Health Management Technology

With the challenge of the electronic health initiative looming, the time had come for Orlando Regional Healthcare to get up to speed, technologically speaking. Our board decided to replace our legacy Clinical Information System (CIS) with one that would meet several organizational goals such as improved clinical outcomes, medication error reduction and anywhere/anytime access to our patients’ records. Established in 1918, Orlando Regional is a Central Fla.-based not-for-profit healthcare organization with over 6,000 clinicians spread over eight hospitals including Arnold Palmer Hospital for Children and M. D. Anderson Cancer Center Orlando with well over 3,300 beds between the two.

As part of our major clinical automation initiative, I was called upon to help implement and manage the technical aspects of the wireless CIS. The new system would automate workflow, allow physicians and clinicians to enter orders, and provide instant access to information. This would reduce our reliance on paper, increase clinical accuracy and efficiency, and improve our revenue cycle. Built with input from representatives from every facility and department that would be using it, the software was also tailored to meet their specific needs.

What began as a “Big Bang” implementation and activation approach was later adjusted to a methodical, and facility-by-facility activation. Ultimately, we found the software capable and the staff willing, but the pre-existing computer hardware was not able to support the workflow of mobile workers consistently in this fast-paced environment.

Chief among the reasons was that all nursing units have dedicated hard-wired PCs. Because of the workflow changes we depended on computers just as much, if not more than paper records, so wireless computers had to be used. At the time, the enterprise did not have a wireless LAN. So, before we acquired the mobile devices, we had to complete our WLAN implementation.

Life is Tough for Tech
As computers in the healthcare environment become more mobile, the reliability of the hardware becomes more critical. The migration to a paperless environment can result in greater disruption when digital equipment such as notebook computers become damaged or somehow impede day-to-day workflow. Other significant disruptors include poor wireless signal reception in key work areas that prevent clinicians from accessing patient records, or poor battery life that requires a notebook to be tethered to an outlet every two hours.

It is an unfortunate truth that life in a hospital can be brutal on technology, where it is prone to drops, spills and general mistreatment. Additionally, the pace of a hospital requires that caregivers focus on caring for patients and not coddling computers. Valuable clinician time can be lost in an environment where patients in duress can jolt or knock over computers, resulting in shattered displays or irreparable damage to disk drives.

As Strong as the Sum of its Parts
In order for our CIS software to help create a paperless environment, we knew that the network delivering data had to be ubiquitous and fast; the software had to be stable; and the hardware had to be reliable. What was needed was a durable computer designed for use on the go. After long deliberation of available choices, our 20-member committee, culled from all disciplines within the various Orlando regional hospitals, chose the Panasonic Toughbooks.

In addition to being durable, we wanted to make sure the form factors we deployed would be easy to use, lightweight, and offer long battery life and wireless connectivity. Ultimately, we purchased more than 1,000 Toughbook ultra portable tablet alternative T2s and T4s. About 25 percent of the units are dedicated to individuals, while the rest of the Toughbooks and other computers are shared devices available on the floor for anyone to log onto. We also bought a number of desktop computers, wheeled cart computers and PCs mounted to articulating arms, leaving the Toughbooks assigned to users working in the most volatile environments—at the front lines of patient care.

Barring accidents, normal notebooks would last about a year or two before problems started. The Panasonics on the other hand, are expected to surpass that record in spite of the occasional drop, which we attribute to the strong magnesium alloy cases and shock mounted removable hard drives. Warranties can become an issue when portable technology suffers damage and must be temporarily removed from service. While the Toughbook’s construction has reduced notebook repairs by 30 percent, a comprehensive service and support warranty from Panasonic ensures expedient and reliable service if it does happen.

Another notebook feature that has proven valuable is the touch-sensitive display and hand strap on the T-series notebooks, despite clinicians finding them awkward to use at first. Holding the notebook by the strap located on the underside of the device near the hinge, you can use the other hand to manipulate your application with the touch sensitive screen. This quickly turned out to be very intuitive because users can switch to using the keyboard without the physical rotation required with a traditional tablet. A clinician can just set the device down and start typing.

More Benefits, Unforeseen and Otherwise
Clinicians must focus solely on their patients and should not have to manage or fix the technology in place to serve them. So, when paper is removed from patient care, the key driver for cultural acceptance is a durable and reliable computing system with a network connection that can deliver information on demand.

We are currently working to implement a voice over IP communications system that will use our 802.11b wireless network, enabling staff to make and receive voice calls. When used in conjunction with our mobile devices, this will ultimately provide our clinicians with virtual access to the information they need, when they need it. We are very dependent on our mobile devices as one of the most important vehicles in delivering safe, consistent and high-quality bedside care.

Alexander I. Veletsos is IS director at Orlando Regional Healthcare, Orlando, Fla. Contact him at alex.veletsos@orhs.org.

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