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Carts in a Time of Transition

June 25, 2010
by Mark Hagland
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As multiple trends shape how clinicians do their work, CIOs ponder the future of mobile carts

Executive summary

CIOs are actively trying to figure out how to plan for the mobile computing needs of their clinicians in the next several years. Though a broad range of viewpoints prevails across the healthcare system, most CIOs believe they will continue to rely heavily on mobile computing carts to meet clinicians’ computing needs within their facilities, even in the face of the emergence of newer, tablet-sized computing devices. Clinician needs and preferences remain paramount considerations as CIOs move to replace sometimes-aging current fleets of computing carts.

Hospital and health system CIOs are finding themselves pulled in multiple directions these days when it comes to the deployment of mobile carts for clinical computing: so much so, in fact, that it sounds like one of those classic “on the one hand, on the other hand” stories. On the one hand, CIOs are committed to meeting the needs of nurses, physicians, and other clinicians, as they pursue their critical work on a day-to-day basis, and that means doing as much as possible to address clinicians’ practical needs - and their preferences - for computing tools. On the other hand, as they look toward the horizon at a new generation of smaller and smaller mobile devices, some CIOs are actively trying to figure out where the concept of computers on carts will fit in what could be a drastically changed computing environment several years down the road. And on yet another hand, most of those interviewed for this report believe that mobile carts will continue to play an important role going forward, though perhaps with some modifications over time.

Mark Bolster, UPMC

In other words, as is the case with practically every important issue facing them these days, hospital and health system CIOs are expressing a broad range of views on the strategic future of mobile computing carts.

Some, like Jim Venturella, CIO, hospital and community services, for the 20-hospital University of Pittsburgh Medical Center (UPMC) system in Pittsburgh, Pa., are firm believers in carts as a fundamental facilitator for clinician computing in today's complex work environment. “For us, carts are an integral part of workflow for our nurses and for many of our medical residents, and I think that will be so into the future,” says Venturella, whose massive organization currently has over 2,200 carts deployed across UPMC's facilities (1,700 computing carts, and 500 medication carts). “We've got many different models of deployment of PCs across our facilities, and in my view, there is no perfect solution to that element of computing, whether it's PCs in patient rooms, right outside patient rooms, or hanging in the hallways.” In that context, he says, “Carts are the best model out there, because of their flexibility, though they tend to be expensive.” Like many CIOs, he plans to keep replenishing his organization's fleet of mobile carts, and cites many factors for the success of carts in his health system's hospitals, particularly the fact that clinicians, especially nurses, use them as portable workstations, especially in crowded, older facilities with limited space. Residents at UPMC's academic hospitals are also big cart fans, and use them for physician documentation, results checking, and to access the organization's picture archiving and communications system (PACS).

Jim venturella
Jim Venturella

Other CIOs, like Gregory Veltri, vice president and CIO of the 500-bed Denver Health, a public hospital in Denver, Colo., can see both advantages and disadvantages going forward into the future, but are following what they see as the mandate of clinician needs and preferences anyway. “Our current carts are at the end of life; we've had them five years,” reports Veltri, who has about 100 carts deployed across the teaching hospital. “We'Re looking to replace the current fleet, to my chagrin, because they are a maintenance headache,” he says, “The batteries wear out; the nurses forget to plug the carts in; and the carts take a lot of abuse-parts get knocked off. But,” he quickly adds, the bottom line for him is that “the nurses like them so much.”

Will smaller mobile devices change the landscape?

Strategically speaking, the biggest wild card factor in the landscape for planning around mobile computing is the unfolding emergence of smaller handheld computing devices, with the most attention of late focusing on Apple's iPad, which debuted this spring to much fanfare and hype. At a time when many hospital organizations are replacing aging fleets of mobile computing carts, will the introduction of the iPad - and almost certainly, of competitor products in the relatively near future - change the calculus around cart planning? CIOs are deeply divided.