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back to article iPads for hospitals: is this a good idea?

Next year, 500 doctors and nurses in Victoria hospitals will trial the use of iPads. Graduate doctors, rather than crusty consultants, will get the devices, as the "younger group of students and graduates of the health professions have grown up with technology all around them," Daniel Andrews, Victoria's health minister, said. …

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Never mind...

Those piddling little common sense issues, it's a new toy and all the management will look "'tho cool" waltzing around the hospital with such cool kit"

The likelihood of anyone who actually does the work getting one being zero. Mind you Apple might have a ruggedized one we don't know about.

Will they sue, if they find out it won't work after being scanned or x-rayed.

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FAIL

You can blend an iPad

but can you dip one in TCP?

££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££££'s

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Anonymous Coward

ARRRRGH! The stupidity bugs me

What the F can an iPad do that couldn't be done with other devices, just as capable, out there?

Freeeeks!

Stop this complete waste of public money. Christ, cheaper device exist, but No, its just cause it's an iPad.

If these decision makers were my employees, I'd have serious doubts on their decision making capability. They clearly need to be challenged, not alone on the point of value from money in the public sector.

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Stop

Really?

What other devices, then?

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lay of the cappuccinos...

What can the iPad do? Be carried like a clipboard. That, along with the battery life and connectivity in this instance, is the killer feature. Many apoplectic commentards have cried about their being cheaper devices, all fail to name them. Windows Table edition? Heavy, stylus dependant input with a woeful to the point of being pointless battery performance. Netbooks? Poor performance, lower battery life, cumbersome. As I said, skip the cappuccino this afternoon, eh?

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@Matt / Narcicist

It doesn't matter which other devices are available, or indeed if any are available - The iPad can't be sterilised and is designed to be touched, it therefore represents a rather brilliant way to transport MRSA, CDIF etc. all round the hospital.

Add to that - it's not ruggidised, had no method to add authentication systems like smart cards, commonly used in hospitals and has limited (if any) medical software available.

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Grenade

Anything....

that encryption that isn't described by the industry as "worse than useless" or that has a 75% markup on it for staters

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@Fraser: And THAT is what i call an argument

Not some hissy fit about being tired of hearing ipad this or that.

Well done, sir.

Not to mention, where does he expect to find ruggedized, medical-caliber electronics cheaper than run of the mill commercials.

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@Fraser

Cannot be sterilized? You mean like the pen and paper solutions that are already in use? What about the computer terminals and other electronic equipment? Are you suggesting ECG machines regularly go through an autoclave? Or are the coated in a layer of biocides and wiped with disinfectants, in which case couldn't the iPad could well be treated (albeit perhaps impotently) in the same manner? It not being 'ruggidised' is strawman; with a cursory glance at the Apple store, there are at least two options there, with more available if one searches, as someone that works in a healthcare authority procurement team will. The "limited" medical apps; strawman again and actually there are quite a few medical apps available for iOS; http://www.lmgtfy.com/?q=ipad+medical+apps. I accept, totally, the authentication gripes, but not an insurmountable one, which doesn't seem to have been a problem for other hospitals, military organisations, businesses, schools, et cetera. I have to ack the question; is it the fact that new tech is being proposed and introduced, or an Apple product that causes offence?

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Ruggedised?

Nope. There'll be tears... and bits of iPad before bedtime.

Also, if they were to start using tablets, shouldn't they have a slot for those NHS access cards?

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WTF?

Tender

Is there no requirement to put this out to tender then?

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Stop

NHS cards?

I'm pretty sure they don't have the NHS in Australia. This is possibly one of the reasons that a lot of junior doctors over here go and work in the healthcare system over there for a year or two.

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Ah

It would help if I could read.

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@Andy 17

depends on the volume. think the order has to be over 100,000 before it goes to tender

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Go

Re purchasing in Australian health system vs NHS

I've worked in IT in both, and in most cases procurement processes in the NHS are MUCH easier than Australia in government run health systems. There is of course some dependence on which NHS trust you work for and internal procurement policy, but for many items from bandages to million pound x-ray devices there is agreed pricing provided by vendors to NHS Supply Chain, and you just pick whatever you want from the shopping list. In a year as project manager in NHS I helped spend several million pounds on IT systems, medical equipment and PC hardware without once having to go to open tender. Back home in Oz and I'm about to go to my second full-blown tender for the year, this time for a system where I know there is only one potential vendor in the market...

