A rapid expansion of computing hardware options is paving the way to better patient engagement and increased productivity. For that to happen, CIOs must balance their choices against workflow issues, infrastructure requirements, and budgetary constraints.
Without a doubt, this is an exciting time when it comes to computer hardware selection, with a rapid growth in options available to doctors and nurses making their daily routines. The choices being made by CIOs are, in a very real sense, transforming the vision of healthcare reform and policy decisions into care delivery reality.
New choices of mobile devices such as tablets and smartphones are providing clinicians with far more flexibility as they make their daily rounds, while wall-mounted flat-screen monitors in patient rooms are proving to be powerful education tools for patients who are being given the information they need to take a more active role in their own care. When added to the more traditional computing inventory of workstations on wheels (WOWs), PCs, and laptops, there seems to be something for everyone when it comes to meeting clinician preferences. Meanwhile, some vendors are beginning to develop software products that support these new hardware tools.
These potential benefits come with their own set of challenges. Most of all, developing a robust IT infrastructure, and introducing these tools in a way that meshes with clinician workflows and enhances productivity, at a time of significant budgetary constraints for hospitals, is a combination of factors that is proving daunting for many healthcare IT leaders. Added to all this is the need to meet meaningful use deadlines at the same time. And in trying to meet those challenges, CIOs are finding that there is no such thing as one-size-fits all.
As noted by Curt Kwak, CIO of the western region of Providence Health and Services, Renton, Wash., “Everybody has the same requirement: make data available, and make data easy to access and use; and the devices need to be very functional. It's the differences in preferences that we are trying to corral and standardize across the enterprise. And that is going to take a little bit to do.”
EVERYBODY HAS THE SAME REQUIREMENT: MAKE DATA AVAILABLE, and MAKE DATA EASY TO ACCESS AND USE; AND THE DEVICES NEED TO BE VERY FUNCTIONAL. IT'S THE DIFFERENCES IN PREFERENCES THAT WE ARE TRYING TO CORRAL AND STANDARDIZE ACROSS THE ENTERPRISE. -CURT KWAK
‘WORKHORSE’ STAYING POWER
Preferences are often tied to workflow and the task at hand. Larry Funk is the former CEO of Laguna Honda Hospital and Rehabilitation Center, a post-acute care facility in San Francisco, who now runs a healthcare consultancy in the San Francisco Bay area. He maintains that nurses do see the value of having a charting device near the bedside, which many hospitals have sought to provide with wall-mounted computers in the patient room or WOWs, but he adds that clinicians still need some degree of privacy and separation during charting. Some hospitals have sought to satisfy both demands by positioning fixed computers outside patient rooms, which allows patients to be observed but also provides a level of privacy for charting activities.
Jim Venturella, CIO of the University of Pittsburgh Medical Center (UPMC) health system's Hospital and Community Services Division, agrees. After testing the model of having computers in patient rooms, “We moved away from that model,” he says. “Clinicians want to be away [from patient rooms] when they are doing documentation or orders,” he says.
In Venturella's view, part of the continuing demand for WOWs involves their versatility. He describes the carts as a sort of go-between model that can be moved in and out of rooms as needed, to accommodate various workflow needs. WOWs are still the workhorse at UPMC, he says. They can be wheeled where needed, and also serve as a workspace. UPMC has just gone through a process of streamlining its carts for medication delivery and specimen collection, he says.
Chuck Podesta, senior vice president and CIO of Fletcher Allen Health Care, Burlington, Vt., who has embraced many of the new hardware choices, maintains a healthy respect for carts. “The issue with nurses is that they always have something in their hands,” he says. “With the cart, they can take all of that stuff with them.” He advises caution when deciding to implement new computing tools. “People need to study workflow before they say we'll just have a bunch of iPads at nursing stations that they can just grab and run. Eventually we will get there, but we are not there yet,” he says.
Roland Garcia, senior vice president and CIO of Baptist Health, Jacksonville, Fla., says choices are influenced by real-estate constraints and the environment of care. At his hospital, the ICU and ED have computing devices by the bedside; while med-surg units have a complement of workstations, WOWs, and mobile devices.