Workstations on Wheels: A solution to improve care delivery, operational efficiency, and the organization’s bottom line

Healthcare providers confront increasingly onerous care delivery, reimbursement, cost containment, and legal and regulatory compliance pressures. Patient safety, profitability, and clinician and consumer loyalty are primary goals and business drivers for virtually every care delivery organization.

Clinical researchers modeling nursing workflow recently compared some care settings to “combat zones.” Caregivers increasingly are burdened by growing numbers of aged, acutely ill, complex, and co-morbid patients as human and capital resource shortages stress the entire healthcare system. And, while a dizzying array of expensive medical and healthcare information technologies (HCIT) have been deployed, systems used by clinicians are poorly adopted, underutilized and not well regarded as solutions to these challenges.

With the proliferation of electronic medical records (EMRs) and maturing wireless technologies, WOWs have become the predominant point-of-care (POC) mobile device form factor. According to HIMSS Analytics (2006), more than 75% of U.S. hospitals report some level of WOW adoption. Other mobile device technologies include tablets, laptops, hand-helds and portable devices such as barcode scanners. But are these tools really in use, or are they sitting idle while overworked clinicians revert to manual, familiar patient care processes?

KLAS’s 2007 “Nursing Adoption of IT – A Look from the Inside Out” research reports that nurses “en masse” believe EMRs are woefully fragmented, hard to use, and inefficient. KLAS research participants rank “device issues” at the POC as the third largest obstacle in nursing adoption of IT.

To date, relatively few healthcare executives leverage IT as a key strategic asset because the majority of IT investments have failed to achieve anticipated benefits or return on investment (ROI).

In order to effectively leverage mobile technology for clinical and financial gain, executives must promote a supportive environment that engages key stakeholders and encourages investments in critical prerequisites such as workflow analyses and training. IT-centric, hardware-oriented approaches to clinical device and WOW selection are doomed to fail.

A number of recent well-publicized clinician-driven studies report unexpected consequences of poorly deployed IT, including mobile clinical devices. Hard-to-use or underperforming mobile clinical devices are an additional encumbrance on already overburdened clinicians.

• Use of WOWs in hallways rather than at the POC results in inefficient and error-prone patient data collection processes. Errors and lag time due to delayed data entry impacts the quality of decisions made by local and remote physicians, care providers, and case managers. In its landmark 2007 report, “Unlocking The Power of Nursing IT,” The Advisory Board Company regards the adoption of “workflow-supportive devices” as essential to hospital ROI on IT, calling it the “first of first order priorities” for hospital executives.
• Poorly designed or ignored processes, as well as under-performing devices, can place patients’ lives at risk. Perhaps most dangerous is a prevalent barcode-enabled medication administration (BCMA) “workaround” that relies on patient ID bands being replicated and placed on WOWs or doorways, where cumbersome WOWs can’t reach the POC. In this case, the technology is more likely to introduce errors than prevent them.

To achieve real benefits and ROI from WOWs, plans and budgets must account for:

• Goal setting and alignment among stakeholders and beneficiaries who focus on adoption and satisfaction metrics instead of targeted budget and schedule goals;

• Clinical leadership and visible support of established best practices;

• Aggressively promoting benefits of new care models (streamlined clinical documentation and safer medication administration processes) to all stakeholders;

• Device training, including policies and procedures related to infection control and battery performance;

• Adequate numbers of devices to support clinician needs;

• Wireless network coverage, reliability and quality of service;

• Clinician leadership and accountability for achieving benefits and “non-compliant” staff remediation.

Upfront investment in requisite change management and infrastructure will soon pay dividends downstream in clinician adoption that drives benefits and ROI. Without this investment, the hospital will never meet its goals or the clinicians’ needs and expectations. Hospital leadership has long undervalued and under-invested in efforts that are critical to IT and to enabling device success.

Nursing care is a key driver of physician and patient satisfaction, and nurses are the largest care provider professional group and predominant users of WOW technology. Thus, investment in the successful adoption of IT by nurses can pay huge dividends in the form of improved clinical, financial and service performance. It also can optimize the benefits of multi-million dollar investments in EMRs and wireless infrastructure.

