Mobile Wireless Workstations: What Hospital IT Professionals Should Know About Selection and Implementation Issues

Transcription

1 WHITE PAPER Mobile Wireless Workstations: What Hospital IT Professionals Should Know About Selection and Implementation Issues

2 Mastering The Last 100 Feet Congratulations. Your hospital is investing substantial capital on a clinical information system (CIS). And now the hospital is well on its way to healthcare s Promised Land, the Electronic Medical Record (EMR). But you re not popping the champagne yet. Another challenge remains: the last 100 feet. 1 That s what one consulting firm, EDI Ltd., calls the final leg of the delivery system that connects the clinician at the patient s bedside to the EMR. Without practical technology to conquer that last 100 feet, healthcare s electronic revolution stops in the hallways. As they have done for ages, clinicians will continue their error-prone ways of collecting information by hand at bedside, and later reentering the same information on desktop computers in nursing stations or elsewhere in the hospital. The mobile clinical workstation, often called a computer on wheels, has emerged as the best device for mastering the last 100 feet. Mobile workstations can communicate with a hospital s medical information systems over wireless networks. For example, if the workstations are linked wirelessly to the hospital s billing system, charges can be captured as they happen, at the point of care. Wireless mobile workstations are a proven tool for improving patient care and increasing clinician productivity. Indeed, your hospital s CIS rollout is sidetracked without mobile wireless workstations rolling on the floors. According to a January 2007 report by health industry analyst Marc Holland, mobile workstations and other mobile clinical devices, or MCDs, must be an essential part of any CIS/EMR implementation plan. 2 A hospital s total investment in mobile workstations can be substantial, especially if the hospital doesn t want clinicians waiting around for the next available cart. Managing that investment is no small task. With their expertise in wireless technologies and hospital applications, IT professionals are usually chosen to manage joint IT/end-user task forces. Often, one project team is responsible for evaluating the best solution and then deploying the selected solution in appropriate units of the hospital. About this paper This paper will help the IT professional seeking the best way to connect doctors and nurses at the point of care with the hospital s information systems. The paper will explain three approaches to meeting a hospital s needs for mobile wireless workstations. Option 1: Do-it-yourself approach (All assembly required.) Option 2: Kit (or partially integrated) approach, where some assembly is required by the hospital Option 3: Fully integrated approach, where the workstation is ready for use out of the box with no assembly required by the hospital In addition, the paper will debunk three myths in the marketplace for mobile wireless workstations: Mobility Myth #1: We can make our own workstations that will be better and cheaper than those available on the market. 1 The last 100 feet in healthcare is analogous to the last mile in the telecommunications industry, where carriers struggled with various technologies to bring high-speed interactive services from neighborhood nodes to each residential household. 2 Mobile Computing: A Critical Component of Clinical IT Effectiveness, January 2007, Marc Holland, Program Director of Healthcare Provider IT Research, at Health Industry Insights, an IDC company

3 Mobility Myth #2: Integrated workstations are too expensive. Mobility Myth #3: Integration means less flexibility. The paper concludes that the integrated approach for implementing mobile wireless workstations is probably the least cost, least risk, and least disruptive solution. It delivers a reliable, easy-to-deploy way for doctors and nurses to more effectively connect with real-time information at the point of care. Wireless Workstations 101 Mobile wireless workstations connect your hospital s extensive investment in EMR technology with the clinician at the patient s bedside. A cart-based mobile workstation, equipped with a computer and power supply, is connected wirelessly to a local area network by WiFi access points. Additional components and devices on the cart can address a host of point-of-care needs, such as barcode scanners, vital signs data capture and monitoring, biometric fingerprint scanning, dual display monitors, and lockable drawers. The workstation s role in patient care Mobile clinical workstations offer a pragmatic way to support the overarching CIS/EMR goals of increasing the efficiency of health care delivery and improving patient care through enhanced communication of medical information. Holland s report highlighted the consequences of not investing in mobile clinical devices: Without MCDs integrated into the clinical workflow, clinicians are forced to perform duplicative work, manually recording orders, vital signs, notes and other medical record documentation at the bedside only to later record it again in electronic form at fixed computers at the nursing station. Such inefficiencies contribute to lost productivity, unbilled charges, inaccurate chart transcriptions and errors in vital sign recording. This can compromise the integrity of patient care and undermine user acceptance of what is arguably the largest clinical IT investment a hospital will ever make. 3

