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Accenture

In the evolving world of electronic healthcare record keeping, technology devices are the key togetting the right information to the right people at the right time.

Many Choices, Real Benefits

Desktops, tablet PCs, mobile laptops, computers on wheels, handheld devices — technology devices that access an EHR system provide a universe of opportunity.

Despite the real benefits these devices offer, the devil is in the details. How can a CMIO or CIO navigate the technology needs of a healthcare organization based on anticipated benefits? The challenge must be resolved between caregivers and devices. Caregivers must adapt their processes to the right devices and devices must be flexible enough to adapt to caregiver needs.

There is no “silver bullet” solution. The key to choosing appropriate devices lies in a careful assessment of the advantages and disadvantages of each device and how the devices will plug into existing systems and the greater EHR enterprise.

Improve Patient Safety

Technology devices have a role in enabling the success of critical initiatives such as clinical documentation and computerized physician order entry (CPOE). These devices can help reduce medication errors in inpatient settings and improve patient safety by adding access points to medical data, increasing the chance that clinicians will have the right patient information at their fingertips when needed.

For example, by using mobile technology devices, nurses can use the clinical system at the point of care to ensure the right medication is being administered at the right time to the right patient. Accurate recording of medication administration becomes a mere byproduct of this action. Similarly, direct CPOE provides widely cited patient safety benefits, such as immediate expert rules and other alerts for the physician to guide the ordering process in real time.

Increase Care Efficiencies

The use of technology dramatically increases care efficiencies. High-tech monitoring devices can “auto capture” information for monitoring patients. For example, critical care nurses spend most of their time monitoring the vital statistics of critically ill patients. During any one shift, they may record great quantities of patient data that are vital to their patients’ well-being, a timeconsuming process.

In a technology enabled healthcare environment, an IV pump can be programmed to administer medication at a certain rate. A nurse can use a handheld device to scan a bar code on the pump. The handheld is connected to the hospital’s wireless network, so the handheld identifies the pump, based on the bar code, and issues a request across the network. The IV pump responds by broadcasting data back and populating a screen on the nurse’s handheld device. By simply scanning the bar code on the IV pump, the caregiver instantly records a great deal of data without investing the time or encountering the potential entry errors of the manual effort.

In addition to substantial patient benefits, direct physician order entry increases efficiency because it eliminates paper and the extra steps — each with extra potential for human error — needed for medical transcription and data entry.

Increase Charge Capture

By moving to electronic charge capture, the cumbersome coding and charge entry process can be dramatically streamlined. Physicians use handheld devices to capture and wirelessly transmit professional charges from the examination area to a coding and billing support team, eliminating the paper trail. In addition, hospital technical charges can be entered into the system immediately, as a by-product of clinical documentation recorded by nurses and ancillary department technicians, reducing — if not eliminating — both the entry and payment lags.

Enhance Mobility

Handheld electronic devices enable clinical staff to carry medication reference information to the point of care. These devices are small enough to keep in pockets or on belts, leaving hands free for other duties. Information on drug indications, doses, interactions and other considerations can be downloaded to these devices for quick reference.

Many hospitals are piloting the use of handheld electronic devices linked via high-bandwidth, wireless networks to the main hospital network. As devices converge, physicians can now use a single device such as a cellular telephone, personal digital assistant or pager and an access point to the hospital network for accessing patient records. In this way, a physician could go home or on vacation and remain actively linked to hospital information.

Save Time

RFID tags, a wireless identification system, can save time in a hospital setting. By embedding them into patients’ armbands when they are admitted to the hospital, the tags allow hospital and emergency personnel to track the status and exact location of patients quickly and easily. RFID, coupled with location-based services, can also be used to locate critical equipment and gear.

Barriers to Success

Despite the many benefits offered by technology devices and electronic record keeping, significant barriers to success remain.

Costs

Technology devices are expensive; no hospital can afford to buy what it won’t use or what will be used less than optimally. It’s important to determine the devices that will clearly help physicians, nurses and other professionals. Correctly estimating the number of devices needed is also imperative.When healthcare organizations fail to accurately predict the volume of devices needed, the equipment is either underutilized or in short demand.

Ownership and Maintenance

A key decision point that influences the number of devices an institution will purchase is who owns and maintains the devices. Devices can either be owned by an individual caregiver or by a work area. When providing devices for each individual (such as a pager), responsibility falls clearly on the user. This requires the purchase of additional devices but it fully engages the caregiver in the “care and feeding” of the device.When devices are assigned to a work area, such as a nursing unit, responsibilities must be clearly outlined. Although this seems mundane, devices without owners quickly become unusable due to unreported problems, creating dissatisfaction with performance and lack of availability within the community.

Ease of Use

When technology devices or processes are difficult to use, they become a barrier to the success of an overall EHR initiative. For example, physicians inputting data into a desktop workstation in patient rooms may be required to log in each time they enter a new room.Without a seamless sign-on, this step in the care-giving process becomes cumbersome, causing frustration and reversing any efficiency gains from adding the technology.

Interoperability

Interoperability among devices, applications and platforms is a huge issue, especially with the EHR initiative in its infancy. Although most applications are moving toward a Web-based infrastructure, the sheer number of applications being developed makes it difficult to link systems under a connected EHR model.

For example, hospitals that embrace tablet PCs are often surprised to discover that applications that run on these devices cannot run on desktops or laptops. On the other hand, laptops and desktops are universally compatible and can share applications.

Likewise, most handheld devices require a specially coded “client” that recognizes that the limited screen size will demand a focused approach to interacting with the caregiver.