Wireless technology is nearly ubiquitous in hospitals, as it is in everyday life. While older clinicians may reject new technology, the younger workforce demands it. Mobile clinical workstations should be vehicles for enhancing clinician productivity and access to critical information and tools at the POC. In today’s emerging “pay for performance” hospital reimbursement environment, these process improvements can significantly impact the organization’s bottom line. With October 2008 Medicare rules, complete and timely clinical documentation related to “present on admission” conditions can improve reimbursement rates and accelerate cash flow.

As EMRs proliferate, increasing numbers of physicians and allied health professionals, as well as patients and their families, are leveraging evolving WOW technology. No single device form factor can effectively support all users, for all processes, at every point of service, in both inpatient and ambulatory settings. Complementary blended devices tailored to specific work centers, processes and users’ preferences are expected to be the norm. WOWs offer advantages in many settings and are preferred by clinicians because their unique capabilities best address their needs, and those of their patients. This is especially true in places where larger screen size and work surface are key.

Next generation WOWs are being enhanced to improve POC access, functionality, technology integration, and telehealth. New capabilities include integration with software that captures data from diverse patient monitors and medical devices (IV smart pumps and ventilators) for seamless transfer of information into the patient’s EMR, with appropriate validation by clinicians, where it immediately is available for physician and care team review.

Today in most care settings, electronic data is transcribed much later manually into the chart or second computer system, which most often is the EMR. While POC data is critical for clinical decision-making, the effort to transcribe this data and enter it into the EMR is inefficient and error prone. This extensive duplicative data entry is a huge unacknowledged resource drain and source of extensive risk for virtually every care delivery organization. For example, the average surgical critical care nurse transcribes more than 1,000 data points in a single 12-hour shift.

Physicians value access to more accurate and timely patient assessment data for establishing treatment protocols. More informed decisions should spawn rapid initiation of appropriate treatments and interventions, ultimately promoting measurably improved clinical, financial and service outcomes.

In a medical surgical department with fewer monitors and typically less frequent data capture, automating monitor and device data capture has proven to save each nurse or Certified Nursing Assistant (CNA) one hour per shift of unproductive time. This incremental timesavings can be reinvested in direct patient care and more responsive service.

Medical imaging has long played a critical role in the diagnosis, treatment and evaluation of patient status. “Telemedicine” is defined as the diagnosis and treatment of patients in remote areas using medical information, x-rays and/or pictures, transmitted over long distances. In “hub-and-spoke” hospital networks, telemedicine supports collaboration among centrally located experts and local physicians and radiologists, extending service and connecting physicians beyond the hospital. Physicians and radiologists within hospital “hub and spoke” networks can centrally evaluate and recommend treatment to remote peers and lesser-trained counterparts.

WOWs are the ideal mobile devices to support telemedicine programs, with large screen views of integrated information, videos and images. Telemedicine capabilities enable diverse physicians and professionals to communicate with patients at the POC offering a variety of services, including language translation, diagnostic support, and virtual patient visits.

Additional strategic initiatives supported by WOWs include:

• Ubiquitous availability of EMR data to authorized users at the POC;
• Patient and family teaching and discharge planning;
• Self-paced independent and clinician-supported disease prevention and management educational programs;
• Patient self-service kiosks that decrease wait times in emergency departments, ambulatory clinics, and hospital admitting departments.

As hospitals and other care delivery organizations face difficult clinical, financial and service challenges, WOWs can be effective vehicles for improved patient care, clinical documentation, and patient services.

A key lesson learned in replacing first-generation WOWs is the need to closely align goals among clinical and IT stakeholders. Inadvertently, hospital executives incent CIOs based on budget and implementation timeframes that conflict with the organization’s targeted business and clinical goals.

Investment in change management, process improvements, end-user training, and wireless network infrastructure will have huge downstream payoffs if targeted process improvements are realized. Without spending in these critical areas, WOW investments won’t pay off. Failed WOW deployments reinforce the ineffectiveness of “device-centric” approaches that predictably end in under-utilized or abandoned devices and squandered investment.

Flo Healthcare’s best-in-class WOWs continually improve in functionality, including tighter integration with software applications and medical device technologies. As the trends discussed in this article continue to develop, CIOs will be expected to manage an increasing number of wireless applications and technologies on a single device platform, best achieved when “built by design” and delivered as a fully integrated “out-of-the-box” solution. With scalable WOW design, workstations can be augmented and customized over time to support the new patient-centric technologies as more robust, cost-effective wireless solutions are available. This process enables a continuing return on initial WOW investments.