4 Implementation approaches Faced with the need to purchase and deploy mobile, point-of-care workstations, the hospital s selection staff can evaluate options in three categories: The do-it-yourself (DIY) approach. This is termed a furniture cart approach to implementation because the hospital undertakes a project to purchase inexpensive carts and turn them into mobile workstations that meet its needs. The hospital itself designs and builds the end product from separate components it selects on the open market; these can include the cart, monitor, PC, power supply, storage compartments, work surfaces, and clinical devices. Full assembly is required by the hospital itself. The objective of the DIY, roll your own approach is often to obtain a custom solution at a low cost. The result is often little more than a regular PC on a rolling cart. The kit approach. Some vendors attempt to give their hospital customers a head start over the DIY approach by bundling basic components with a cart in a ready-to-assemble form. In this approach, the vendor pre-selects components and partially integrates them on a cart to satisfy basic mobile computing requirements. Hospitals typically must seek other sources for components that satisfy additional requirements. The fully integrated approach. The vendor delivers a fully functional, pre-assembled workstation configured to your computing specifications. Simply roll it out of the box, charge the battery, and it s ready to work. Who does what? In all three approaches, some party the hospital staff, the manufacturer, a dealer or a value-added reseller should be accountable in each phase of the product s development and life cycle. These phases include: 1. Design 2. Logistics and assembly 3. Quality assurance 4. User-defined configuration 5. Repair and disassembly 6. Service and support To repeat: Each phase should be addressed by some entity. Is that always the case? The remainder of this paper explores the implications of the who-does-what decision and helps you decide which implementation approach will best help you master the last 100 feet. The DIY Approach: Beware of the first two words! Hospitals attempting the do it yourself approach frequently stumble on those first two words: Do and it. The hospital fails to adequately consider what s involved in the do part of the equation. Likewise, they have little knowledge base for determining what it (the workstation) should be before the first units are produced and deployed. Let s say you are an IT professional heading up a task force to provide 70 mobile workstations for a 300-bed hospital. Your first assignment is to propose a realistic budget. Evaluating the market, you learn about leading solutions that promise to meet the vast majority of your needs. You also discover, though, that these integrated solutions cost far more than the combined cost of a PC, a cart, and a power supply. A cart is a cart, you conclude. We can do this inhouse and save a ton. We can buy basic carts and equip them to do exactly what we need to do. Oops! You have just been taken in by Mobility Myth #1: We can make our own workstations that will be better and cheaper than those available on the market.

5 19 potholes in the road to home-grown carts To understand why this myth ignores reality, consider four points. 1. It s almost impossible to excel at anything on the first attempt. Remember, the leading providers of integrated workstations have set a high bar in the marketplace. They have brand equity and market share to protect, so they must offer excellent value to stay in business. Therefore, to run a successful in-house project, the project manager will need to equal or exceed high-end commercial offerings at a lower total cost of ownership. To achieve this lofty goal, the project manager will need an incredible array of skills: He or she will need to be an adept buyer, product designer, researcher, engineer, plant manager, production manager, quality assurance manager, scheduler, and financial planner. 2. Most participants in the DIY project team have no prior experience with mobile, wireless workstations, so they fail to consider the complexities and the pitfalls inherent in the project. (See sidebar) 3. There s a strong likelihood that everyone associated with the project including top management will view it as a one-time event. That s short-sighted thinking. Who is responsible for repair and maintenance? User training and support? Documentation? Modifications and change management? 4. Building the first unit may give the project team a false sense of security. Things go well in the lab and then an internal sales effort begins to gain user acceptance. Design issues: 1. The tendency for overkill: loading up the solution s design with unnecessary functions or objectives 2. The tendency for group think, with no one taking a leadership role and no central point of accountability 3. Trying to integrate or bridge components not designed for mobility 4. Failure to consider reliability issues 5. Inadequate consideration of how future changes will be accommodated Logistics and assembly issues: 6. The heavy time investment in researching and evaluating multiple vendors to supply the various components 7. Finding space for, and creating, an ad-hoc manufacturing plant in the hospital 8. Staffing for production: Should you use existing staff, rely on temporary employees, or find a qualified integrator? 9. Lack of experience in creating an effective product feedback mechanism. (Reputable manufacturers usually have processes in place to revise their designs, incorporating lessons learned from prototypes and first-production runs.) Quality assurance issues: 10. Procedures, performance standards or criteria and checklists often lacking for assembly, integration, and testing 11. Lack of burn-in for appropriate components 12. Lack of a test procedure at the system level 13. Little or no documentation to support the processes over time User-defined configuration issues: 14. Insufficient upgrade planning 15. Initial designs can t accommodate feature creep Repair/disassembly issues: 16. Time, methods and costs are rarely considered in design phase 17. Usually not documented by the project team Service and support issues: 18. All approaches need an internal Help desk. However, with the DIY approach, troubleshooting problems with multiple vendors can become a time-consuming issue. 19. Routine maintenance: Internal resources are needed for all three approaches, but the multiple-vendor issue complicates routine maintenance for the DIY approach. 5

