Making the most of mobility: far beyond wish lists and clinical acceptance, an abundance of factors must be addressed for successful implementation of point-of-care workstations - Point-Of-Care Workstations

Health Management Technology, Oct, 2002 by Gary M. Coonan

Addressing patient safety and confidentiality regulations became a primary focus for most healthcare leaders during the past five years, and placing computer workstations at the point of care (POC) was considered one obvious solution. The vision of most CIOs now is to enable intelligent communications and to provide patient information, medical data and error prompts any time, anywhere through seamless mobile systems.

The number of wireless devices used in healthcare is expected to triple by 2005. A study by Technology Assessment Associates concludes that technology improves data accuracy, reduces errors and improves overall patient care while controlling costs. Today, many metro hospitals use mobile workstations for medical records, diagnostics, charting, pharmacy, admissions, billing, OR and ER services. Many smaller hospitals are just now adding the technology to their budget cycles due to the lack of funding, top management buy-in, personnel acceptance or sufficient IT resources.

To successfully go live with mobile workstations, IT and clinical analysts must sort through numerous issues.

The process of integrating current or new software into universal point-of-care systems is complex:

* Finding robust, reliable, wireless and user-friendly workstations may be an arduous task;

* Devising meaningful methods to quantify the benefits and return on investment to justify the expense can make or break the program;

* Motivating clinicians to accept and use the real-time systems, and getting vendors to effectively deliver reliable products and support, can deliver unexpected challenges to CIOs' plans.

Bedside Benefits

Even with the challenges, there is no better way to reduce errors and ensure patient safety than having decision support and documentation POC workstations in use from admission through discharge. Today, pioneers of real-time information systems are beginning to see marked results that verify cost savings, error reduction, patient satisfaction and overall efficiency.

Joe Bruno, field technician coordinator for Memorial Medical Center in Modesto, CA, says, "We are one of four corporate regional centers and the leader when implementing new technology. Having mobile bedside devices made sense to us. This keeps the caregiver at the patient's bedside, and while the caregiver enters data, a bond can develop between the two, making the patient relaxed and more open to quicker healing. The plus comes in the form of the follow-up survey completed by the patient. A summary indicates compassion and the human touch makes our facility the best in the area."

A white paper by Mercury MD also concludes, "Physicians can confirm results at the bedside to expedite the patient disposition process and reduce length of stay. Physician extenders can review patient diagnostic studies at the bedside, increasing patient satisfaction. Immediate access to information eliminates the time-consuming burden of data gathering ... shouldered by nursing. Pharmacists can access culture data, metabolic test results and medication profiles on the spot to assist in guiding physician medication choices."

Physicians can write prescriptions at the point of care, from their offices or home computers. While inputting orders, physicians can be prompted about drug interactions, potential alternatives, formulary restrictions and patient limitations. As a result, generally illegible handwriting is not an issue and the electronic support systems at the bedside can deter errors.

As an example, when incorrect data is entered, a warning flashes and the nurse or physician can re-evaluate the orders or procedures. Bar code scanning systems added to mobile workstations now ensure the right patient receives the correct medications at the right times. Other benefits include an ability to refer to progress notes and basic patient records when the attending nurse or physician is working with the patient. Records such as exam notes, diagnoses and patient orders can be accessed, and the user also can generate records including capturing charges.

Changing Attitudes

Just a few years ago, physician and clinician acceptance was one of the primary factors working against utilization of POC technology. Today, the benefits mentioned above and the availability of documentation when legal issues arise help to dilute objections. In some cases, management's mandate to accept and use technology has forced immediate change, in the long run, however, education and training are more successful measures.

Because interns and student nurses use advanced technology in medical and nursing schools, they are attracted to facilities with sophisticated technology when they begin their professional careers.

"With the shortage of nurses and more demand on our expanding hospital, utilization of fully integrated computer workstations and sophisticated systems may help us attract young nurse graduates and recruit more experienced nurses also," says J.W. Huff, director of information systems at Williamson Medical Center in Franklin, TN. "We generally apply one Stinger workstation to every two nurses on patient floors, and these are also used by physicians and ancillary departments. Although it varies by department, one workstation supports approximately 12 patients at a time. The results include a readable, more accurate and consistent chart, along with reduction in stay-over time for nurses to catch up on the paperwork."