If hospitals hope to control costs, patient clinical information will have to be entered and retrieved on computers at the places where physicians and nurses do their work. That's what consultants are preaching as essential to minimize duplication and length of stay.
Installing these "point-of-care" computers at enough locations to do the job, however, is a headache as long as they have to be individually wired to the computer system through walls.
In times of uncertain occupancy, when floors get activated, closed down or used only half the time, there's a big financial and clinical balance to strike in deciding how many patient rooms get computers, how much costly cabling is necessary and whether a terminal can fit among a room's other gadgetry.
But those concerns would evaporate into thin air if a point-of-care system:
Didn't have to be wired at all.
Could be tucked under an arm and carried from room to room.
Covered the entire hospital by operating wherever a caregiver happens to be instead of only where computers happen to be installed.
Increasingly, hospitals are reaching into thin air for the technology to establish just such a wireless, mobile system of hand-held computers.
Demand and supply.Advances intechnology are expanding the capabilities of a wireless point-of-care system at the same time vendors are licking their chops over budding demand for a device that can place orders at bedside and call up results the moment they're available.
One such vendor is Telxon Corp., which officially entered the healthcare market last month after building a base of 7,000 customers in retailing, grocery and warehouse uses of wireless computer technology.
The Akron, Ohio-based company will go head-to-head with healthcare industry vendors such as CliniCom, of Boulder, Colo., which developed a hand-held wireless computer system in 1991 and reports 25 customers to date.
Telxon hooked up with the West Virginia University Hospitals in Morgantown to help adapt the electronic tablets to clinical use. The tertiary center was looking for a bedside computer system but not at the going rate of a wired personal-computer network covering every patient room, said Dwyne Patrick, divisional director for clinical and information management systems.
It would have cost about $1 million to buy personal computers and install computer jacks in all 250 patient rooms, Mr. Patrick said.
Instead, the hospital got a series of 32 antennas covering the facility's 10 floors like a miniature cellular phone grid. The system is linked to three existing computer systems. The cost was about $165,000, he said-$65,000 for the radio-frequency network, $100,000 for 60 wireless tablet-size computers (See chart, p. 96).
The hospital's cost is not reflective of list price, Mr. Patrick noted, because the university got a break as a development partner. But he added, "Even if it cost exactly the same (as a wired PC system), you get communication to every square inch of that facility."
That's one reason why only 60 wireless tablets were needed, he said. "It's an anywhere-to-anywhere connectivity. It gets us out of the mode of having to take the caregiver to the terminal. The terminal is with the caregiver all the time."
The formula works out to one terminal for every four rooms. Instead of being stationed in a room when they're needed for the room's few patients, tablets are taken where they're needed, whomever the patient. "The cost of a bedside system is really the idle time," Mr. Patrick said. A terminal fixed in a patient room may be used only 10 to 20 minutes a day, he said. "With the wireless (system), those 60 units are in use all day long."
And they're not just in use on the patient floor, he said. Physicians can take them to the call room, the cafeteria or the pharmacy and get a connection to the main computer systems.
The tablets communicate with a clinical information system bought from TDS Healthcare Systems Corp., a patient management and accounting system from HBO & Co. and a separate operating-room system. Mr. Patrick said the tablets need no extra software to make them compatible with the existing systems. The TDS system works with a light pen on a screen, so nurses who are familiar with the personal-computer routine see the same look on the pen-based tablet and use it the same way, he said.
Unlike earlier portable computers that had to be loaded with data from the main system at the beginning of a work shift and then unloaded back into the system later, the university hospital's wireless tablets speak directly to the information systems and receive data instantly when transmitted from the lab, pharmacy, X-ray room or respiratory therapy department.
Clinical advantages. Mr. Patrick said it's a big improvement for physician rounds, which can take up to three hours in a teaching hospital. Results and notes reported to a patient's chart after rounds begin are available to attending physicians walking the floors. Also, new orders can be sent through the computer system right away instead of all at once at the end of rounds.
