Google’s Android OS is now a global best seller

For once the hype can be believed.  Google’s mobile operating system, Android, shipped with more smart phones than any other manufacturer in the last quarter of 2010, beating Nokia, RIM and Apple, according to figures released yesterday by research firm Canalys.

We note that the Canalys figures include two variants of Android made for the Chinese market, Tapas and OMS, which leverage Google’s open source code.  Global sales figures will continue to be driven by demand from the world largest economies, and China is already the #2 market for smart phones with 7 million units sold behind the USA with almost 15 million (Q2 2010 figures). What we don’t know however, is how much these Chinese variants contributed to the overall Android figures – but our guess is that they probably tipped the balance.

Its probably worth noting that these figures relate to new sales – and not to all smart phones currently in use.  However given the relatively short lifecycle of mobile phones (people typically upgrade to a new phone every 1-2 years), come 2013, Android could well be the dominant operating systems for mobile phones.  See these stats from StatCounter that show the global picture in mobile OS use according to their observations of web traffic.

Source: StatCounter Global Stats – Mobile Browser Market Share

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Apple in Health Care event – February 2nd 2011

d4 will be presenting at the Regent Street Apple Store on February 2nd 2011 at 7pm.

Billed as a business networking event, this Apple in Health Care is described on the store event page as follows:

Discover how the latest Apple technology – from the Mac to iPad and iPhone – is being used to innovate in the health care industry.

Learn how health care professionals are using Apple-based solutions for everything from practice management to medical imaging and surgery, with demonstrations of DICOM viewers from OsiriX and practice management solutions from MacPractice.

See the Regent Street store page event listing for more details, or send an email to to reserve your place.  We look forward to seeing you there!

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Top UK Medical Apps (Jan 20th)

Source: (via Apple iTunes RSS GB feed for top grossing Medical apps)

Rank / Change Icon Name Price
1 +11 Doctor’s Toolbag £4.99
2 -1 Oxford Handbook of Clinical Medicin… £34.99
3 -1 British National Formulary 60 (Sept… £26.49
4 -1 Relax with Andrew Johnson £1.79
5 +3 UKParaPack £14.99
6 +3 Oxford Handbook of Clinical Special… £34.99
7 +57 The Atlas of Emergency Medicine £114.99
8 -1 Learn Muscles : Anatomy Quiz & Refe… £1.79
9 +2 Easy Weight Loss £2.99
10 0 Differential Diagnosis from the BMJ… £4.99
11 Oxford Handbook of General Practice… £34.99
12 +3 Quit Smoking Now with Max Kirsten £4.99
13 +13 Best Practice decision support from… £0.00
14 +55 The Merck Manual £20.99
15 +1 Lose Weight with Andrew Johnson £1.79
16 +18 Campbell’s Operative Orthopaedics: … £52.99
17 -4 Sleep £0.59
18 +10 Drugs & Medications £0.59
19 -14 Oxford Handbook for the Foundation … £34.99
20 -14 Oxford Handbook of Acute Medicine, … £34.99
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In the run up to Christmas, we announced that d4 are working with Happtique, a subsidiary of the not-for-profit Greater New York Hospitals Association (GNYHA). d4.Happtique will make it easier for UK health professionals to discover and use healthcare apps.

We aim to have d4.Happtique fully operational this summer.  Over the course of the next 6 months we will develop our research into the app market and gather feedback from health professionals on

  1. the apps they currently own
  2. the apps they plan to buy, and
  3. the apps they want developers to make

As part of our research we have created a service to help identify and classify the apps bought by health professionals.  An alpha version of is now available, and we will be testing and developing the site further in the coming weeks and months.

The site allows you to browse the full range of apps available via the UK Apple App Store, by device (iPadiPhoneiPod), category (e.g. Health & Fitness) and price (FreePaid). More importantly, it can show which Medical apps are the most popular in the UK, measured by gross revenues (see below) or by number of downloads. These metrics have their downsides, but we hope you’ll agree its a start on our journey to help health professionals find relevant and useful apps.  As always, we’d welcome your feedback.

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Is there a *professional* app for that?

Apple have successfully cornered the nascent consumer market for mobile applications with an extremely successful blend of strategy and marketing (e.g. the “there’s an app for that” advertising campaign).

But while the App Store has been an unbridled consumer success for Apple, its suitability for the professional buyer is not without issue. We outline four challenges below and introduce a new service,, designed primarily to help health professionals find relevant and useful apps.

1. The choice can be bewildering – 20,000 apps are released each month

Software developers across the world are busy creating apps for sale to Apple customers through the App Store. This is potentially good news if you’re looking for a niche app, as there’s more chance it exists. But there is a downside to this explosion of choice – with 20,000 plus apps being released each month, finding the right app for you becomes harder and harder. [NB  the 20,000+ new release each month are both new apps and new versions of existing apps.]

2. There’s no quality control of app content – yet.

Apple approve apps for the App Store provided they function as specified by the developer.  But Apple make no warranties for the validity of the content contained within an app. So can a health professional be confident that a particular app is fit for purpose? Is an app for medical use subject to regulatory approval?  The FDA are believed to actively monitor apps sold in the USA but the position in the UK is even less clear.

3. Classification is at best superficial – and at worst misleading

In some ways the mechanics of the Apple App Store further compound the problem. Apps can be categorised into 20 genres, although some carry multiple labels.  At first inspection the most relevant categories for health professionals are “Medical” and “Health & Fitness” genres.  But on closer inspection these categories contain a mish-mash of apps that range from novelty/entertainment purposes through to authoritative reference texts. Only in the App Store would you find Massage Skills Pro sharing the Medical best-seller list with the British National Formulary (BNF) and the Oxford Handbook of Clinical Medicine (OHCM).