FWIW, we trialled several Windows based tablets including the Panasonics (then in prototype) and they just didn't cut it - available apps needed keyboard & mouse input to be practical, the fact that the tablets were too chunky, too heavy and had poor battery life was the smaller part of the issue. If Apple's iOS makes development of practical touch-friendly apps simpler, that's all to the good. Much of the hoo-ha about "medical grade" devices being washable is pretty irrelevant whan A) nobody washes their keyboards and mice properly now anyway B) anything with lots of corners and crevices is never going to be easy to disinfect properly C) nurses and docs chew on pens and eat their lunch while writing in patient notes (seen it happen in a Gastro ward in lockdown mode!), poo-glove-file-pen-mouth-pen-keyboard-colleague-next patient...

Apple don't claim the iPad to be infection-control certified, but as a form factor it has a lot going for it being all smooth surfaces with minimal edges and crevices and nicely sealed. So long as the front panel can withstand some alcohol (it's glass, right?) I believe it is lower infection risk than any other tablet I have seen, medical or no.

Just don't drop it, or let it get nicked!

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Chances of survival: slim

Having just booted out of office a spin-obsessed UK government hell-bent on overspending and jumping on the latest bandwagon ... I can sympathise with Australia's situation at the moment.

At least they had the good sense to off-load their Prime Minister when it looked like he was going the cost them the upcoming election (eh, Gordon?). If it doesn't work, expect the new party to start cutting off silly-bugger schemes like this forthwith.

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Joke

Plus

Knowing the sweltering temperature in most hospitals, they'll all overheat...

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Do it!

Put all your confidential patient data on an app connecting the Ipads, revolutionise healthcare at the same time, and blow your budget!

Downsides: Apple and the app author can see all the private information no doubt, can use it to target ads and leak it on the web, has more chance of being stolen, costs more than the competition and has less battery.

And lets not forget they could remove the app the hospital is using at any time without warning (meaning bye bye to all patient data)

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WON'T YOU THINK OF THE CHILDREN!?

Hey, do you want to know a secret? You don't have to get Apple's approval for an app if you are an enterprise developer, which this Healthcare trust will almost certainly be. You can deploy your own apps on the devices without going anywhere near the App Store, all with Apple's help too and without them seeing *any* of the data (not that they *can* see any of the data; that's Google's trick)! You lot seem to forget that the individuals concerned are generally much, MUCH, cleverer than you!

Let's remember to think things through before ranting on the internets next time, eh?

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The children will steal the ipads

So it's still okay to pay out for Ipads and then spend on apps and a new system rather than use the old one they have access to already?

The whole point was that they're introducing something there is no need for and it will suck up a chunk of that hospitals budget, meaning healthcare quality could quite possibly go down.

You gave yourself up as a fanboy when you had to attack Google there just because i pointed out the flaws in buying ipads for a hospital.

Apple has a killswitch for apps too fanboy, they could lose their access to that app for any reason apple decides

Google used the killswitch on an app, which acted maliciously, whereas apple refuses to allow an app onto the store if they don't like it for any reason.

Theres protecting the consumer and there's being a git

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Anonymous Coward

Your bits are safe with me

http://www.theregister.co.uk/2010/07/27/wpa2_security/

http://www.theregister.co.uk/2006/10/04/google_talks_tories/

http://www.theregister.co.uk/2009/08/10/tory_nhs_plan/

Can this be better than hanging the notes on the end of the bed that staff have access to and can add to? _Doctors' writing provides better encryption than SSL._ No authentication problems say compared to iPad: session time outs, passing the iPad on/around other staff. Who's typing is that? Who typed cl instead of ml???

Everyone who has said this is a bad idea is correct. They didn't go and buy an iPad in order to work it out either. How clever are the "individuals concerned"?

Battery life, recharging (doctors' day is longer than an iPads)

Security

Maintenance

Network outages

Patient identification (one bed, one pad of notes) (one iPad many patients)

Liver and bacon ice cream anyone? No bad idea.

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Black Helicopters

Then we must all bow down to *your* superior intellect...

Do you really, *really* truthfully and honestly, believe that these people are doing this on a whim? Do your really think that they haven't trialled it already?

"Battery life, recharging (doctors' day is longer than an iPads)

Security

Maintenance

Network outages

Patient identification (one bed, one pad of notes) (one iPad many patients)"

So what you are suggesting is that the medical staff should continue to use pen and paper? That's fine, but you should make it clear that this isn't because they chose iPad, but because they chose a digital solution to replace the existing analogue one? You do know that this is a *technology* site, right?

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FAIL

Ho hum, ad hominem...