"The difference between an order that gets entered an hour or two from now when someone comes back to the nursing station, and the order that gets entered right now while they're still in the patient's room, can mean the difference between the patient going home today and going home tomorrow," Mr. Patrick said.
He also said the wireless system "attacks the hidden paperwork"-all the writing down of data from patient rooms, exam rooms and chart rooms that's then taken back to a computer terminal to be entered.
Both the Telxon and CliniCom terminals have bar-code capability to scan drug labels and patient bracelets for information and to check whether the right patient is getting the right medication.
And both vendors boast a tablet durability that assumes nurses and physicians will be hard-pressed to always hang onto their electronic clipboard. "We've had several bad drops or trips with them and they kept right on functioning," Mr. Patrick said.
Telxon executives said the tablet is built to take a four-foot drop. CliniCom's solid-state tablet also is designed to be drop-resistant and spillproof, said spokeswoman Julie Bartos.
The battery on a Telxon tablet is built to last an eight-hour shift, said Gene Lewis, director of healthcare industry sales for the company. The CliniCom tablet's charge lasts one to three hours depending on use, said Ms. Bartos. The tablets are kept in a recharging rack until a nurse or physician pulls one out, she added.
The combination of immediate two-way connection with the main system and the eight-hour charge life can make data entry more evenly spaced throughout a shift, reducing the peak in computer demand that normally would happen at the beginning and end of shifts. Clinicians also save the amount of time it otherwise would take to enter all of the orders and paperwork at the end of a shift, Mr. Lewis said.
Shortcomings. So far, nothing has interfered with the integrity of the radio signal between tablet and computer system. However, Mr. Patrick said clinicians have encountered the opposite problem: The signal itself has interfered with certain medical equipment, such as electrocardiographs, when a tablet gets within a foot or two of the device.
Interference with sophisticated medical devices is one of the main concerns for hospitals considering radio-frequency systems, said Colleen Wells, a consultant with Superior Consultant Co. Any effect on heart monitors, oxygen-measuring equipment and other electronic devices could be disastrous. The odds of causing harm to a patient may be slim, but "it only takes one time for that to happen," Ms. Wells said.
That's why vendors have to continually test their wireless devices on medical devices to determine the side effects and incorporate countermeasures, she said. And the testing must be ongoing, because new innovations are coming on the market all the time.
Another drawback of the tablets, Ms. Wells said, is that they don't allow nurses to enter free text to expand on the information they enter by selecting information on the screen with a stylus or light pen. A clinician would have to plug the tablet into a keyboard, which is usually not worth the hassle, she said.
Mr. Patrick said the university hospital plans to insert radio-transmission cards in laptop computers, which will connect with the administrative system and allow admission and discharge directly from patient rooms, he said.
Such cards also can be installed in cable-connected personal computers to make them portable, Mr. Patrick said. Telxon has installed cards in 25 PCs so far, at a cost of $675 each. That gives the hospital flexibility to move computers where they're needed without having to consider whether the new location has the proper cabling, said Mr. Lewis.
When the technology for creating wireless local-area networks became available about three years ago, vendors and enthusiasts envisioned a fully wireless hospital information system, said Craig J. Mathias, principal of the Farpoint Group, an Ashland, Mass.-based computer communications consulting firm. "Now the emphasis is on portability," Mr. Mathias said.
Wireless technology also can help connect buildings in a network or campus. Later this year, West Virginia University Hospitals plans to add two facilities to its radio-transmission network: Chestnut Ridge Psychiatric Hospital, which is about a half block away, and Mountain View Regional Rehabilitation Hospital, two blocks away. Connections currently are leased from the local telephone company.
Running conduit connections to the two institutions would have cost between $75,000 and $125,000, said Mr. Patrick. The cost of a wireless connection is expected to be about $5,000, he said.