Easy Steps to Point-of-Care Computing - Industry Trend or Event

Health Management Technology, July, 1999 by Ava Schutzman

Point-of-care computing is one the fastest growing market segments within clinical computing. Healthcare organizations pondering a POC implementation effort are often faced with a staggering choice of vendors, applications, client and server hardware, and implementation models.

While sifting through so many, options can be a major task, the benefits of implementing a POC solution are worth the effort. Many organizations have discovered the price/performance viability of POC technology and have come to see how such technology can be integrated with critical applications. Early adopters have started to reap both qualitative and "hard dollar" benefits from implementing POC technologies.

POC Market & Technology

Results from the last two years of surveys at the annual Health Information and Management Systems Society (HIMSS) conference confirm that interest in POC solutions is growing. For example, in the 1998 HIMSS Leadership Survey sponsored by IBM, CIOs were asked to choose from a variety of clinical information challenges faced by healthcare institutions today and to rank them in order of magnitude. "Collecting patient data at the point-of-care" was identified as the third most important factor, accounting for 15% of responses.

Investing in point-of-care devices such as pen tablet computers or personal digital assistants (PDAs) and wireless technology accounted for up to 30% of the 1998 responses to questions about CIOs' spending plans for emerging technologies. In the 1999 HIMSS survey, that percentage increased to 33% despite the need for Y2K investments, with increased interest in wireless information appliances.

Each component requires planning and design to implement correctly. Each must interact with the other components to function properly. And each must be maintained and supported throughout its useful life. The number of different vendors involved can be overwhelming!

POC Device Choices

It is the mix and complexity of POC applications in an organization, combined with the degree of mobility needed, that determines the choice of device types.

In Diagram 1, the vertical axis shows the intensity or severity of the healthcare environment, which gets more complex as you move up the axis. On the bottom horizontal axis, as you move to the right-hand side, applications become more demanding from an IT perspective. The simpler functions shown on the left include check-off sheets such as used either clinically for MD rounds, or administratively for inventory management of various types.

[Diagram 1 ILLUSTRATION OMITTED]

The third dimension, mobility, is represented by the color of the circle; generally, with green or blue, applications require more mobility, e.g., on-site trauma or inventory management vs. purple icons for stationery intensive care or surgery.

The point-of-care devices segmentation map (Diagram 2 on page 22) shows the range of devices and vehicles (carts and rolling stands) that may be used portably in patient care settings. As you move further up and to the right in the diagram, the devices provide more functions or utility and are correspondingly more expensive. POC computing devices are available in a number of different configurations. Each offers varying functions at varying costs. The graph depicts the range of devices, from handheld PDAs and pen or tablet computers, to laptops strapped to carts, to wall-mounted flat display systems, to extremely robust workstations. All are deployed in mobile modes.

[Diagram 2 ILLUSTRATION OMITTED]

You can map the second diagram to the application environments depicted in the first diagram: The heavier, more robust workstations and wall-mounted devices will tend to be more appropriate to stationery applications such as intensive care. Lightweight handhelds will be most useful for extremely mobile applications such as trauma, home care, nursing at the bedside, and, for administrative purposes, inventory management.

For each different case, however, a different mix of applications may have to be chosen.

Technology and WLAN Vendors

A wireless LAN is a data communications system that provides wireless peer-to-peer (PC-to-PC) and point-to-point (LAN-to-LAN) connectivity within a building or campus.

Most wireless LANs -- or WLANS -- are used to augment, rather than replace, wired LANs. As such, they are incremental to the current network infrastructure. WLANs provide connectivity to a LAN in places where wiring is difficult, costly, or inconvenient to employ. The technology most commonly used in wireless networks is called "spread-spectrum," and it has two different implementations for transmissions: direct sequencing and frequency hopping.

Direct sequencing sends a redundant bit pattern, called a "chip," for each bit of information transmitted. In frequency hopping, a radio signal "hops" randomly through a large band of frequencies as it emits bursts of data.

Data security need not be a concern with wireless networks. Besides the inherent security of 2.4GHz frequency-hopping spread-spectrum transmissions, wireless manufacturers have supported the creation and adoption of communications security standards, including encryption of send/receive signals that provide "wired equivalent privacy" and much better overall data protection. As with all technologies, WLAN vendors are continually improving the price/performance equation. Faster transmission speeds with increasingly better performance are in development.