Carts in a Time of Transition

On one end of the spectrum are executives like Denis Baker, vice president and CIO of the 800-bed Sarasota (Fla.) Memorial Hospital, who says, “From my point of view, carts were a bad solution to the problem to begin with. Maybe, given the state of laptops at the time, they were the only practical solution” a decade ago, Baker says. But, he says, he objects to the cost of carts, and to what he sees as the lack of healthcare-focused customization he'd like to see on the carts currently being deployed in hospital organizations. Baker sees a future, including at his organization, which is building a replacement patient care tower, in which “We'll be getting away from the personal computer concept, and creating community computers, with charging stations for devices outside every patient room, and devices fairly ubiquitous throughout the patient care area.”

But most CIOs are far less categorical about the issue, and even those, like Russ Branzell, CIO and vice president of IS at the 427-bed, two-hospital Poudre Valley Health System in Fort Collins, Colo., who would like to try to migrate to smaller devices like iPads, see a continuing trajectory for computers on carts. On the one hand, Branzell says, “Organizations that haven't made a considerable investment in carts will probably look for other solutions, such as the iPad-type device, which already has more robustness than it did a few months ago.” On the other hand, he says, “I think we will use our carts for four or five more years, but we may reconfigure them, based on nurses’ preferences. So instead of having heavy laptop devices on carts, we may instead be working on very thin notebooks or on touch-screens driven by VMware (virtualization software developed by the Palo Alto, Calif.-based VMware).”

Other CIOs are strongly inclined in favor of carts to begin with; and among those is David Muntz, senior vice president and CIO of the Baylor Health Care System, a 14-hospital system based in Dallas. “I favor carts to begin with, because they enable mobility, especially for nurses,” Muntz says, adding what other CIOs have noted: “Carts are really for nurses; desktops are fundamentally for doctors. The only things l don't like are the battery power issues and the large physical footprint of carts,” he says. In any case, Muntz says, “Right now, the problem with the tablets and other small form factors is that you need both hands free when you go into the patient room. And the small form factor is better, but not for bedside computing.” At Baylor, Muntz notes, “We let users choose how they'll compute; and some units have chosen wall-mounts. But no matter what configuration of devices you choose, there will be a mismatch for at least a part of your organization,” because, he says, clinicians will inevitably express a range of preferences among quite diverse mobile computing options.

Such results are backed up by studies, such as a few performed in the past couple of years by researchers in the Waltham, Mass.-based Emerging Practices division of the Falls Church, Va.-based CSC. Based on studies of clinician work patterns and device preferences commissioned by large hospital systems recently, Jared Rhoads, senior research analyst in CSC's Emerging Practices, says, “I definitely could see a roaming pharmacist using the iPad, and maybe some docs; but you can't use it for everything. Hospitals are not going to be deploying iPads en masse, completely replacing laptops and carts.” Instead, especially for nurses, Rhoads sees most hospital organizations continuing to rely strongly on mobile carts, with a combination of different types of computers (sometimes fully loaded laptops, but in many cases, so-called “dumb terminals”) on them, for most of the intensive, day-to-day computing needs of non-physicians. “In our organization's recent study of laptops, workstations, and mobile devices, there wasn't a clear winner” in terms of clinician preference, notes Fran Turisco, principal researcher in Emerging Practices. Put another way, Rhoads says, “We found that no one device within any organization has ever turned out to be both the most preferred device on the part of some people and yet also the most acceptable to all people. In fact,” he says, “the device that tends to excite some people the most, turns some people off.”

Given all this, CIOs will inevitably have to determine what their organizations’ clinicians want in terms of a mobile computing environment, and how precisely they work, in order to create the best working conditions for them; and for the vast majority, that will mean ongoing investments in computing carts, say most of those interviewed for this article. What advice would CIOs like UPMC's Venturella give their colleagues? “Start from the standpoint of workflow,” he urges. “Make sure not to overbuy, but also that you have enough devices out there. And that will probably mean devices of different types, and from different vendors. It's all about understanding workflow, and understanding your facility configuration - and satisfying the clinicians who strive to deliver the best patient care every day.”

Healthcare Informatics 2010 July;27(7):26-29