Is there really an app for that?

Happy new years! With a new year and 6 solid months of pharmacy informatics experience, it is time to re-visit "Internal Med? There's an app for that!" with an another perspective.

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Timothy Cole asked an intriguing question on ASHP Connect regarding an "Apple friendly Hospital":

Hello everyone!

I'd like to know if anyone out there knows of or has worked for an Apple based hospital or at least an Apple friendly hospital? The hospital I work at uses Meditech and PCs and it just seems like there HAS to be a better way to do things.
What is your experience / opinion of the most user friendly EMR / PHA module / system? What about one that is the most consistent or the most efficient?

This question really highlights the inherent weakness of all EHRs out there: their standardization and interoperability is awful.

A majority of the answers to the question involve Citrix or some other type of virtualization. Unfortunately, for a majority of the big name clinical information systems out there, there is no app for that. In order to access the software on mobile hardware or a non-native platform (eg., tablet or OS X, respectively), you will need to emulate the environment. On a Macintosh laptop, this means Parallels, Citrix, VMWare - the list goes on. On tablets, this is much more difficult due to processing power. Native ports are near impossible because:

1. Most hospitals are Windows based, which leads to #2
2. There is no money to be made developing for minority stakeholders (think of orphan drugs without the subsidization)
3. The code behind all of these EHRs are proprietary and closed source
4. Application programming interfaces (APIs) are not readily available even if you want to write something yourself

This made me think of possible advantages if an EHR were web based (homegrown & SaaS models). Sure, it could still be spagetti code, but at least standards in web development are more widely accepted. In the Apple example, you could perhaps re-tool the EHR as an iOS webapp. A webapp is basically a webpage which behaves transparently as a regular application on an iDevice. One could use a whole bunch of acronyms like Js, AJAX, CSS, HTML on the client side app if the EHR used any of these acronyms on the server side: PHP, Perl, Java, .NET, or ASP.

An iOS webapp of a web based EHR would just require some reformatting of the user interface. That sounds a lot more pleasant than learning Objective C (the language of native iOS apps).

http://imagineric.ericd.net/wp-content/uploads/2011/03/bang.png

One step further would be to make it a native iOS app. Using the UIWebView framework, it would be the same as the previous solution, except the entire thing is wrapped in an Objective C "shell." For the programming averse, a software dev. kit (SDK) like PhoneGap may be the solution.

In a similar argument of why there's no app for that, mHIMSS recently stated a major barrier:

To use a mobile device effectively requires a complete redesign of the way information is presented

This would be less of a barrier if a vendor simply offered better APIs to facilitate interoperability and interfaces. A lesson that EHR vendors can learn from the National Library of Medicine is to provide better ways to utilize their data and framework. Data is king; apps are merely ways to access it. Application programming interfaces can make it much much easier to do so.

via rxinformatica