Chrome OS and the Future of Medical Computing

Google gave Medgadget a CR-48 for Christmas. Below is a take on how Chrome OS might fit into the future of medical computing by our editor Sean Duffy.
The world of medicine is in the midst of a bubbly love affair with the iPad. From Stanford Medical School, that recently gave their whole incoming class iPads, to ClearPractice’s stunning iPad EMR Nimble, Apple’s thin little tablet is sliding under the doors of hospitals all across the country. And the medical app store has shown tremendous promise as a supporting ecosystem, full of handy clinical tools, live vital sign dashboards, radiology suites, and anatomy learning applications. There is exceptional momentum toward making the iPad THE default clinical computing tool. And for the next 5-10 years, the iPad will, in all likelihood continue to shake up medicine.
But what about long term? Your Medgadget editors recently got a CR-48, Google’s Chrome OS pilot notebook and in between fighting with the bloody awful trackpad, we’ve been thinking hard about how the operating system might fit into the future world of medicine. The hardware is, as other reviewers have already said, good for a pilot machine, but certainly wouldn’t go into production. The relevant details are that sweeping your fingers over the matte finish feels like petting a soft, exotic animal, using the trackpad is frustrating, hammering on the keys gives the sense that you’re using a high quality MacBook keyboard ripoff, and looking at the rather dim screen makes you suddenly think the world is too bright.

Yet on the whole, playing with the CR-48 is like peeking into the future – the far, far away future. And though it’s hard to fill in all the details now, there’s a lot of potential for Chrome OS in the world of medicine. Here’s why…
Disposability: Medicine beats up devices. The 24 hour pace, rapid fire use, and harsh environment of the clinical setting stresses technology in a way that few other settings do. In some ways, the ultimate machine for the medical world is the one in which the doctor, nurse, patient, etc, cares the least about if it’s dropped, lost, or broken. There are a couple of factors that make a technology disposable, but the two largest are cost and the user effort in customization. By making the OS free and processor light, and by removing the need for large local storage, Chrome OS devices have the potential to be extremely cheap. The CR48 runs on a single core Atom processor, and though it’s not fast, it’s definitely usable. It also doesn’t have a hard drive but rather a light bit of solid state memory. If any operating system has the potential to enable quality hardware from an interaction standpoint at a low enough cost to make it feel disposable, it’s Chrome OS. Google is pushing this selling point harder than all others. As evidence, take a look at Google’s spectacular Chrome OS Demolition Lab and tell the chat bot how you’d like to see the CR48 destroyed.
The other factor that makes a technology disposable is a low setup requirement. Even if my MacBook Pro were free, I’d care a tremendous amount if it broke because I’ve spent days fiddling with the settings, installing Bootcamp, setting up my default browsers, readers, and background apps, customizing my dock, etc. And if I got a new machine, I’d have to redo the entire process. When I first opened up the CR48, I typed in my Google account and suddenly MY browser appeared, with all my extensions, links, apps, settings, the works. The CR48 put me at home quicker than any set up process of any machine I’ve ever used. If my Chrome OS device ended up falling into a volcano, assuming I could quickly nab another machine, I wouldn’t care in the least.
Interchangeability: Medicine is a technological culture of sharing. Tools like vital sign machines, and even pagers, are passed around in a relay race of practitioner and patient changes. This is largely because of expense and need. Buying every doctor at your hospital an iPad is conceptually different (and more expensive) than buying enough iPads for all the doctors that are in the hospital at one time. Chrome OS allows hand offs without sacrificing customizability in workflow, tools, etc. If I picked up ANY CR48 right now and typed in my information, it could become MY machine in less than a minute. This CR48 is the first computer to provide this level of interchangeability. In the clinical world, the ability to shape shift into your personal machine has benefits for both the hospital, that needs to purchase and support fewer devices, and the clinicians who can grab the nearest Chrome OS machine and make it their own.