"So it's still okay to pay out for Ipads and then spend on apps and a new system rather than use the old one they have access to already?"

"The whole point was that they're introducing something there is no need for and it will suck up a chunk of that hospitals budget, meaning healthcare quality could quite possibly go down."

Translation: WON'T YOU THINK OF THE CHILDREN!!! What an absolute load of twaddle! What if, and here is an "outside of the box" idea, the current infrastructure is considerably out of date and isn't providing what the medical staff need? All you are crying about is the fact that iPad has been chosen and quite frankly it's pathetic.

"You gave yourself up as a fanboy when you had to attack Google there just because i pointed out the flaws in buying ipads for a hospital." Quite! I mean HOW DARE I SPEAK UP FOR APPLE! A good ol' ad hominem 'attack'; the last resort of those that have *conceded the debate*. My 6 year old nephew does the same, except he call you smelly-poo-bum, which I suppose is a step up from that. So, you accept your argument is baseless then? Last time I checked, my HTC Legend doesn't run iOS 4 BTW and although I'd love to have it, TextMate is still only available for OSX, so my Windows PC won't run it...

"Apple has a killswitch for apps too fanboy, they could lose their access to that app for any reason apple decides"

"Google used the killswitch on an app, which acted maliciously, whereas apple refuses to allow an app onto the store if they don't like it for any reason." This whole "APP STORE IS TEH EVILS" is getting tired to be honest. Yes, they've rejected some apps using the reasoning of a toddler and, yes, some guidance from on high as to what is and what isn't acceptable would be a 'Good Thing'(TM), but they've been ridiculed into reversing the more asinine ones! It's Apples shop, and in the 2/3 years it been running Apple they've yet to pull the trigger, contrary to what all the individuals like you have asserted. They have also yet to have the issues that Android has had with piracy and malware, but that's another story. Face it mate, you are talking, erroneously, from out of your bum.

"Theres protecting the consumer and there's being a git" There is also having a reasonable debate, and not resorting to name calling. Sarcasm is fine, attacking an idea is fine, being a little patronising, whilst not ideal, is OK, but resorting to name calling isn't, how ever minor it is (is it mods?). Any point that you had has been rendered totally irrelevant because you could behave in a grown up manner...

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Trends Setters

Not exactly, but corporations and their ilk are fanatics in the use of trying new toys. Call it the "Fad of the Month Club".

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WTF?

What a waste of cash

Total waste of money. That said: can you wash a traditional pen(cil) and paper?

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titlar

You can't wash a paper pad but getting a new one wouldn't set you back £600ish or however much the iPad costs.

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@Ocular Sinister

do you know how much the nhs spend on storage of paper records. Its a huge problem, this is why the NHS area I work for are spearheading an electronic record. saving mega millions and providing much more acurate data

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Jobs Horns

So Jobsie

Is going to really become God?

What are his views on abortion for example, I wonder will he block apps that help with abortion.

Other problem, What if the docs quickly need to use Youtube (flash) to help with cerebral procedure?

Oh and will it work for left handed people?

can the iHate icon be set as default for me? Please? :)

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Erm...

Lest than a week in and the kids are already bored and causing trouble in the summer holidays...

You don't actually have a clue, do you. Doctors tend not to perform really tricky procedures, such as neurological dissections, whilst on rounds, or refer to a video whilst performing an abortion? As for "Youtube (flash)" (Really?! It uses FLASH?! You're kidding, right..!), you are aware that there is <gufaw>an app for that</gufaw>! Has been since the original iPhone/iPod touch. It's imaginatively called 'The YouTube App'. Also, left handed people will be able to use it just fine, since it's not got the same flawed antenna design as the iPhone 4, which after all the fuss isn't *that* flawed, just if you hold it in a peculiar way. Anyhoo, hating anything is for losers, learn to love, makes the world a much happier place. Come to think of it, wouldn't the little troll icon be more fitting than the iHate icon?

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Anonymous Coward

Title

While they shouldn't need a video to know how to perform a relatively common operation like an abortion; it's not uncommon to use to use some sort of teleconferencing setup to help doctors perform obscure operations in remote areas. I don't think they use Flash for that though.

Note: in this case, remote can just mean that the relevant specialist is hundreds of miles away from the hospital with the needy patient.

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Ahhhhhhhh yes....

... The Sacred J will rule the old folks homes. But then, being in the hospital business is just what he needs. Expect to see a suitable liver donar app that tests blood via the touch screen and phones home.

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Anonymous Coward

Absolutely correct!

