San Diego Business Journal

Pairing tablet computing and wireless communication has the potential to push health care into new realms of quick and portable access to information and response, and San Diego stands to be at the epicenter.

Principal players locally include such heavyweights as Qualcomm Inc., the West Wireless Health Institute, and Palomar Pomerado Health, which is preparing to launch a tablet-based system. Paul Sonnier, co-chairman of the Healthcare Communications Special Interest Group at CommNexus San Diego, also counts among those leading the charge to advance this barely explored notion of ubiquitous computing.

“Just as in the early days of home computing, the world of wireless and mobile health (mHealth) is full of small and large players trying to get their products noticed and adopted as the dominant technology,” said Sonnier, who also founded the Wireless Health group on LinkedIn. “They are having to bet their futures on the outcomes of many wider issues, such as the regulation of wireless devices and the acceptance of them by consumers and health professionals. Time will tell, of course, but at the moment a healthy chaos reigns.”

By virtue of how it connects with the world, the tablet — with Apple Inc.’s iPad in the forefront — is the breakthrough product that may make the innovation possible, according to Ramesh Rao, director of the UC San Diego division of the California Institute for Telecommunications and Information Technology.

“The iPad is more than just another device,” Rao said. “The Apple ecosystem allows for greater interaction so you can have such great support for the things you want to do — while it pays great attention to the human-computer interface.”

Connectivity Key to Mobility

With 3.3 million iPads sold by July 21, according to Apple, the device has set a high standard that other tablets will have to meet, starting with its ability to switch seamlessly between Wi-Fi and cellular connections.

That is key to the innovations to come, according to Don Jones, vice president of health and life sciences at Qualcomm.

“A laptop makes you a radio station manager,” Jones said. “By putting cellular technology inside, the tablet switches between radio stations without the consumer knowing it. Connectivity wherever health care professionals are, is going to be very important.”

Palomar Pomerado Health is working with San Jose-based Cisco Systems Inc. to be the first American hospital network to use tablet-based systems.

“In health care, 98 percent of the organizations are late adopters, because they will sit back and wait to see how useful a new technology is,” said Orlando Portale, the chief technology and innovation officer at Palomar Pomerado Health. “We’re going to step out and develop prototype applications for tablets geared for the physician and we think they’ll like it and use it.”

Portale said the hospital’s goal is to let providers have immediate access to a patient’s health care history, clinical information like test results and imaging — all at once.

“There’s a challenge in how to present the information on the tablet and make it easy to use,” he said. “The back-end challenge is integrating the information from a lot of different sources and proprietary systems.”

The plan also includes a “robust” videoconferencing capability.

“One scenario is a primary care doctor reaching out to do a real-time videoconference with a specialist, a cardiologist or radiologist, for example,” he said. “In the hospital, we foresee a multicast conference: the nurse, pharmacist and doctor on a virtual consultation with all of the patient’s past and current information available to all of them as they meet.”

Wired for Optimum Work Flow

Getting doctors and health care providers to use the technology is one of a handful of critical issues. The medical field is known for its resistance to technologies that don’t actually make delivering better care easier and faster.

“The rule is, don’t mess with the doctor’s work flow,” said Darrel Drinan, founder and chief executive officer of PhiloMetron Inc., a San Diego health care company developing proprietary wireless diagnostic products and services. “Cedars-Sinai (Medical Center in Los Angeles) installed a $34 million system in 2002 and the doctors turned in their PDAs rather than be expected to use it.”

Drinan, a contrarian voice in the very excited conversation around the synchronicity of wireless, tablets and health care, said his expertise tells him he doesn’t know if the technology addresses a problem that needs to be solved.

“I believe in solving problems with technology, not in building technology for unknown problems,” Drinan said. “This isn’t the solution to the problem of giving a patient clear, simple information in the six and a half minutes they get with the doctor, on average. For a clinician looking at clinical information, it has value.

“But the smart solution really is being able to deliver the smart analytics that happen in the clinician’s brain,” he added.

While analysis still has to happen in the clinical mind, offering more data and faster connection to the people who can offer relevant observations, from the specialist on vacation to the nurse on the floor, may improve and speed up health care delivery.

Data Security Issues

Plenty of issues remain. Data security, heightened by federal Health Insurance Portability and Accountability Act regulations, will be a critical issue. Access to the reams of medical records that are barely electronic at this point may be a problem.

“The data set resides in the clinical information systems and they are silos,” Drinan said. “They don’t want the data contaminated and they don’t want to lose the franchise.”

Data in the form of records, images, notes and prescriptions are stored in systems that were developed proprietarily and may not be set up for the interactive environment of the future.

“How do you put it in a form that’s useful to the clinicians?” Drinan said. “If they can do a mash-up of all the data and move it through quickly, it will be useful.”

Jones said that making it truly handy will be the breakthrough — and that may mean sewing bigger pockets on lab coats.

“Health care professionals use their hands a lot and the tablet stops being a personal device and becomes a room accessory when it has to be set down,” he said. “The winning tablet will be the one that fits in the lab coat pocket.”

Marty Graham is a freelance writer for the San Diego Business Journal.