Mobile Computing Improves Patient Care

Regardless of which industry you're in, making your employees comfortable with the technology they are using is imperative to making a solution effective. Think about it; employees will be hesitant to use the technology and systems available if they are not comfortable. Employee reluctance results in each employee using their own system, which can result in decreased productivity, increased overtime, and an unpleasant working environment. Now imagine this situation in a hospital, and factor in new HIPAA (Health Insurance Portability and Accountability Act) privacy laws and the lack of access to real-time patient data. This was the case at Delnor-Community Hospital (Geneva, IL), a 118-bed facility located in the western suburbs of Chicago.

Outdated System Fails To Meet HIPAA Standards
Delnor-Community Hospital oversees 10,000 admissions and observations, 31,733 ER visits, 753,255 outpatient visits, and 1,514 births a year. With that volume and an outdated data collection system, the process of gathering and accessing patient medical records was not efficient. "In 1998 we started using a nursing documentation software from a healthcare software vendor. Nursing and ancillary departments were documenting and reviewing patient medical records online on wall-mounted computers at the patients' bedsides," says Lisa Janeway, clinical coordinator at Delnor-Community Hospital. Nurses and ancillary staff would use these computers to enter data typically found on a patient's medical chart. However, these staff members were not using these systems to their fullest extent due to a lack of practicality. "The patients or visitors would interrupt when staff members were entering data, the device itself was loud, and the screen could not be repositioned for privacy," explains Janeway.

To compensate for the weaknesses of the system, staff members collected data from patients by writing it down on paper first. After collecting the data, the information was entered into the hospital's documentation system on the PCs located in the nurses' stations. "The terminals at the nurses' stations were limited in number, causing wait time and end-of-shift documentation. Not only did this lead to overtime, but it also created a breakdown in information. Patients' real-time medical data was not available to employees [dieticians, doctors, etc.] who often needed access to it for diagnosis and care," says Janeway. Since physicians also need access to these nurses' stations computers, they were becoming frustrated when nurses were not using the systems available in patients' rooms.

New HIPAA privacy laws and an approaching deadline put Delnor in a time crunch to replace its legacy systems. "HIPAA privacy rules were not being met using our former systems. In some of the patient rooms, non-care providers could see personal medical information on the computer screens," Janeway says. If Delnor did not spend the money it was allocated for new technology, it would forfeit those funds.

Integrator Demos Several Solutions In One Day
After running usage statistics on the wall-mounted devices and investigating several options to remedy the problem, Delnor chose a mobile cart solution. To find out which technology and options were available, a multidisciplinary evaluation team attended a trade show to seek out a technology partner. Delnor looked for a supplier that could demonstrate several products from several vendors in one day at their location. "So many times a new product is demonstrated and by the time you see the next one, you have forgotten what the first one was like," explains Janeway. "Infologix, Inc. (Bensalem, PA) [integrator of wireless data collection systems] was able to bring a variety of mobile carts to our facility almost immediately after the conference. This enabled us to test all of the devices on the units so we could make the best decision." The following components were chosen for a total mobile computing solution:

• 60 Infologix laptop carts
• 60 Compaq EVO 800C laptops
• 12 Compaq EVO 600C laptops & laptop cases
• 27 Compaq 15-inch flat screen and small form factor PCs
• 27 Ergotran arms
• 6500 and 4000 series Cisco catalyst switches
• 30 Cisco Aironet access points
• Cisco LEAP (light extensible authentication protocol) on Client for security
• Cisco Aironet NICs (network interface cards)

Before the hospital completely replaced its legacy system, testing had to be performed. "The first thing we had to do was make sure the batteries worked. From there, we did load testing to determine how many carts would work on one access point without jeopardizing performance. After that, we tested each mobile computer's print functions and Internet access, and we ran through every application to make sure the software was installed properly," says Janeway. The carts were piloted on a medical/surgery floor for one week. Then, each of the 60 carts was brought up one at a time, so glitches were worked out before the next one went live. Infologix worked with the hospital to make sure the tests were conducted properly and integration with its WLAN (wireless local area network) was complete.

Reduced Hardware, Real-Time Capabilities
Delnor met its deadline with a successful implementation completed in six months, and the hospital came in under budget. It was able to replace 164 computers with 94. Post-implementation studies performed by Delnor show the nursing and ancillary staffs are using carts almost 100% of the time. "Now we have real-time data. With the cart, staff members can wheel it right up to the patient, sit down face to face, and do the interview while they enter the data," says Janeway. Since the data is now entered immediately, other hospital staff members can gain access to the information as soon as it becomes available to the nursing staff. Computers are available to every nurse on duty, so they are no longer lining up at stations waiting for a terminal to open up, and double entry has been eliminated.

Since the carts are mobile, HIPAA regulations are being met. Staff members have the ability to place screens where only the staff member collecting the data can view patient information. The newer system also allowed the hospital to install new software programs and gain Internet access. Using the Internet, staff members can check on medications and other online nursing references to help teach the patients about their condition. The staff can also use the carts to make meetings with groups, such as social services, more efficient by using them to display patient information during conferences.

With this mobile cart solution, Delnor was able to make its employees comfortable with the technology they had to use daily. By working with an integrator, the hospital was also able to test many solutions at once and make its deadline. According to Janeway, Delnor will be implementing similar mobile carts from Infologix in the future in its pharmacy, respiratory therapy, and same-day surgery departments.