But no-one it seems has suggested that iPad becomes the *only* piece of digital equipment that the medics use. There are plenty of solutions (with bigger screens, which is perhaps *more* of an issue, no?), and as you have already indicated, the won't reply on Flash for that (or Skype for that matter!). I was merely mocking the OP's myopic, asinine and baseless missive.

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Flame

Feel the rage

There's a lot of hate in here, for something that looks like an experiment on the other side of the planet.

But then again, the mere suggestion of anything Apple-flavoured does seem to stir the haters in the El Reg forums into shooting their mouths off without reading (or understanding) the original article.

Perhaps some of the experts on here might like to try asking questions about the horrific IT kludge that's being forced on the NHS, rather than worry about how our antipodean cousins are choosing to invest/waste their cash.

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@ Guybles...

Why don't you enlighten us as to what YOU think you know about the "IT kludge" that is being forced on the NHS... I'll then correct you.

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And I Assume ...

... you've gotten the halo cleaning app The Sacred J provides for the true believers.

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NHS stuck in the M$/Windoze world, and closed standards

It's all very well talking about using the ipad in the NHS, certainly many clinicians want it, but unfortunately due to the short sightedness of NHS management, it is doubtful that many, if not all, of the applications will even work on the ipads. Applications tend to be written for Microsoft Windows, and the web browser such as PACS and Choose and Book will only work on Internet Explorer. That would exclude the likes of Firefox and Safari.

You will have a hard time convincing the NHS to use open standards for applications, especially the ones in the cloud...

Someone should have been thinking open standards from the start, when specifications were drawn up, when projects were initiated.

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Windows?

*Cough* PACS is DICOM imagery that works on far more than Windows. Works perfectly fine on all major variants of UNIX. Just the viewers you'll frequently see are windows based, as surprise surprise, that's what the hospital has the most experience with, so vendors tend to write software for it.

With the current NHS deal with microsoft having lapsed, and the Oracle one in full force, a lot of apps are going web based (APEX is proving popular). And with web based apps.. Guess what.. The iPad works nicely with that.

Some apps, granted, don't work away from Windows (at the moment), but that could change very quickly.

Would be interesting to see what the trials say, and then see how that evolves with the Android based tablets too..

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Stuck on Windoze? you would be surprised

Many places historically "stuck on windoze" are looking at the iPad, and it's being driven both from the clinicians and from IT.

I know of a couple of iPad trials ongoing in my local health department, which has always been Windows to the core. iPhones have already gained wide traction across the upper echelons of IT staff in the health department, and a number of specialized iPhone apps have sprung up for the increasing number of doctors using them. IPads are a logical extension now that people have realised that the sky doesn't fall in if you don't buy it from Bill.

Our local police service (previously Windows centric) have also been using iPhones on patrol for the last year, and the avaiability of vehicle databases through an iPhone app has been credited with numerous arrests that otherwise wouldn't have happened.

Open standards are great, but there's nothing like "consumerising" a device/standard to lower costs and increase acceptance. People may think iPhones and iPads are pricey, but compare them to the custom kit that for decades has been flogged for medical use and they are dirt cheap.

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Panasonic

I just had a look at the panasonic mentioned in the article. I want one of them SO MCUH right now.

Anyway, using something as proprietary as an iPad is a foolish idea. The trust would essentailly be at the mercy of the manufacturers for updates, tools, programs etc. With no chance to buy from a third party, the manufacturers could charge as much as they want. Don't like the price? Your patients die.

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you want one HOW MCUH?

The iPad more "at the mercy of the manufacturer" than a Panasonic tablet? Have you seen how many apps there are out there that take advantage of the iPads features? Vs how many apps available from third parties taking advantage of windows tablets features? That's hilarious.

And have you seen how crippled devices like the panasonic can be by issues with custom drivers for their limited-run hardware on patch tuesday, and how infrequently such drivers are updated?

As for the price, your panasonic tablet costs double what an iPad does. Broke one? Good luck picking up a replacement on the high street!

Your head must be scrambled if you really believe all you wrote and want one SO MCUH!

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FAIL

@ Lottie... you are full of fail.

I'm confused how you can level this accusation at Apple, when ultimately the same accusation can be directed at ANY supplier of ANY piece of equipment, no matter how non-proprietary.

Also, can you explain how price has anything to do with patients dying? I presume you have seen a formal use-case for this device so you know exactly how it will be used in hospital? Presumably patients will be dying because the iPad will fail when displaying real time results from ECG sensors? Despite it not actually being able to interface with these diagnostic technologies?

