"If I ask clinicians what they need, they tell me they want a computer with a 50-inch high-resolution screen and unlimited battery life that fits in the palm of their hand. I don't know how to make that happen," jokes David House, vice president and CIO at Baptist Health, Little Rock, Ark. Baptist Health has some 3,500 "workstations" at its seven hospitals that use a wide variety of hardware and software, House says. And that makes maintenance a nightmare. So Baptist is slowly moving toward a thin client approach. Gradually, more clinicians are accessing applications that reside on servers by using low-cost PCs and other devices serving as thin clients.
Some hospitals that are just starting to phase in electronic health records, however, are attempting to simultaneously phase in standard hardware as well. For example, 60-bed Bates County Memorial Hospital in Butler, Mo., will primarily use tablet computers paired with its new EHR, says Daniel Cook, a hospital employee with the title "I.T. consultant." The tablets were a perfect fit for many reasons, Cook says. One key factor, he says, is that they include a built-in bar code reader for use with the hospital's emerging medication administration program.
FORECASTING THE FUTURE
House, the CIO at Baptist Health in Arkansas, is finding it difficult to predict what hardware options will emerge in the years ahead. "Doctors and nurses will be using the smallest, lightest devices with the longest battery life that have the most communication capability and highest resolution screen that they can get," he says. "But what we'll really get is a compromise between all those things."
For the immediate future, House sees no ideal option. This whole idea of a workstation strategy has been a work in progress for us," he laments. "I keep hoping and dreaming to one day find the perfect device, but I can't find it."
Baptist's seven hospitals in Arkansas have tried a long list of hardware strategies. For example, the hospitals tried PCs in patients' rooms, but wound up pulling them out because of a lack of space as well as concerns about expense and data security. They also tried placing computers in alcoves in the hallways, but those generally didn't work out because of the lack of a place to sit. Plus, the hospitals have used tablets that clinicians carry as well as laptops mounted on computer carts.
After weighing all the available options, House has concluded that a thin client approach may be the best solution, at least for now. Although he believes that thin clients "are really the only way to create an economically supportable model," he's waiting for the devices to improve. A thin client strategy greatly reduces the acquisition and maintenance costs for front-end devices, he acknowledges. But it involves new expenses, such as robust servers to house applications as well new infrastructure.
Baptist already has invested in an application access network from Citrix Systems Inc., Fort Lauderdale, Fla., to support devices functioning as thin clients. Most of these devices are basic PCs, primarily from Dell Inc., Round Rock, Texas. Eventually, House expects to invest in true thin clients without hard drives once the technology improves.
Meanwhile, about 125 doctors who already used smart phones to access e-mail wanted to be able to use the devices to view clinical data from the hospitals' core system, from GE Healthcare, Waukesha, Wis. So Baptist acquired remote access technology from Thomson Reuters, New York, to enable doctors to use phones to view lab results, transcribed reports, radiology results, vital signs and other data, especially when they're not in the hospital.
About 40 physicians use Blackberries from Research in Motion, Waterloo, Ontario. Others use a wide variety of other smart phones.
"In our model, we don't provide the mobile technology, the doctors do, so I have to accommodate many devices," House says.
AN EVOLUTION
Like Baptist Health and many other provider organizations, the Seton Family of Hospitals in Austin, Texas, a unit of Ascension Health, finds itself in the midst of what some might call a never-ending hardware transition.
For the past four years, doctors and nurses have accessed a clinical information system from Cerner Corp., Kansas City, Mo., primarily by using Dell laptops mounted on mobile carts, says Gerry Lewis, CIO. The carts are mainly from Flo Healthcare, now a unit of Emerson Electric Co., St. Louis.
The 10 hospitals in the delivery system tried tablet computers, but found that most of the mobile devices never left their docking stations because clinicians wanted to use them with a keyboard. Thus, using carts, which hold a laptop, a 19-inch monitor, a full-size keyboard and a 12-hour battery, proved much more practical, Lewis says.
As the laptops wear out over the next several years, Seton plans to, in certain cases, phase in thin clients from Wyse Technology, San Jose, Calif., linked to an existing Citrix network. In addition to using the devices on carts, some will be placed at nursing stations, Lewis says.
"We'll never use thin clients 100%," the CIO says, acknowledging that other computers may be better-suited over the long haul for certain uses. But the thin clients should dramatically slash both hardware and maintenance costs, Lewis predicts.
INFRASTRUCTURE ISSUES
As they experiment with thin clients, hospitals must install the necessary network infrastructure to support remote access to applications. And some hospitals are finding that, over time, their network strategy must evolve.
In moving to thin clients in tandem with a rollout of a clinical information system from Meditech, Westwood, Mass., Norton Healthcare has shifted from a Citrix infrastructure to networking technology from VMware Inc., Palo Alto, Calif., a unit of Hewlett-Packard.
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