The recent proliferation of mobile clinical point-of-care applications presents several significant challenges for the CIO. As more and more devices become available and clinicians are continuously courted with the latest magic bullets, CIOs are faced with tough situations, like how to determine which devices — and how many — to purchase in order to appease clinicians. And then there are the issues of how to support multiple applications on a wireless infrastructure, and how to anticipate and manage workflow changes.
Some have likened it to a juggling act, where the CIO stands at center stage trying to balance the needs and preferences of the clinicians with what is feasible, both from financial and logistical standpoints.
One of the biggest challenges, according to Frank Clark, Ph.D., CIO and vice president of information technology at Medical University of South Carolina (MUSC, Charleston, S.C.), is that there is so much disparity from one clinician to the next when it comes to personal preferences. And it isn't simply an issue of nurses and other clinicians gravitating toward one type of device while physicians liking another.
“It depends on the individual,” says Clark. “Some nursing units will have a predilection toward a cart or computer on wheels, and some like the handhelds. Some like to chart and asses in the room, others like to go outside. And physicians are the same way; there's no one type of appliance that's favored by all.”
Clinicians' preferences also vary according to their setting, he says. At MUSC, which includes two adult hospitals, a children's hospital, and a psychiatric facility in its 600-bed system, Clark has found that the clinicians at each facility practice medicine — and therefore document care — differently. And the discrepancies aren't just seen from one facility to the next, but also from one unit to the next, making it next to impossible for a CIO to predict what types of applications to order.
“Sometimes we feel a nurse is a nurse, but that's not the case. What type of care someone practices has an impact on their preference of devices and how they deliver and administer care to the patient,” says Clark.
As a result, Clark, who has been CIO at MUSC for five years, chose to deploy a variety of devices including carts, wall-mounted devices, and traditional PCs. Most recently, the health system implemented the C5 Mobile Clinical Assistant tablet from Motion Computing Inc. (Austin, Texas), which will integrate with San Francisco-based McKesson's Horizon Expert Documentation system for nursing documentation, and Horizon's AdminRx for bar coding medication administration. “We've tried to meet the clinicians' requests, and to that end, we've deployed a mixture of devices,” says Clark. “I think you just have to estimate the total number of devices on the front end, but then try not to get into details as to the mix of how many fixed devices, carts, tablets and PDAs.”
The strategy he has employed is not uncommon; in fact, more and more facilities are opting to offer multiple applications, even within the same units.
“There's enough opportunity for all of the devices that are currently being marketed,” says Marc Holland, analyst, Health Industry Insights, an IDC company (Framingham, Mass.). “You have to look at who is the end user because what is appropriate for a nurse is not necessarily appropriate for a physician, and neither of those may be appropriate for one or more various professionals like phlebotomists or physical therapists,” he explains.
Along those same lines, he adds, what is appropriate in an office setting or ambulatory setting may not be appropriate in an inpatient setting.
The solution, it would seem, is to supply applications to fit the varying needs of clinicians. The challenge here, says Clark, lies in planning and budgeting not just for different types of devices, but also for the right quantities of each device.
“You don't want caregivers to have to wait in line for a device, particularly clinicians who are rounding,” says Clark. “And you want to make sure the devices are accessible. It's a numbers game. Not only are you trying to have enough; you're trying to have the right mix of devices, and we've had to go back and refine and order additional devices to make sure of that.”
Things can snowball quickly, says Holland, particularly if a CIO doesn't want to say no to devices that are favored by particular groups of clinicians. But, he says, “If you say yes to all of those, then you wind up needing to support five, six, or seven different devices.”
And this, aside from stretching the limits of the CIO budget, can also wreak havoc on a facility's wireless infrastructure.
Having the infrastructure
The first consideration in rolling out multiple point-of-care devices, says Clark, is to ensure continuous coverage — a task that can be quite daunting.
Making sure that the wireless network is up and running with no dropped connections and timely responses has been challenging, according to Clark. His staff has had to add additional access points and antennas, and has experimented with using different bandwidths and levels.
The complexities, however, don't stop there.