Mobile Computing Workstations: The Paperless Trail

One hospital’s well-planned journey to wireless point of care and EMR
Ellen Hansen, director of Clinical Informatics Children's Healthcare of Atlanta


May 22, 2006

Electronic medical information improves patient safety by providing immediate and complete access to complex patient information. Having access to information reduces medical errors — yet three decades have elapsed since the electronic medical record (EMR) was first conceived and 16 years have passed since the Institute of Medicine's report called for EMRs.

But time isn’t the only thing littering the long road to EMR.

In 2002, the U.S. healthcare industry used more than 25 billion pieces of paper. In addition, medical knowledge is currently doubling every two years, which, at this rate, will add more facts about the human body in the next 10 years than in the whole history of medicine.

How can clinicians and physicians possibly learn and apply this influx of knowledge in a paper-driven environment without technology?

These and other regulatory and consumer demands are propelling the healthcare industry to boldly go where so many other industries have already gone: into the world of computerization.

But computerizing medical records is not enough — hospitals must also shift away from record keeping in remote nurses' stations and move to interactive documentation at the patient's bedside. It is at the bedside that ongoing assessment and interaction with patients takes place. Studies have shown that the more time a clinician spends at a patient's bedside, the higher the quality of care and the better

the outcome.

Wireless mobile workstations enable clinicians to make the transition more effectively from remote paper charting to real-time electronic charting at the point of care.

Children's Healthcare of Atlanta recently completed the second stage of a multistage transition to EMRs. Today, Children's has electronic access to admission history, medication administration records, orders, results and pharmacy activities, as well as enhanced communication between clinicians and pharmacy. Wireless mobile workstations from Flo Healthcare have been major tools in the success of this implementation.

Methodical Assessment

How did Children's prepare for the implementation of mobile carts? Children's utilizes “department champions” to partner with the project team in the design and build of the EMR. Department champions are front-line clinicians and end-users who are affected by the implementation of the EMR. The hospital has 120 department champions representing 160 departments.

In July 2004, Children's invited several cart vendors to participate in a multiday vendor fair for the department champions. The vendors each had 10 minutes to present their product, and the champions compared the features through hands-on assessment of each cart. The champions then completed a survey ranking each cart and describing the key features that mattered most to them. From this data, a request for proposal (RFP) was drafted, incorporating the features the champions stated were most important to them.

Armed with this information, Children's participated in the 2005 annual HIMSS conference and assessed the exhibiting vendors. It also conducted an Internet search of viable vendors, matching the end-user RFP requirements to the existing products. It determined the top three cart vendors matching its needs and invited these vendors to Children's for a full-scale assessment.

Narrowing the Search

Each of the vendors provided three carts, along with written instructions, to Children's. One cart from each vendor was placed at each hospital location. The carts were moved unit to unit every 24 hours until every unit had spent a day with the carts. Vendors were not permitted to instruct the staff, because the level of intuitiveness of the cart was one of the chief pre- requisites from end-users.

Additionally, the carts were compared side by side as the end-users had time to interact with them. End-users then completed a survey ranking the RFP features of each cart, and the surveys were collated. Vendors were provided with a summary of the scores and verbatim comments on the features of their carts. The final cart selected was from Flo Healthcare, an Atlanta-based mobile cart vendor.

Overcoming Obstacles

One of the most significant barriers to the adoption of the EMR is the lack of ready access to a computer. By placing one mobile workstation between every two bed spaces in general care areas and one at every bed space in the ICU, Children's is living up to its commitment to eliminate waiting for a workstation to access the EMR.

Involving the end-users in the selection of the cart was a key factor to gaining their buy-in. And by providing wireless capability, recharging opportunities and biometric access, Children's made it easy to move the workstation to where it is needed and to log in and out.

Taking time to educate personnel on the use of the cart ensured that all end-users had the skills and information they needed to be successful. Working closely with internal engineering, biomedical engineering staff and Flo Healthcare, Children's has made sure the carts are in working order at all times. With wireless capability and quick, easy access to the EMR, it doesn't make sense to pass a cart in the hallway to go to the nurses' station anymore.

Children's is now well prepared for the full-scale implementation of EMRs and the continual improvement in the safety and quality of care it delivers.


