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From the October 2002 Issue Order in Chaos: Transforming Best-of-Breed Solutions Into Integrated Solutions |
Making the Most of Mobility Far beyond wish lists and clinical acceptance, an abundance of factors must be addressed for successful implementation of point-of-care workstations. By Gary M. Coonan
The number of wireless devices used in healthcare is expected to triple by 2005. A study by Technology Assessment Associates concludes that technology improves data accuracy, reduces errors and improves overall patient care while controlling costs. Today, many metro hospitals use mobile workstations for medical records, diagnostics, charting, pharmacy, admissions, billing, OR and ER services. Many smaller hospitals are just now adding the technology to their budget cycles due to the lack of funding, top management buy-in, personnel acceptance or sufficient IT resources. To successfully go live with mobile workstations, IT and clinical analysts must sort through numerous issues. The process of integrating current or new software into universal point-of-care systems is complex:
Bedside Benefits Even with the challenges, there is no better way to reduce errors and ensure patient safety than having decision support and documentation POC workstations in use from admission through discharge. Today, pioneers of real-time information systems are beginning to see marked results that verify cost savings, error reduction, patient satisfaction and overall efficiency.
Joe Bruno, field technician coordinator for Memorial Medical Center in Modesto, CA, says, “We are one of four corporate regional centers and the leader when implementing new technology. Having mobile bedside devices made sense to us. This keeps the caregiver at the patient’s bedside, and while the caregiver enters data, a bond can develop between the two, making the patient relaxed and more open to quicker healing. The plus comes in the form of the follow-up survey completed by the patient. A summary indicates compassion and the human touch makes our facility the best in the area.” A white paper by Mercury MD also concludes, “Physicians can confirm results at the bedside to expedite the patient disposition process and reduce length of stay. Physician extenders can review patient diagnostic studies at the bedside, increasing patient satisfaction. Immediate access to information eliminates the time-consuming burden of data gathering … shouldered by nursing. Pharmacists can access culture data, metabolic test results and medication profiles on the spot to assist in guiding physician medication choices.” Physicians can write prescriptions at the point of care, from their offices or home computers. While inputting orders, physicians can be prompted about drug interactions, potential alternatives, formulary restrictions and patient limitations. As a result, generally illegible handwriting is not an issue and the electronic support systems at the bedside can deter errors. As an example, when incorrect data is entered, a warning flashes and the nurse or physician can re-evaluate the orders or procedures. Bar code scanning systems added to mobile workstations now ensure the right patient receives the correct medications at the right times. Other benefits include an ability to refer to progress notes and basic patient records when the attending nurse or physician is working with the patient. Records such as exam notes, diagnoses and patient orders can be accessed, and the user also can generate records including capturing charges. Changing Attitudes Just a few years ago, physician and clinician acceptance was one of the primary factors working against utilization of POC technology. Today, the benefits mentioned above and the availability of documentation when legal issues arise help to dilute objections. In some cases, management’s mandate to accept and use technology has forced immediate change, in the long run, however, education and training are more successful measures. Because interns and student nurses use advanced technology in medical and nursing schools, they are attracted to facilities with sophisticated technology when they begin their professional careers.
“With the shortage of nurses and more demand on our expanding hospital, utilization of fully integrated computer workstations and sophisticated systems may help us attract young nurse graduates and recruit more experienced nurses also,” says J.W. Huff, director of information systems at Williamson Medical Center in Franklin, TN. “We generally apply one Stinger workstation to every two nurses on patient floors, and these are also used by physicians and ancillary departments. Although it varies by department, one workstation supports approximately 12 patients at a time. The results include a readable, more accurate and consistent chart, along with reduction in stay-over time for nurses to catch up on the paperwork.”
Educational programs that start months or even years prior to going live have helped to quell user reluctance. “Change is always hard,” says Jani Greene-Arnold, clinical coordinator at Merle West Medical Center of Klamath Falls, OR. “We worked for more than a year to communicate and illustrate the benefits our employees would receive with point-of-care systems. We finally convinced our staff that mobile systems eliminate need for double documentation. The fact that they can enter data anytime, anywhere is a major time-saving factor. They don’t have to rekey data, and the information goes with the patient. Our staff can take occasional breaks now, and they have more time to give more personalized care. ” Run Times and Beyond Even with improved clinical workflow, reduced paperwork, more timely decision making and fewer medical errors, a number of hurdles still face most IT departments. Achieving reliable run times over entire shifts continues to plague operations. Most mobile workstations transport off-the-shelf laptops with consumer features that quickly deplete the small battery’s power. Most hospitals add larger, external power systems to their mobile workstations. However, these are drained quickly by the laptop battery’s need to restore. Down time can result, causing user frustration and increased costs such as stay-over. A fully integrated computer workstation designed to eliminate the unnecessary power draining features of standard laptops is one answer. Most facilities plug in workstations when not in use, yet critical care departments need full shift run-times, so the problem must be resolved. When hardware causes down time, quick-change programs that allow the hard drive or CPU to be replaced in only minutes provide immediate solutions. Longer warranty periods and easy-change configurations establish little need for IT or third party repair services. In most hospitals, the standard process for product selection begins with clinical informatics personnel outlining their user “wish lists” for a perfect system. Generally, users require a workstation that is small, lightweight and easy to move around in cramped quarters. The workstation should allow users to sit when entering data, and it should be easily adjusted to their specific height when they need to move. Clinicians refuse to use tools to adjust the desktop into position, and they usually want a writing surface and drawer space. Large screens are always requested, and many want touch screens, a feature that complicates power issues. Today, IT managers are exploring voice recognition technology, since they perceive it will delight older, less computer literate nurses and physicians. Other wish list entries include workstations that are color-coded by department, with add-on accessories to customize units for specific functions. OR, ER, pediatrics, neo-natal/nursery, ICU, and recovery and isolation all require workstations that can handle fluids and can be continually wiped down. Administrators demand features to deter physical theft of the computer and insist that patient information cannot be easily read or accessed by anyone other than authorized users. The IT department generally wants to disallow external loading devices so staff cannot alter the applications or add games and work distractions. Significance of Going Live Going live can be brutal. Months of planning, writing procedures and documentation, and implementing training and motivational programs precede the actual installation. IT, clinical informatics personnel and even vendors all realize they will live at the facility until the installation and implementation process is completed and running well. Many organizations install department-by-department, taking time to study the obstacles as they go. Pioneering facilities often become the research centers and facilitate less complicated implementation for the others. It is not always possible to foresee complications with first time installations, and many IT staffers feel that management support to delay the go-live date is critical until all tests verify success. Being late with the installation or waiting on a superior new product is better than forcing the program through because of a deadline. Standardization of online services, better care assessment and decision support, more accurate medication administration, overall costs savings, and unparalleled patient safety and satisfaction are all usually gained through programs that implement mobile, point-of-care technology. Most say it’s worth the pain and expense—that the savings in efficiency, lives and reputation will balance the scale.
For more information about POC workstations from Stinger, www.rsleads.com/210ht-197 © 2002 Nelson Publishing, Inc |
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Addressing patient safety and confidentiality
regulations became a primary focus for most healthcare leaders during the past five years, and placing computer workstations at the point of care (POC) was considered one obvious solution. The vision of most CIOs now is to enable intelligent communications and to provide patient information, medical data and error prompts any time, anywhere through seamless mobile systems.
Joe Bruno
J.W. Huff
Jani Greene–Arnold
Gary M. Coonan
is chief executive officer of Stinger Industries, LLC, Murfreesboro, TN. Contact him at