6 There is a significant difference between testing a concept model and using a workstation over its life cycle in a clinical environment. loses the integrated manufacturer s ability to improve reliability by tracking track claims and spare parts data from thousands of workstations. Because of these fallacies, the roll-your-own cart approach is rife with hidden costs and risks not only during the design/build project, but throughout the lifecycle of the wireless workstations. Weeks or months after starting with a DIY approach, hospitals finally recognize that the selection team failed to thoroughly analyze the workstations total cost of ownership (TCO). As previously noted, the employees on the project team devote substantial time to the selection, design, assembly, testing and deployment phases. Their time needs to be included in the TCO calculation. Other critical factors impacting DIY s TCO come into play after deployment. These include: Upgrade costs: Will new teams need to be formed to evaluate, build and implement enhancements? Safety: One of the main goals of using mobile workstations is to improve patient safety. A DIY workstation that does not use the proper methods of design, production, and certification testing may actually be a safety risk to the patient if proper attention is not given to electrical effects, such as noise, leakage current, and resistance to ground. Few hospital staffers have the skills to implement IEC/UL , the standard at the point of care for electronic equipment. This standard applies to all equipment used in the patient vicinity, or within six feet of the patient. Also, the standard covers mechanical stability, pinch hazards, and materials that are safe for use in a clinical environment. The Kit Approach: Settling for half a loaf Repair and maintenance costs: How will warranty claims with various vendors be managed? Many component vendors do not warrant their products to work with other vendors products. If a component goes end of life prematurely, a mini-project may be required to find a suitable replacement. Compromise is but the sacrifice of one right or good in the hope of retaining another--too often ending in the loss of both. Tyron Edwards, American theologian Compromise makes a good umbrella, but a poor roof. James Russell Lowell, American poet, editor, diplomat Reliability and longevity: The reliability and the expected lifespan of a newly built DIY workstation are unknown, but they are almost certainly less than equivalent metrics for an integrated workstation from a reputable vendor. The DIY approach lacks the integrated manufacturer s staff of market researchers, product engineers, lab technicians, and quality assurance specialists. Moreover, the DIY approach Most medical equipment cart providers today deliver their solutions in the form of a kit. The kit approach borrows from the success of integrated mobile workstations but doesn t solve the issues that plague the DIY approach. Instead, kit vendors attempt to find compromises in two fundamentally different philosophies. 6

7 Kit users often rationalize their choice with these myths: Mobility Myth #2: Integrated workstations are too expensive. Kit providers base their entire business case on notion that costs are too high for integrated workstations. Many of the same hidden costs of the DIY approach, however, also lurk in the kit approach. When you buy a kit, you still have to do assembly. You still have to seek out components that address needs not answered by the kit; then you have to evaluate them, test them, add them to the carts, and manage their warranties separately from the kit manufacturer s warranty. Will the added component s reliability and lifespan match those of the kit? (Keep your fingers crossed!) Mobility Myth #3: Integration means less flexibility. Kit providers claim that their products open architecture will accommodate virtually any modification needed to the basic bundle. Open architecture, however, is not a panacea. Kits touting open architecture probably aren t designed for your specific needs resulting in less flexibility than integrated solutions that feature universal attachment points and a wide range of tested upgrade choices. With the kit approach, a hospital that needs an upgrade path is in the same predicament as do-it-yourselfers: Working alone, without the manufacturer s expertise, guidance and vast array of experiences. The Fully Integrated Approach: Out-of-the-box deployment A fully integrated solution provides a well-thought-out design using components that are designed to work together in a mobile, wireless environment. Instead of launching what would be a virtually new business the design and manufacture of a customized workstation the selection team focuses on deciding which outside solution best supports its existing core business and goals. Once selected, an integrated solution needs only to be purchased and deployed. The purchase process selects the best value product based upon stakeholder criteria. After the purchase decision, it is a matter of managing the implementation of the new workstations into hospital operations. The deployment process capitalizes on an out-of-the-box solution proven in hundreds of hospitals. For both IT and end-user employees, this means much less disruption of their priorities and responsibilities. The streamlined, non-disruptive nature of this approach stands in sharp contrast to the DIY approach, which requires R&D, product design, multi-vendor sourcing, manufacture, assembly, testing and deployment. Most of these activities are relatively uncharted waters for a hospital s personnel. Almost every hospital s management is under constant pressure to control costs and allocate scarce investment capital astutely. It s important to consider where the project team s time is best invested: inventing and building a mobile clinical workstation from the ground up, or turning over that role to outside experts so that team members can apply their capabilities to the core mission of patient care. 7