See What’s New

Children’s Healthcare of Atlanta sent a team of nursing and informatics professionals to the 2005 annual meeting and exhibition of the Healthcare Information and Management Systems Society (HIMSS) in order to view the very latest that manufacturers were offering in mobile computing workstations. The HIMSS 06 event offers the same opportunity for viewing many units under one roof — here’s a preview of three new and/or redesigned products to be found at the show.
Rioux Vision Unveils Newest
Wireless Mobile Workstation at HIMSS
The Rio, introduced at HIMSS, doubles as both workstation and med cart and offers a number of innovations designed to better assist healthcare providers in the practice of point-of-care medicine. An optional medication distribution system that can be attached and removed with ease is among its standout features. The system features multiple, interchangeable drawer configurations and independent lock/double-lock mechanisms that can be freely programmed for each drawer.
Once making an initial investment, healthcare facilities can easily expand the capabilities of their Rio workstation fleet rather than purchasing different workstations in the future.
The new workstation features an innovative removable battery system that allows swapping of systems while one recharges, eliminating the need to switch workstations midstream and the restriction of attachment to a wall outlet.
With the unveiling of Rio, Rioux Vision also introduces new power management software that logs battery charge and discharge, allows for on-screen display of power status, and notifies Rioux Vision directly when power system problems occur.
The Rio joins a full suite of computing solutions offered by the company, including the Freedom and Liberty mobile wireless workstations, the Allegiance wall-mounted workstation and the Unity laptop assistant.
Lionville’s iCart for Point of Care Meets
Demands Across Disciplines
Drawing on more than 40 years of experience, Lionville has developed a new generation of innovative carts, cabinets and accessories for point-of-care applications. Lionville products offer all disciplines – information technology, nursing and pharmacy – an unsurpassed range of unique features and benefits.
For information technology: versatile mobile carts designed with flexible technology capabilities that support all software platforms and hardware options including thin or thick client, laptop and all-in-one computers.
For nursing: iCart is ergonomically designed to combine the security features of a medication cart with the timesaving efficiency and error reduction of bedside computing and medication administration.

Additionally, iCart offers:
• Support for all computer technology
• Med security and mobile computing
• Long-life portable battery options
• iCart/pc — one and three drawer models
• iCart/pc — adjustable height models
• Laptop security tray with accessible keyboard on multipivot arm and accessory drawer with dividers
Laptop security trays are available in three different styles for Lionville iCarts. Some trays feature storage space for thin profile battery packs directly under the laptop tray. Some include two-way mouse pads. Trays can be mounted on a choice of multipivot articulating or single pole arms, or on a lazy susan for optimum flexibility in choice. Side-mounted arms are also available for med cart models.
Other accessories for efficient mobile computing include scanner baskets and brackets, articulating or swivel keyboard trays and various sharps bin and other storage options.
Artromick’s New Initi Packs Big Array of Features into Skinny Footprint
The new Initi Mobile Computing MedServer by Artromick blends the features of mobile computing workstations with the security and organization of medication carts. Artromick defines a new benchmark to promote enhanced patient care and improve patient safety with innovative features including:
• Keyless access with auto-relocking
• Facility-wide remote security
• Configurable medication storage
• PowerLift height adjustment
• Advanced power management
• 17-inch all-in-one computer with Pentium M processor
• Organized and expansive work
• Ergonomic design
The Initi Mobile Computing MedServer achieves ease of use and maneuverability with its compact 18-inch-wide footprint. Streamlined nurse workflow is assured by taking the organization and security of the medication administration process to the point of care, further increasing efficiency to reduce medication errors.

Details That Make a Difference

Before purchasing new mobile computing workstations, Children’s Healthcare of Atlanta harvested end-user input to establish a comprehensive plan, a set of priority features and the vendor attributes and services that were essential. It attributes its successful integration of mobile computing in part to these details:

• Power outlets were placed between every two bed spaces to facilitate recharging the carts close to the point of care.

• Effective user training was key — approximately 2,700 users in more than 100 departments participated in eight to 16 hours of training to learn the new EMR functionality, and carts were rolled out to the units weeks prior to implementation so users could work with them before the EMR rollout. A recent survey 30 days post go-live demonstrated an 85 percent satisfaction rate with the EMR and the carts.

• A small footprint and simple design were important features, facilitating easy maneuverability.

• Battery type — Children’s liked the nickel metal hydride battery, which provides longer use with each charge than a standard battery.

• Vendor flexibility — partnering with Flo to address needs and issues before, during and after rollout was critical to the hospital’s success. The company made adjustments to its carts based on user feedback and, partnering with Children's engineers and biomedical engineers, provided strong support of the carts, including completion of all cable management and integration of the thin client, keyboard, mouse and biometric devices.

  • Ellen Hansen, RN, BSN, MS, is director of Clinical Informatics for Children's Healthcare of Atlanta.