Mobile Carts Turn a Corner

Beckie Kelly Schuerenberg, Senior Editor
Health Data Management Magazine, July 1, 2008

When All

Children’s Hospital purchased mobile computer carts about four years ago, I.T. staff had high hopes for the devices. They envisioned clinicians using them to take various clinical systems, including admission/discharge/transfer, nursing documentation and electronic records, to the bedside.

The St. Petersburg, Fla.-based hospital’s nurses, however, weren’t as enthusiastic about the carts. After trying several models, they complained the carts were too big, bulky and slow to use regularly during patient care, says Deborah Whittemore, client technology specialist.

So after a few years of inconsistent use, the hospital’s I.T. staff decided to implement new carts. But this time, they ensured clinicians were much more involved in the selection process, Whittemore says.

“We put test devices from three or four vendors on our floors and then waited for nurses to give their opinions of them,” she says. “And everyone had an opinion.”

The nurses finally settled on the 1750 model cart from Flo Healthcare, Norcross, Ga. The hospital now has more than 70 of the devices deployed in various departments and plans to purchase 30 more later this year.

“We want to stay with this model,” Whittemore says. “We’ve seen other ones, but this one really has all the accessories that we wanted.”

Many hospitals began deploying carts several years ago to help mobilize their clinical systems. But some, like All Children’s, have had a difficult time selecting one type of cart as the standard.

Some of this uncertainty could be a result of the increasing number of vendors and the variety of accessory combinations for the devices that are now available, says Gregg Malkary, managing director at Spyglass Consulting, Menlo Park, Calif.

“Mobile carts have been around a while,” he says. “But they’ve really evolved and now there are a lot of differences among them.”

Some hospitals, however, have concluded that their issues with cart adoption aren’t related to the hardware itself, but the software, infrastructure and workflow they are trying to use with it, Malkary adds.

“If all these things aren’t integrated together, the solution won’t work,” he says. “So sometimes choosing a mobile cart is really a matter of trial and error.”

And some experts urge hospitals to optimize their clinical workflows before even considering purchasing carts.

Evaluating Features

Before executives at All Children’s Hospital took their second shot at deploying mobile carts, they evaluated new hardware with features and accessories they believed would resolve nurses’ issues with the original devices.

To address their size and weight concerns, the hospital wanted the new carts to be equipped with a thin-client PC, which doesn’t have a hard drive and wirelessly connects to a server where applications reside. Executives believed this would make them lighter than the previous devices they had deployed, which housed a fully loaded laptop PC. In a further effort to keep the carts lighter, they declined to add drawers or shelves to the devices.

Long battery life also was an important feature for All Children’s nurses because their old carts only alerted them to battery status when they had 20 minutes of run time left. So the hospital wanted its second-generation carts to have a gauge to enable nurses to easily determine at all times how much battery life they have left.

The executives and nurses chose the 1750 model carts because they have all these features and accessories.

“Without nurses’ input on various features, I.T. would have purchased whatever we wanted and the devices would have ended up sitting in a closet,” says Whittemore, the client technology specialist. “They had been using other carts before, but not a cart like this one. So they took right to them when we began implementation.”

Now All Children’s nurses regularly use the new carts to access the PowerChart electronic health records system from Cerner Corp., Kansas City, Mo., and other clinical applications from Medical Information Technology Inc., Westwood, Mass. The hospital plans to offer access to more clinical applications on the same devices, Whittemore says.

But just as I.T. executives thought they had found their mobile cart panacea, clinicians and other employees began asking for modifications. For example, some nurses and admissions staff members requested that drawers and shelves be added to the devices so they could store the pens and paperclips they use with various paper forms.

The hospital also is evaluating adding a bar-code medication verification application from Meditech, which would require equipping some of the carts with a scanner and base.

While Whittemore doesn’t think a single drawer or scanner would add too much weight to the carts, she plans to retrofit a few and then test them to ensure the accessories won’t cause users to reject the devices like they did with the previous models.

“We’ll let clinicians see how they will work with the new drawer,” she says. “If they like them, we will buy more of that kind, and if not, we will try something different. But now, the nurses don’t want to let go of the new mobile carts. They’ve changed their whole attitude about the hardware.”

Workflow Issues

Although Lawrence & Memorial Hospital involved nurses in the selection of its original carts from the start, many still had issues with the hardware after it was deployed.

But the problems weren’t because the 280-bed, New London, Conn.-based hospital chose the wrong cart or accessories for it, contends Paula Archer, pharmacy clinical analyst. Instead, the slow adoption was the result of software and workflow issues, she says.

“There were a lot of hiccups and bumps,” Archer says. “But a lot of that could have been taken care of with better user training on the software and devices.”

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