Care-Giving Preferences

Sometimes technology devices deliver benefits but are not used by nurses or physicians due to personal preferences about how to deliver patient care. For example, some clinicians do not like to be distracted by computer hardware when they are in a patient’s room, as they prefer to focus attention on the person receiving their care. Alleviating the problem by moving devices to the hallway creates challenges with privacy and accuracy. Locating devices at the nursing station is next to impossible in most institutions because of the limited workspace and competing needs. The location and types of devices used must be matched to personal preferences while providing for ease of use.

Security

As more and more IT systems are converted to Web-based infrastructures, healthcare providers will continue to incur risk in exchanging health information over the Internet. Technically these problems are solvable; however, the perception of reduced security is enough to hamper the adoption of new technology devices in many organizations.

In addition, the physical location of some devices compromises the security of patient information. In some hospitals, desktop PCs are located outside patient rooms, requiring nurses to “chart” in the hallway, making it easy for patient health information to be divulged to passersby.

Obsolescence

Technology devices change rapidly, creating cost barriers to purchasing new equipment. The possible obsolescence of a technology device and its software should be considered as part of an organization’s overall device strategy.

The Approach: Establish a Technology Device Strategy

Before investing in technology devices and software, healthcare organizations must take a conservative approach by assessing needs and creating a design for implementation. One of the most important considerations for all players must be how these devices will work in to individual EHR systems and the community EHR as a whole. Several steps and considerations are helpful for organizations that are developing a technology device strategy.

Plan for Evolving Standards

Because interoperability is a huge issue, organizations must decide which standards will be adopted as part of a technology device strategy. For example, HL7 is the leading, ANSI-accredited, international standard for data exchange among computer systems in healthcare. There are additional standards for fixed and wireless networks, operating system platforms, bar coding, security and authentication, coding and electronic health record architecture. Healthcare organizations should choose an infrastructure and devices that comply with evolving healthcare standards to minimize roadblocks and incompatibilities that might be encountered with individual EHR initiatives.

Conduct a Needs Assessment

Needs assessment is an evaluation of the functions desired from computer and networking technology or the needs the technology is expected to meet. This step helps determine exactly what devices are needed and can save hours of wasted effort and expenditures.

All players need to be considered when crafting a needs assessment. A surgical nursing unit’s needs differ greatly from those of a critical care nursing unit. Likewise the billing department needs different equipment than the pharmacy. A cross-functional team of clinical professionals who will use the devices, technology specialists and EHR application specialists should form the core team for conducting the needs assessment.

After determining the types of devices needed to complement the EHR functionality, criteria should be established to guide the final decision.

Consider Usability

Consider usability when selecting devices. For example, many hospitals prefer using desktops to communicate patient information because they are relatively inexpensive and easy to use. They are, however, cumbersome in patient rooms. By developing workarounds, such as mounting the desktop on a platform affixed to the wall with an adjustable, swinging arm, nurses can access computers without adding to room clutter. In this way, hospitals make a desktop device “usable,” increasing the chance it will be utilized.

Allocate for Device Footprints

Some devices are larger than others, so consider a device’s footprint as part of the selection criteria. For example, many hospitals use computers on wheeled carts (COWs) to make desktop computers mobile. These devices also provide additional workspace for writing when necessary.

Address Security

Technology devices, such as laptop computers and memory chips, are valuable and are often stolen from hospitals. Some hospitals have solved this problem by chaining computer equipment to carts or workstations, but this can compromise the mobility of these devices. Healthcare organizations with expensive equipment must develop a security plan that protects technology assets without sacrificing usability.

Consider Maintenance and Upkeep Requirements

Most mobile devices use batteries so purchasing and maintaining batteries must be considered as part of a healthcare organization’s workflow.

For example, if a clinic decides to equip patient rooms with mobile laptops, someone must round up all used laptop batteries at the end of a shift and ensure they are charged for the next person’s use. Also many batteries have a one-year warranty, so a decision must be made up front concerning who will buy and replace them.

Support components for the devices, such as the COWs themselves, can provide just the needed fix for battery challenges and should be considered and selected together with the device. Although handy, carts take up space and a hospital must create a “corral” for its COWs so they are not left unattended and are readily available to medical staff.

Other component considerations, such as wireless capabilities integrated into the desktops or laptops, reduce the challenges of separate cards to be maintained.

Consider the Vendor

Whether purchasing desktop PCs for a nursing unit or designing applications for a laboratory, healthcare organizations should seek vendors that make these tasks easy and help choose technology equipment and software that will interoperate with the evolving EHR model.

Vendor collaboration is also a must. If physicians begin using handheld devices, they must deal with a handheld vendor and a separate company that develops handheld applications. For maximum success, both vendors must come together to help users address interoperability issues.

Finalize Selection

Once needs are assessed and criteria are established, a device fair should be scheduled to finalize the selection of specific devices. In addition to the team of experts, the user community as a whole should be invited so that usability feedback can be considered from different perspectives.

The device fair affords the opportunity to rapidly assess how a device meets needs and selection criteria. The fair should also include components such as mobile carts and adjustable, swinging arms, so devices can be assessed in the proper context.

Summary

There are many technology devices available to healthcare practitioners and the benefits they offer are real and tangible. Improved patient safety, reduced error and increased efficiency — healthcare organizations that are experimenting with new devices are achieving impressive results.

Understanding barriers to success and addressing these concerns up front will help healthcare organizations develop the right device strategy to ensure technology helps rather than hinders practitioners. In addition, the need for planning cannot be overemphasized. By assessing needs and planning for different players, evolving standards, usability, security and other factors, organizations can develop a device strategy compatible with a connected EHR.

The best strategy in device selection is to focus on functionality and results. Too many healthcare organizations become distracted by gadgetry and lose sight of the real reasons behind introducing technology — improving patient care and saving time and money.