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February 18 , 2008

Note-Taking With a Flair
By Selena Chavis
For The Record
Vol. 20 No. 4 P. 24

Tablet PCs can be a wonderful device to enhance mobile data sharing, but experts caution that the results won’t be there without the proper wireless infrastructure.

In healthcare’s ever-evolving and delicate balancing act of maximizing efficiencies, improving accuracies, and delivering better outcomes, stepping out toward a more mobile work environment is often a key ingredient to success.

Industry research suggests that wireless technology is poised to dramatically improve the user experience at the provider-patient interface, prompting many hospitals to fill at least one piece of the mobility puzzle by deploying network-enabled tablet PCs to physicians.

Consider the case of the audiology department at Children’s Hospital Boston. After investigating everything from smartphones to existing vendors’ diagnostic equipment, Brian Fligor, ScD, CCC-A, the facility’s director of diagnostic audiology, found that tablet PCs were the best choice to meet the department’s mobility needs. Noting that clinicians had historically recorded data on paper during patient evaluations, Fligor says that as services became more complex, the sharing of information became “extremely burdensome.”

“We said, ‘There’s got to be a better way,’” he recalls, adding that staff continually dealt with the frustrations of trying to effectively transfer and deliver needed information to other departments and institutions, sometimes causing delays in patient care. “The stakes are there—they really are,” he says.

Having a solid wireless strategy has become an industry reality that frequently goes hand in hand with the move toward an electronic medical record (EMR), reinforcing the claim made by many wireless technology vendors that healthcare is currently “the strongest wireless vertical.”

Recent research by Forrester suggests that a large percentage of North American enterprises—including healthcare organizations—are planning to extend mobile data access to between 17% and 20% of their employees. Couple that with research by New Jersey-based Insight Research Corporation revealing expectations that the U.S. healthcare telecommunications services market is expected to grow from $6.3 billion in 2006 to $8.1 billion in 2011, and it’s easy to comprehend why spending on wireless technology in healthcare is expected to grow at more than twice the overall rate.

Tablet PCs are an evolution of the portable PC. Vendors tout the benefits of these devices: They take the best of a standard laptop and add features such as multimodal input where users can input via a keyboard, pen, or voice. Often the size of a medical chart, tablet PCs can be carried like a clipboard and offer medical providers the capability of wireless, real-time data input, as well as the ability to share information while interacting directly with a patient.

However, these devices have not come without their challenges. Healthcare facilities have been faced with numerous obstacles in effectively deploying the technology and have sometimes found that these devices do not adequately meet the needs of the multitasking, multiuser, mobile, fast-paced work environment of today’s hospitals.

“I think facilities overlook the infrastructure challenges quite a bit,” says Joe D’Antonio, senior manager of Soarian HIM product development for Siemens Medical Solutions, regarding the fact that many hospitals have learned through experience why spending the infrastructure money up front pays off in the end. “The more advanced devices use a wireless infrastructure, but there’s an infrastructure cost with that. The question becomes, ‘Is this where we as a facility want to spend our money?’”

Lou Martinage, director of marketing and business development with Virginia-based MobileAccess, notes that hospital deployment of wireless infrastructure in conjunction with tablet PCs comes with its own unique set of challenges due to the complexity of the structures, as well as the fact that numerous wireless vendors may already be operating in the building. “These are large, heavy building facilities with thick structures. That impedes the process,” he says.

Forrester research suggests many enterprises are finding that mobile reality does not live up to vendor vision. A recent report on the evolution of the enterprise mobility market reveals that the idea of instant access to information wherever a user roams actually turns into organizations “stitching together a patchwork of technologies to offer intermittent connectivity” at best. The most common complaints include spotty network coverage, inadequate devices with high maintenance costs, and the usability of applications on small devices.

Successful Implementations
The nature of how tablet PCs are used may look different in various healthcare settings, but the consensus offered by a number of hospitals is that the transition has been well worth the investment.

For Wisconsin-based Marshfield Clinic, an organization encompassing 40 centers and 774 physicians in 80 medical specialties, tablet PCs were the answer that moved the group from a hybrid environment to completely chartless. Early adopters of the electronic movement with initial plans dating back to the mid-1980s, the organization was essentially waiting on the technology to catch up with it, according to Chief Information Officer Carl Christensen.

“We could have made this move quite a bit earlier, but we made the decision to wait for a device that was mobile and wireless,” Christensen says concerning the readiness of Marshfield’s physician group. “The breakthrough for us was when Microsoft deployed the Tablet OS [operating system].”

With an initial rollout in 2003, the organization put the effort into overdrive when the opportunity was presented to participate in a Centers for Medicare & Medicaid Services demonstration program that would provide monetary benefits and bonus payments. Christensen says that Marshfield’s results ranked them first of 11 facilities, laying the foundation for a significant bonus. “We could not have done that without the [full EMR], and the tablet PC paradigm itself was key to the overall success,” he says.

Children’s Hospital Boston realized immediate benefits in efficiency after deploying Mi-Co tablet PCs to clinicians in its audiology department. Before the implementation, Fligor says patients would spend approximately seven minutes in the waiting room, and an audiologist would then spend approximately 20 to 25 minutes with each patient. Increased efficiencies via tablet PC use have essentially shaved five minutes off each patient’s visit, allowing a potential increase in volume of approximately 10%. “I would have been really pleased with a 3% increase,” Fligor says, pointing to the fact that 10% of an average 16,000 patients annually is significant. “The clinical interaction with patients didn’t change. … The efficiencies were found in the administrative piece.”

