unsettling to enterprises that permit employees to "bring your own device," or BYOD.

The biggest mobile targets of malware so far have been devices powered by Android, since it is in the widest use and is an open platform.

But that may change soon. Zscaler's report said in a survey covering 200 billion transactions, Apple iOS web traffic jumped from 40% in the last quarter of 2011 to 48% in the first quarter of 2012, surpassing Android, which dropped to 37%.

More iOS traffic means more Apple devices in use at enterprises, which is likely to make them more attractive to cyber criminals.

And a significant majority of enterprises allow BYOD: A survey released in April by the SANS Institute found that 61% of more than 500 companies surveyed allowed BYOD. A press release announcing the survey included as part of its headline: "Lack of awareness, chaos pervades with BYOD."

The so-called "consumerization of IT" is an apparently unstoppable trend. And most businesses don't want to stop it, because of the advantages that collaboration and social networking with mobile devices can bring to the enterprise. Still, increasing security threats could undermine those advantages.

Blake Turrentine, CEO of HotWAN and trainer at Black Hat, has been a penetration tester for more than 12 years. His continuing mantra is, "most everything you do on a smartphone can and may be monitored," although he does qualify that by saying he believes Apple iOS devices that are kept up to date with the latest firmware are relatively secure.

Rachel Ratcliff Womack, a vice president with the digital security firm Stroz Friedberg, told The Bottom Line's Herb Weisbaum on MSNBC that most people carry both business and personal information on their mobile devices. "It brings those two worlds together in a very convenient package for criminals to target," she said.

And the damage malware can do is the same as on other devices: steal personal information, drain bank accounts and spy on users.

"[Yet] users may view these devices as eminently secure, when in reality they are just waiting to receive more attention from cyber criminals," James Lyne, director of technology strategies at the online security firm Sophos, told Weisbaum.

In the face of these impending threats, multiple security surveys find both employees and employers appear to be relatively blase about them. SANS reported that only 9% of companies participating in its survey said they were "fully aware" of all the devices accessing their networks. Another 50% were "vaguely or fairly" aware. Nearly a third of the companies said they had no management policy for employee mobile devices.

Some of this may be inevitable. Turrentine says he doubts that enterprises can control their employees' personal devices. "Users control their own phones," he says, acknowledging that this is "a big [security] hole." The proliferation of smartphones, alone with their ever-expanding capabilities means "the attack surface is expanded," he says, noting that Apple devices are prized because of their cutting-edge functionality.

And he agrees that security is not the priority it should be at all levels -- users, enterprise leaders and the manufacturers themselves. The pressure on the makers of devices is not for better security but more functionality. "They're racing so fast to come up with more capabilities, because the mobile market is changing so rapidly," he says.

Meanwhile, Mike Geide, senior researcher at Zscaler ThreatlabZ tells Network World that employees regularly try to bypass their companies' security policies, even using anonymous proxy servers to get to unauthorized web sites.

Turrentine says even relatively savvy smartphone users seem blissfully unaware of the ways they are exposing their confidential information. He says he visited a Verizon kiosk in a shopping mall and talked to some of the workers there who were doing things like, "downloading questionable third-party apps and also doing online banking."

The good news, he and others say, is that a solution is not terribly complicated. The best thing users can do is to make sure they have the latest versions of apps and the operating system of their device. Turrentine says the latest iOS is fairly secure, noting that it took the jailbreak community 10 months to break the iPad 2.

Beyond that, Lyne tells The Bottom Line that users should have a robust password, use encryption, and be very careful about what apps they install.

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China clears Google Motorola bid

Google is looking to increase its trove of patents with the purchase of Motorola Chinese regulators have approved Google's $12.5bn (£7.9bn) purchase of US phone maker Motorola Mobility, the final hurdle for the deal to go through. 

Chinese authorities said Google must keep its mobile software, Android, free for other device makers for up to five years.

The acquisition, would be Google's biggest ever.

It has already won clearance from US and European regulators.

Google's purchase of Motorola Mobility allows it to move into manufacturing of phones and tablet computers for the first time. 

It also gives Google access to more than 17,000 of the company's valuable patents, which will help it defend itself and Android phone manufacturers in patent disputes.

Google said the Chinese government cleared the deal on Saturday. 

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Apple Drops 4G Branding From New iPad

 

Apple is changing the way it's marketing the iPad + 4G, dropping the 4G altogether and replacing it with the word "cellular."

The move comes after complaints from an Australian competition regulator. While Apple was marketing the tablet as "4G" in the country, it currently cannot connect to Australia's 4G network or the 4G networks in other countries outside of the U.S. Due to that fact, regulators felt Apple was misleading Australian customers about the device's possible data speeds.

While much of the iPad's website marketing -- at least here in the U.S -- still has the the 4G LTE designation, when it comes time to buy the tablet in the store, you're now given the option to purchase just a "Wi-Fi" version, or a "Wi-Fi + Cellular" model.

While the term "4G" does refer to the data speed a device can achieve, it simply means that it can connect to a 4th-generation data network faster than its 3G predecessor. In the U.S., many device manufacturers use the "4G" label on devices that are not capable of data speeds as fast as some of their 4G competition.

 

SEE ALSO: What is 4G? An FAQ on Next Generation Wireless
 
One example is Apple's iPhone 4S on AT&T, which now has a 4G designation, although according to the International Telecommunications Union the network the iPhone specifically runs on (HSDPA) is not a fourth-generation network. It's more like 3.5G.

The new iPad is currently only capable of connecting to five true 4G networks, all of which are located in the

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