Security: In healthcare, data security mishaps carry heavy consequences for both patients and organizations. In 2001, when Lilly, through a small technical error, accidentally exposed around 600 email addresses of users who had signed up for tips on Prozac.com, the federal government cracked down hard. Lily was left with hefty fines and 20 years of government oversight. It’s telling that GoogleHealth is the only Google service that requires double sign in.
The reality is that the less clinical data that is kept on a local machine the better. There’s really no such thing as perfect hard drive encryption and losing a machine with troves of patient information might carry dire consequences for the patients on that machine. Imagine, for instance, suddenly exposing the HIV+ status of hundreds of individuals through the loss or theft of a device.
And yes, software exists that can remotely wipe and track stolen or lost devices, but cunning hackers can make easy work of these. The serious threat of lost data is diminished significantly through the use of Chrome OS. A cloud EMR (or other application with patient data) allows network administrators to focus on securing fewer points of entry and be less worried about every single machine in the hospital network. If a Chrome OS device used in the clinical setting were lost, it’d be a minor incident.
And viruses, which are another way data can be compromised, are likely to be a non-issue for Chrome OS. The Chrome browser is widely recognized as the world’s most secure browser thanks to its clever sandboxing approach, which locks code running on your machine to specific areas. And if a problem were to arise, quick automatic updates of the OS would likely stomp them faster than on a traditional OS. Some of the worst security blunders in history have come from viruses or hacks that exploit out of date software. Tremendous benefit follows keeping all machines up to date, all the time.
Hardware customizability: The last aspect to Chrome OS that might give it wings in the medical world is the very simple fact that the hardware is customizable. Apple, for now, contracts out excellent hardware but could you imagine them making one specific to medicine? Maybe a tablet with an anti-microbial surface? Or a device with both CDMA and GSM wireless chips to ensure data connectivity? Part of the iPad’s appeal is that the tablet form factor is simply great for clinical medicine. Soon there will be many other tablets and soon some of those tablets might run Chrome OS. And these Chrome OS tablets might be thinner, lighter, and last longer than ever given that Chrome OS needs only minimal hardware. Also, Samsung’s Nexus S, and Amazon’s Kindle have shown that folks besides Apple can, with the appropriate dose of will, produce great hardware too.
So what needs to happen to make Chrome OS more appealing, both for the world of medicine and elsewhere? Firstly, bandwidth in the US needs to get faster. At some point, the data transfer rate between a cloud server and local machine will approach the data transfer rate between a hard drive and a local machine’s RAM. When that happens, running hosted applications through one’s browser won’t feel significantly different than running applications locally. This will enable a whole new suite of web apps, from radiology viewers that can access all of a patient’s scans and render them in a beautiful, quick 3D, to medical information databases that are continuously up to date. Apple originally resisted 3rd party applications on iOS, suggesting instead that developers code web applications. These, however, weren’t powerful or quick enough, especially given Apple’s 3G network. They were hindered just enough that they never took off, but as data transfer from the cloud to the user’s machine gets quicker, this is likely to change.
Another necessary shift is that the Internet will need to be viewed as even more of a required utility. The CR48 is more of less worthless when it’s not connected to a WiFi network. But at some point, when having access to the Internet is viewed as essential as having electricity, it could become acceptable that computers will need to be connected to the web in order to run properly.
Perhaps most importantly, there’s a secondary benefit that will come from bringing medical computing into the cloud, be it through Chrome OS or simply an increased adoption of cloud EMRs. Health IT evangelists often imagine a world where data standards and anonymous sharing enable a whole new level of medical analytics. With pooled health data new hypotheses might be tested that previously would have required expensive observational trials. Drugs with harmful side-effects would be more easily identified and new treatment protocols could be written. The sort of sharing necessary for these robust analytics is made much more difficult when patient data is on local machines, either on a doctor’s computer, or a hospital’s servers. The adoption of Chrome OS has the potential to catalyze the move to the cloud, and thus this holy grail of medical analytics.
Link: Chrome OS