A growing number of health care organizations are making new choices of mobile hardware after getting some experience with point-of-care computing under their belts.
For example, over the past four years, Alegent Health, an Omaha, Neb.-based nine-hospital delivery system, struck out twice with its choice of point-of-care mobile hardware.
In 2004, its physicians balked at using the Tablet PCs Alegent Health purchased from Motion Computing Inc., Austin, Texas, because they believed the hardware didn’t have a large enough screen to effectively run computerized physician order entry. And in 2006, its nurses complained that the two brands of mobile carts the delivery system implemented for bedside documentation and medication administration were too heavy and bulky to push, says Michael Westcott, M.D., chief medical information officer.
“We worked with the vendors to make changes and incorporate new designs to improve maneuverability, but we still had issues,” he says. “It got to the point where our nurses were complaining of back and neck problems from pushing the carts and asked if there was something else we could offer them.”
After two disappointing deployments, Alegent Health executives decided to try a new form factor. In April 2007, the med-surg unit of the delivery system’s Lakeside Hospital became a pilot site for the new C5 Mobile Clinical Assistant from Motion Computing. The device, which resembles a tablet but is equipped with a handle, was originally designed by Intel Corp., and released by Motion in February 2007.
While the pilot only lasted a few weeks, it resulted in a 62% increase in nurse satisfaction with the hardware and related clinical workflow changes. Further, the delivery system recorded a 42% improvement in point-of-care documentation when nurses were using the C5 devices, Westcott says.
“When we compiled the results of the pilot, it was amazing,” he says. “Nurses really liked the handle. Now physicians are asking me when they can have the device with a handle that they’ve seen the nurses use.”
Alegent Health has deployed 18 C5 devices in the same department that piloted them. And it plans to buy more of the new hardware to implement in other departments later this year, Westcott says.
Phase Two
Now that many health care organizations have experience with point-of-care computing, they are finding they need different functionalities or different form factors than they originally selected, says Erica Drazen, partner for emerging practices in the global health services group of Computer Sciences Corp., El Segundo, Calif.
“Point-of-care mobile hardware is still a work in progress,” she says. “That’s not surprising though because a lot of hospitals still haven’t enabled access to data at the point of care. But for those that have, there are always mobile hardware issues they didn’t anticipate once they got into it.”
For example, clinicians sometimes don’t realize what they need from a point-of-care device until after they’ve been using one for a while. So just a few months into a deployment, they might complain that the hardware they chose is too heavy or doesn’t have a large enough screen.
Health care organizations also might not realize they don’t have the infrastructure to support the devices they’ve selected until after implementation. In some such cases, a hospital’s original mobile hardware doesn’t get used as intended because there are not enough places to store and recharge the devices or a stable enough wireless network for them to work effectively, Drazen says.
Further, industry practices have changed since some health care organizations began their foray into point-of-care computing. For example, the amount of data that can be used at the point of care has dramatically increased, while some hospitals’ mobile hardware was selected to support only a single, small data application.
“There’s still no one single device for point-of-care computing,” Drazen says. “It’s experimental and even very individual within a hospital or title of caregiver. As a result, everyone offers multiple types of devices for different tasks.”
While Alegent Health plans to deploy more C5 devices, the delivery system currently offers a mix of mobile devices for point-of-care computing. Most nurses still use the original mobile carts to access the documentation and medication administration applications, from Siemens Medical Solutions, Malvern, Pa., at the point of care.
Others, however, are using the Motion Computing Tablet PCs that were originally intended for physicians. The delivery system equipped the devices with a scanner and set up docking stations for them in clinical areas so nurses could get accustomed to a new form factor before the C5 pilot, says Westcott, the CMIO.
Alegent Health worked with the vendor before the pilot to determine what features and functionalities the delivery system now needed from a mobile computing device.
“Nurses thought the mobile carts would work best for them before we implemented the documentation system,” he says. “But when we added medication administration, we were trying to have them do something they weren’t designed to do.”
The pre-pilot analysis found that nurses not only wanted to use a smaller device at the point of care, but also one that offered an integrated scanner so they wouldn’t have to deal with cables and cords as they did with the carts and Tablet PCs.
While the size issue was inherently eliminated with the smaller form factor of the C5, there were other features of the new device that the nurses found appealing during the pilot. For example, instead of scanning bar codes on patient wristbands and medications during administration, nurses can use the C5 to take a photograph of the bar codes to facilitate verification. This feature enables nurses to loosely hold the C5 over the bar code rather than awkwardly turn the patient’s arm or the device to get a direct line of site that’s usually required for scanning, Westcott says.
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