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Technology Integration at the Point of Care


By Beckie Kelly Schuerenberg, Senior Editor July 2007
Duncan (Okla.) Regional Hospital CIO Roger Neal had a single, yet extremely important, requirement for a point-of-care medication administration system: It had to fit within nurses' workflow.

That single requirement, however, could only be met by tying together multiple aspects of the system. First, the software had to provide an intuitive interface and be tightly integrated with the 150-bed facility's hospital information system. And, more important in Neal's eyes, the hospital had to find a hardware device that nurses wouldn't balk at using.

"There are a lot of medication administration systems out there, but when you get to the device, that's the breaking point," Neal says. "Nurses need hardware that's designed to fit their workflow-something that's not heavy, has a good battery life and can help them do everything they need to do at the point of care."

Duncan Regional ultimately implemented technology from San Diego-based IntelliDOT Corp. The vendor's CAREt system comprises software integrated with proprietary handheld devices that can be used to scan bar codes on drugs, patient wristbands and nurse badges for verification during medication administration. The devices also can be used to scan paper forms with bar codes in the shape of dots developed by the vendor that have been programmed to represent common documentation data, such as normal vital signs.

The CAREt handheld application integrates with Duncan Regional's hospital information system, from Medical Information Technology Inc., Westwood, Mass. The hospital also has asked the vendor of its infusion pumps, Cardinal Health Inc., Dublin, Ohio, to work with IntelliDOT to develop a wireless interface between the devices and the CAREt system.

"We want to ensure we are giving nurses all the available information at the point of care," Neal says. "So it doesn't matter if we have to integrate three or nine systems. At the end of the day, it's much better for the nurse and the patient."

Now that wireless networks have become nearly standard, a growing number of provider organizations are making them the backbone for ambitious point-of-care technology strategies. The strategies are yielding innovations in a number of areas, including medication administration, patient registration, clinical reference information access, charge capture and hospice care.

But many providers, including Duncan Regional Hospital, aren't moving full speed ahead with point-of-care initiatives until they are satisfied they can deliver a seamless system to clinicians.

"The slow movement in point-of-care technologies hasn't been for lack of interest, but because of what's required in the process, one requirement being that vendors tightly connect the technologies that providers want to use together at the point of care," says John Quinn, a partner in the health and life science consulting practice at New York-based Accenture. "There's been an incremental improvement each year in what hospitals are using at the point of care, and if you look at it over a five-year period, they've made a giant leap."

Movin' On Up

In Duncan Regional's case, before moving up to the bar code-based system it implemented last spring, the hospital's executives looked into other applications that run on radio frequency identification technology.

RFID often is touted as superior to bar codes for data capture because it doesn't require a line of sight. Nurses, for example, don't have to move a patient's arm to match up their wristband with an RFID-based reader as they would with one that reads bar codes.

But despite the advantages of RFID, Duncan Regional in the end chose the bar code-based CAREt technology because it offers an integrated hardware and software application that can work with its hospital information system, Neal says.

"We looked at a few different types of systems, but it's nice to have a single vendor for the hardware and software," he says. "And because of the integration, whatever we capture on it, we can put right back into the patient's EMR."

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