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Green Bay and Milwaukee, Wis
. - Placing computing power at the point of care is a major thrust in the move toward greater adoption of healthcare information technology, but hospitals and clinics are still learning about both the possibilities and the limits of different technology solutions.
That isn't preventing them, however, from taking technology vehicles out for a spin.
In their attempt to see what IT can do, they have found that a number of computing devices work in the clinical setting - desktops, laptops, tablet PCs, and personal digital assistants - but theoretically nurses work best with robust mobile technology.
Thus far, keeping it robust and reliable has proven to be a challenge, which could impact future technology enhancements.Aurora Health Care
, where the technological foundation is a single electronic health record for 3.5 million patients, has gone to mobile carts, also known as Computers on Wheels or COWs, for its automated nursing documentation.
The experiences of two Aurora Health Care nurses illustrate the promise and problems inherent in healthcare information technology. To get an idea about whether the actual benefits met or perhaps exceeded pre-installment expectations, WTN interviewed Kenneth Uecker, a staff nurse in the intensive care unit at Aurora Bay Care Medical Center in Green Bay, and Terri Pawlak, a staff nurse in the rehabilitation unit at Aurora Sinai Medical Center in Milwaukee.Having a COW
In recent years, Aurora Health Care has gradually implemented information technology like the mobile carts, but it's no small undertaking. The organization has more than 25,000 employees at facilities throughout eastern Wisconsin, including a dozen acute care hospitals, a psychiatric hospital, more than 100 clinics, and 130 community pharmacies.
Aurora Health Care wants to keep data on all patients available across its entire network, but that requires a high level of electronic access. According to Judy Murphy, a registered nurse and vice president of information services for the Milwaukee-based health system, all of its facilities have fully implemented the mobile carts in recent years, with more than 1,300 COWs in service at its acute care hospitals. Aurora Sinai Medical Center has used laptops on carts for automated documentation since 2003, and Aurora Bay Care Medical Center has used them since 2004.
Murphy indicated that nurses in hospitals use several different laptop models, including MPC
, and Toshiba
. The carts that hold them, which are Levitator compact mobile workstations, are manufactured by Stinger Medical
. The laptops are of regular weight with batteries that last from four to six hours, depending on their use. (Physicians in the hospital and clinic use Lenonvo ThinkPad
, which are ultra-portable laptops that are not mounted on carts and are carried independently.)
Uecker said the COWs' purported benefits of mobility, usability, and processor speed have enabled him to do his job more efficiently when entering patient data, gaining access to patients' electronic medical records, reviewing lab results or radiology reports, checking drug compatibility, and other charting tasks.
As a result, most paper documentation has been eliminated, and tracking down the right chart often was time-consuming - even if they were supposed to be in specific
storage location. The only paper documents that remain are patient education records and pharmacy orders written by doctors (although Aurora Bay Care is moving to Computerized Physician Order Entry
Time savings, work efficiency, improved care, and the ability to create a more accurate patient record are the main benefits of being able to pull information from multiple sources without digging through paper records, especially because the information is presented in a logical fashion.
Everything we do with computer charts is done through those COWs, Uecker said. It combines all material from the patient in one spot without the need to check multiple charts.
A companion product to the automated nursing documentation is INet, which is used in the ICUs to allow nurses to automatically pull data from the patients' bedside monitors, including vital signs, and merge it with their electronic chart. Aurora views it as another electronic tool that saves time and increases the accuracy of nursing documentation.The downsides
At Aurora Bay Care, the mobility advantage of COWs was mitigated by time and health factors. At first, nurses moved the carts from room to room, but because the carts were cumbersome to move around and because of concern about infection risk associated with movement, the staff has abandoned that in favor of keeping one cart stationed in each hospital room.
The laptops connect to hospital servers via a wireless network, and the downside has been the reliability of that wireless connection, Uecker said. Connectivity issues are not always the fault of the network - employee mistakes include the failure to shut them off to avoid a loss of battery power, or neglecting to recharge them - but at times poor network connectivity has forced nurses to rely on old paper methods of documentation, which then requires the new data to be entered on a desktop computer.
Replacing the antennas on the COWs and improvements to network hubs have improved reliability, but not to the point where it's dressed to the five nines (where it is reliable 99.999 percent of the time). Uecker said some nurses and their union now advocate a wired connection to address reliability issues, and if it chose to go that route, Aurora Bay Care would not be the first hospital to install bedside computers as an alternative to mobile workstations.At your fingertips
At Aurora Sinai, Pawlak said the COWs have delivered on the promised value, provided employees keep them recharged by plugging them in, and provided the connectivity issues are addressed.
It was meant to have everything at our fingertips at the bedside when we treat patients, and it does that, she said.
In this case, everything includes information about minimum and maximum medication dosages, and patient history such as previous hospitalizations, lab results, and notes about recent visits and diagnoses.
In addition to paying attention to the battery, the learning curve includes operational issues and new clinical processes that must be mastered by a staff of people who, in some cases, have no cell phone or even an answering machine at home.
I'm techie, but even I still like to have my computer at my desk, Pawlak acknowledged. It does allow me to do my job better and more efficiently. It's good for patient safety, too, because I don't have to dash off to a desktop in the building.
According to Pawlak, the only remaining paper records are patient teaching records, patient care plans, and physician progress notes and order sheets.Enhanced connections
Although the units are called Computers on Wheels, they serve as a hub in a wheel because they could enable other healthcare IT, including bar-coded medicine administration. Aurora Bay Care and Aurora Sinai would like to implement bar-coded meds, but before they are used for the involved and precise practice of meds administration - right patient, right medication, right dosage, right route, and right time - connectivity issues must be addressed.
Without a higher degree of reliability, Uecker said, we simply can't do that.Related stories
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