4. Anyone can write a review – but that’s also a problem

Another potential source of useful information on whether to buy an app or not are the reviews written about it.  Anyone who buys an app can rate it between 1 and 5 and provide a short text commentary which are displayed on the App Store for potential buyers to read.  Which is fine, apart from the fact that anyone can write a review.  It is believed that top developers pay people to buy their app and write a favourable review to help drive up purchases.  If you are a health professional, can you trust an anonymous review not knowing whether the individual is a qualified medical practitioner, a lay person or an imposter?

5. But perhaps the biggest challenge is this:

Popular is not synonymous with Useful

The real issue however with the App Store is the ranking algorithm.  Most apps are downloaded because they are found in the most downloaded/highest earning lists, either overall, or by category. Requirements to make the top list clearly vary depending on the popularity of the category.  And there are ways you can game the algorithm, e.g. by having regular updates, which inflate the download count.  But the challenges is this: as a developer, if you’re app isn’t popular because it serves a particular niche, your professional, useful app may never reach the end users you had in mind. And as an end user, you’ll probably never find it amongst the thousands of apps competing for your attention.

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A Framework for Clinical Communication Supporting Healthcare Delivery

Type Journal Article
Author Jim Jirjis
Author Jacob B. Weiss
Author Dario Giuse
Author S. Trent Rosenbloom
Volume 2005
Pages 375-379
Date 2005
Extra PMID: 16779065
PMCID: 1560606
Journal Abbr AMIA Annu Symp Proc
Library Catalog PubMed Central
Abstract Interpersonal communications related to healthcare delivery, called clinical communications, take up a considerable amount of time. Nonetheless, there exist few tools in electronic health record systems that support clinical communications. We describe a framework for clinical communications and describe our experiences implementing tools to manage and document them within an electronic health record system. Categories of clinical communications include communications between patients and healthcare providers, among healthcare providers on a single clinical team, between healthcare providers in different clinical teams and different institutions, and between healthcare providers and individuals who can provide additional educational or evidence based materials to support care delivery.
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Assessment of Information Needs for Informed, Coordinated Activities in the Clinical Environment

Type Journal Article
Author Tate T. Kubose
Author James J. Cimino
Author Vimla L. Patel
Pages 948-948
Publication Proceedings of the AMIA Symposium
ISSN 1531-605X
Date 2001
Extra undefinedPMCID: 2243281
Journal Abbr Proc AMIA Symp
Library Catalog PubMed Central
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Beyond paging: building a web-based communication tool for nurses and physicians

Type Journal Article
Author Kenneth A Locke
Author Barbara Duffey-Rosenstein
Author Giancarlo De Lio
Author Dante Morra
Author Nicolas Hariton
Volume 24
Issue 1
Pages 105-110
Publication Journal of General Internal Medicine
ISSN 1525-1497
Date Jan 2009
Extra PMID: 18958533
Journal Abbr J Gen Intern Med
DOI 10.1007/s11606-008-0827-2
Accessed 2010-09-08 21:20:50
Library Catalog NCBI PubMed
Abstract INTRODUCTION: The traditional means of communication between nurses and physicians is through paging. This method is disruptive to the workflow of both professions and is too non-specific to be used for all types of messages. AIMS: We undertook a quality improvement project to streamline communication between nurses and trainees for urgent and non-urgent matters. We assessed user uptake and satisfaction with the new method. SETTING: A General Internal Medicine teaching unit in a tertiary care academic centre. METHODS: Through collaborative techniques, we developed a novel communication method that sends non-urgent messages to a Web-based task list and urgent messages to an alphanumeric pager. We implemented this new technology using a collaborative process between nurses and physicians to address all concerns. EVALUATION: Post-implementation surveillance indicated a high degree of uptake of the new practice. User surveys and focus groups showed a high level of satisfaction and a perceived decrease in interruptions to the workflow of both nurses and physicians with the new system. Usage data indicated that the new system may increase overall non-urgent communication. CONCLUSION: A Web-based system to triage urgent and non-urgent messages between nurses and physicians was developed collaboratively and implemented successfully to improve workflow for both groups.
Short Title Beyond paging
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Challenges for Health-Care Reform

Type Journal Article
Author B. Bernanke
Publication Speech at the Senate Finance Committee Health Reform Summit, Washington DC, Board of Governors of the Federal Reserve System
Date 2008
Library Catalog Google Scholar
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Challenges to physicians’ use of a wireless alert pager

Type Journal Article
Author Madhu C Reddy
Author Wanda Pratt
Author David W McDonald
Author M Michael Shabot
Pages 544-548
Publication AMIA … Annual Symposium Proceedings / AMIA Symposium. AMIA Symposium
ISSN 1942-597X
Date 2003
Extra PMID: 14728232
Journal Abbr AMIA Annu Symp Proc
Accessed 2010-09-08 21:04:02
Library Catalog NCBI PubMed
Abstract Pagers, personal data assistants (PDAs) and other devices that have wireless connectivity are becoming a popular method for delivering patient related information to medical decision makers. Although medical informatics research has emphasized the design, and implementation of pagers as event notification mechanisms, researchers have not paid as much attention to how this technology impacts medical work. We present a case study of physicians in a Surgical Intensive Care Unit (SICU) using wireless alert pagers. The pagers provide a variety of alphanumeric clinical alert messages and are widely used by SICU physicians. However, the use of the pagers has created unanticipated challenges to the physicians' traditional work practices. These challenges include: (1) flattening of hierarchical workflows, (2) coping with information overload and missing context, and (3) lack of feedback. These challenges are tied to both the specific technical design of the system and the traditional structure of medical work.
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