Fligor says the department saw two primary opportunities for enhancing workflow through the tablet PCs: improved accuracies and efficiencies saved through instant data entry that interfaces with the primary patient record. Data are now collected and entered into the PC on the fly and then instantly transferred to the appropriate department form. “This takes away the possibility of human error,” says Fligor.

Also, since the Mi-Co solution integrates directly into the hospital patient record application, the data immediately become part of the permanent record, allowing the efficient sharing of data with other departments.

Located on the same campus as four other healthcare entities, including Marshfield Clinic, Saint Clare’s Hospital was erected with technological innovation in mind. Considered one of the most high-tech hospitals in the nation, the 86-bed facility opened its doors in 2005 with no chart rooms and a fully operable EMR.

“We wanted to achieve all digital technology and have that single record for anytime, anywhere access,” explains IT director Tanya Townsend, noting it was clear from the outset that they would need some type of mobile device. “The tablet is the device of choice for all clinical areas.”

The Fujitsu tablet PC product was chosen because it’s the hardware selection used by neighboring Marshfield Clinic, and the facility wanted clinicians to be able to use the devices seamlessly throughout the campus.

Since the facility had no previous history or benchmarks to provide comparisons, Townsend notes that it was obvious there would be cost savings from the beginning because multiple clinicians could access information “anytime, anyplace.”

Townsend says the organization saved money by eliminating square footage that would have been necessary for medical records filing, as well as by more compact HIM staffing models. Couple that with industry standards that suggest costs can average $5 per chart pull, and the cost savings begin to stack up quickly, she adds.

The Infrastructure Challenge
While these case studies presented realized successful implementations of tablet PC technology, professionals are quick to point out that one major stumbling block to success is building a wireless infrastructure that will adequately support an organization’s needs.

Realizing that clinicians and physicians were only going to adapt to the technology if it met their needs and truly provided access anywhere in the facility, Christensen says Marshfield acknowledged early on that “this thing lives or dies by having a wireless network that works.”

With that in mind, he points out that it’s critical to have a vendor that will refine and improve the technology along the way, especially in an industry where the technology is still evolving. “This project would have failed if we hadn’t had that relationship with Fujitsu. We had some show stopper problems that came up,” Christensen says.

The same challenges also arose at Saint Clare’s Hospital, especially in the area of managing the software applications. “Our software applications require a static connection. … Making sure the wireless infrastructure supported that was definitely a challenge,” Townsend recalls. “That’s still something we are working through.”

D’Antonio recognizes the challenges of making software applications work well on mobile devices, pointing out that the industry needs to work harder toward making those applications mobile friendly.

“That’s one of the challenges of EMR,” he says, adding that the hardware technology for tablet PCs is more advanced than the software side. “We have to prioritize what becomes the next focus for EMR environments. We are making strides; it’s moving fast.”

In the meantime, Townsend says the greatest challenges come when clinicians are moving from unit to unit. Currently, she suggests that they just take the time to relaunch the program.

One way to combat challenges associated with infrastructure is to consider a universal wireless network, Townsend suggests. “We have a lot of different wireless technologies competing with the same network,” she notes. Currently in the process of upgrading the system, she says this piece of technology will allow multiple wireless services to operate from the same network at Saint Clare’s.

Martinage suggests that hospitals consider a universal wireless network when contemplating their full wireless strategy. “For a hospital, you want to get it right the first time. Maybe you don’t know exactly what you need today, but wouldn’t you want the flexibility down the road?” he questions, pointing out that the better alternative is to look at the broad range of requirements a facility may develop. “Put in a multiuse infrastructure instead of a single use. … It’s an opportunity to make the tablet PC more pervasive throughout the hospital than it might otherwise be.”

Rollout Considerations
Do not underestimate the need for training, say professionals involved in tablet PC implementation. “Everything was as hard or harder than we thought it would be,” Christensen acknowledges.

Townsend points out that allowing clinicians to have alternatives proved helpful for training and rollout. “People like options. One size does not fit all,” she says, adding that Saint Clare’s provided clinicians with not only the tablet PC option to use at bedside but also docking stations outside the rooms and computers on rolling carts.

Making group and one-on-one training sessions available also helped in getting some of the professionals on board, Townsend says. While group sessions worked well for nursing staff and some other specialties, physicians required more individualized attention.

In tandem with the need to work with technology vendors such as Fujitsu that are willing to refine and improve the hardware side of tablet PCs, Fligor points out that Mi-Co was also willing to customize applications to the workflow of the audiology department, greatly increasing the opportunity for success during rollout.

“They had no background in audiology, yet they knew how to take information on paper and develop an elegant piece of software,” he notes, adding that forms and interfaces were customized. “There are certain pieces of information that are uniform across all audio clinics. This application could work for any audiology department.”

— Selena Chavis is a Florida-based freelance journalist whose writing appears regularly in various trade and consumer publications covering everything from corporate and managerial topics to healthcare and travel.