8 A Key Decision Factor: The Value of Your Time If a project team spends huge amounts of time on learning about, creating and building wireless mobile workstations, what are you leaving on the table in the way of patient care? Are the perceived savings worth the time you and others must invest? Perhaps that time could be better utilized to make safety, patient care and productivity improvements in the organization. With a fully integrated, turnkey solution, your hospital turns over the management of all the complexities to a trusted partner. Look for a leading manufacturer that has successfully deployed tens of thousands of workstations at hundreds of hospitals. Table 1: The table below compares the relative costs typically experienced by hospitals deploying mobile wireless workstations. The comparison shows relative costs for key components of the total cost of ownership using a do-it-yourself approach, a kit approach, and an integrated approach. To get your free total cost of ownership evaluation, please contact Flo Healthcare at FLO $= Low, $$= Medium, $$$=High In summary, hospitals that select fully integrated mobile workstations can expect to gain the integration edge : 1. The ease of purchasing instead of diverting resources to invent one s own solution 2. Greater reliability 3. Longer expected lifespan 4. Less cost and risk 5. Defined upgrade path 6. A partner with high expertise in wireless, mobile healthcare computing 7. More time to focus on improving patient care IDC: You get what you pay for In IDC Health Industry Insight s report on mobile computing devices, analyst Marc Holland discussed vendor selection criteria and the total cost of ownership at length. He concluded: Cheaper MCDs have increased reliability issues, and with such problems, incur great downtime, repair costs and decreased productivity. Not to mention potentially having a detrimental effect on quality of care and patient safety. When all factors are considered, the old adage you get what you pay for is often true. The MCDs with greater base prices actually cost less over time than cheaper models. COST OF OWNERSHIP ITEMS DIY KIT INTEGRATED Purchase price $ $$ $$$ Labor cost $$$ $$ $ Support cost $$$ $$ $ Replacement of upgrade cost $$$ $$ $ Downtime opportunity cost $$$ $$ $ Life expectancy cost $$$ $$ $ Total Cost of Ownership $$$ $$ $ 8

9 When millions have been spent of the development of a robust CIS, the place to cut corners should not be directed to the device which plays such an integral role in capturing the vitals signs, charges, medication dosing and medical record information which form the foundation of the electronic medical record itself. Flo Healthcare Industry leadership. With 50,000 mobile devices and wireless infrastructure systems installed in more than 800 hospitals, Flo Healthcare is the acknowledged leader in total-hospital and system-wide wireless and mobile clinical workstations in North America. Integrated solutions that satisfy a wide range of clinical needs. Our products are known for their flexibility, ergonomics, aesthetics and ease of use. Flo Healthcare manufactures wireless mobile workstations that let doctors and nurses work smarter and more productively by capturing and accessing information at the point of care. Our line of fully integrated mobile workstations helps hospitals to improve care, enhance safety and increase staff productivity. All Flo Healthcare workstations can be configured to meet the hospital s immediate needs and adapted as needs evolve. All Flo Healthcare workstations are optimized for clinical best practices. As one of the few workstation manufacturers dedicated to the healthcare market, we are in daily contact with clinicians nationwide. By observing how they work and soliciting their opinions, we continually refine our products for functional, technological and ergonomic superiority. Flo Healthcare is proud of its track record and its high standards for: Innovation. We own seven U.S. patents, including two mobile clinical workstation patents. High quality and reliability. Business Week and the Industrial Design Society of America honored a Flo Healthcare workstation with their prestigious Industrial Design Excellence Award. The best proof point of our quality, though, is customer satisfaction. We encourage prospective customers to talk to our users. Exceptional service. Flo Healthcare has highly experienced customer service and technical support teams to help customers minimize downtime. Strategic industry partnerships with leading CIS providers, OEMs, and value-added resellers. 9

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