My guess is though that you forgot to engage your brain before posting and just saw an opportunity to bash a technology that is trying to do something different.

I'm not sure how the iPad will be used in hospital, I'm not even sure how any required medical apps will get onto it, but I can see a fantastic use case in reducing paperwork and sharing consultation notes, updating patient records, internal and external emails and the like... and this ultra mobile use case is shared by many businesses - and not just medical ones. A lot of people have bashed the iPad as having no practical use. I agree to a point... but on the other hand, what are YOU going to do on a netbook PC whilst having a coffee in Starbucks that you can't also do on an iPad? Email - check. Web - check. Facebook - check. I doubt very much you will be trying to code a web application, or trying to remotely connect to your companies SAP system via a VPN. But then that's never been what the iPad is about.

Apple has taken the risk and produced a device that requires minimal technical support to use, can be used by just about anyone with an IQ above 50, and is actually fun. I know few people who have actually bought one, but those that have - love it.

I was resistant to the iPhone for a long time, but now I have actually used one for a month, I wouldn't give it up - it is a fantastic piece of kit.

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a proven idea

Apple has actually done this before, way long ago. Apple's other problems at the time meant that this didn't go forward but the trial showed very positive results.

It's not the price of the device that matters. In the case of the iPad, it's actually quite reasonable. What matters is the improvement in medical outcomes, or "quality of care". For example, preventing a severe case of adverse drug interaction is a great benefit to the patient and saves a lot of care and money. The list goes on and on.

Kudos to Victoria for doing this.

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You cannot be serious..

why ipads? why now? what possible requirements list does the ipad meet? secure? durable? fit for purpose? battery life? environmental conditions? what about getting data on/off? integration? itunes? hahaha.

is this just some highlevel muppet who got sucked into the hype?

appalling.

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Yes thats right...

Windows and Android-vapourware tablets are much more suited to the task.

Virus free, un-crackable with not a chance of user/patient data being fed back to the all devouring ad broker mother company.

Nice clunky fragmented interface or if you like the super new Windows 7 which has been specially designed for err, tablet computing.

And, wait for it, with oooh "Approximately 6 hours of battery life" according to the Panasonic Toughbook blerb.

Way to go man... way to go!

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Anonymous Coward

Meets all of those

We're trialling one now in my practice and so far it's dream. It meets all of those criteria that you imply it wouldn't and it gets you closer to the patient. There is nothing like sitting down next to the patient and going over their clinical data on the iPad. In addition, I wouldn't put any of my patient data anywhere near a windows machine. Despite all of their security measures our University department has emailed viruses on more than a few occasions but those of us on Apple kit of course have not had a problem. Rail against Apple all you like but if you just want to get the job done with a low cost of ownership and excellent tech support, you can't knock them.

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Ya Think ...

... nurses, doctors, orderlies, and etc. wear those cool colorful scrubs because that's all they can buy?

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Err...

"...Rail against Apple all you like but if you just want to get the job done with a low cost of ownership and excellent tech support, you can't knock them...."

I have to challenge that Apple is expensive and have very poor technical support, their general customer support is even worse - I speak from experience, both personally and from several people at work,

If the iPad does the job, that's fine, but this is a medical device designed to be touched and you say that you show patients their data on the device (implying they are very close to it). This would seem like an excellent way to contaminate it, how do you keep it sterile?

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Anonymous Coward

Re Err...

Have to disagree on cost as if for example you compare a MacBook with a similar machine, say a Sony VAIO the purchase price is much the same. As they need very little support the TCO is much lower than when we had Windows PCs & we buy a 3 year warranty with each machine for a fraction of what say PC World would charge (not I know perhaps the best comparison!). As for tech support we now have a dozen or so Macs & many colleagues have them as they are pretty common in medical circles. Our experience is that Apples tech support is frankly stellar. We have direct access to level 2 tech support but when travelling, anywhere with an Apple store can provide help if needed. The only time I have needed it seriously was when a motherboard went on my MacBook on a flight to Seattle & their local store had the board replaced in just over two hours. YMMV of course!

With regard to sterility we only use the iPad at consultations so it doesn't go into an environment where it has to be sterile. Clinically clean is fine and all you can achieve with any device.... I'll bet you can't autoclave a Panasonic Toughbook <g>

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FAIL

Lazy commentards!

"Besides ... the iPad doesn't support centralised management and doesn't have good options for bespoke app installation."

Er, yes. Yes it does. Here, I'll give you the link: http://developer.apple.com/programs/iphone/enterprise/

Clearly you believe research is something that only happens to other people.

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