To pay off in administrative and clinical value, a workstation doesn't only have to be easy to use. It has to be there to use, period.
And the outlay could be sizable for ample and accessible workstations.
A 300-bed hospital with full medical and surgical services as well as laboratory, pharmacy and radiology units would typically need about 200 workstations for proper coverage, said George Mayes, technology consultant with First Data Corp.'s Health Systems Group.
A full-function personal computer with capabilities for multimedia screen presentation ranges from $1,500 to $2,500 per PC, and the local-area computer networking of groups of PCs runs $500 to $2,000 per connection, Mr. Mayes said.
Installed software for such basic needs as spreadsheet and word-processing work and electronic mail typically adds $300 to $500 to the per-workstation cost, he said. That puts the cost per installed PC at $1,800 to $5,000.
But that doesn't include the core software marketed by information system vendors to run the workstation network, connect it to a central database, and manage such tasks as scheduling, data manipulation and insurance eligibility.
The price of a core system for a 300-bed hospital varies greatly depending on the floor space and scope of a hospital or health system, and implementing it is a major project about equal to the purchase cost, said Lawrence Pawola, senior vice president at Sheldon I. Dorenfest Associates, a Chicago-based healthcare consulting firm.
But a basic system, including the extra demands for implementation and ongoing support for clinical systems, runs at least $1 million, Mr. Pawola said. And to get the more advanced patient-care capabilities available today will cost $3 million to $4 million, maybe more, he said.
Despite the initial cost, some consultants say there are no shortcuts.
Initial acceptance of a computer-based order and results system could suffer if clinicians can't get on a workstation conveniently.
But hospitals with sufficient coverage could still have a problem if the computers aren't bought with power in mind, said Colleen Wells, an Arlington, Texas-based consultant with Superior Consultant Co. Bargain-hunting for hardware on the edge of obsolescence could limit a health network's ability to make the most of breakthroughs in computing technology, Ms. Wells said.
Until PCs started popping up in linked configurations called client/server networks a few years ago, the computers generally used for communicating with the main processing unit were so-called "dumb terminals," said Ms. Wells.
Stand-alone PCs ran spreadsheet programs and other commercially available software, but hospital workers had to log on and off to get information from the mainframe for PC applications, Ms. Wells said.
But now PCs can be connected to each other and to the main computer, taking the place of dumb terminals while retaining the power to run software in their individual processors, she said.
Because of that advance, it makes no sense to invest new money in dumb terminals rather than upgrade to new PCs, she said. Even if an institution isn't ready to pay for newer technologies such as client/server networks, the building blocks are already bought.
Placement of computers in an area should "tie in with the work design and work flow," said Ms. Wells. If there aren't enough workstations, there'll be nurses standing in line to enter information. Some administrators "think they can put one in a critical-care unit, and that's not realistic," she said.
And the operation of a computer should be standard wherever it is, Mr. Pawola said. "If I'm a doctor going from site to site, I want access to my data for a patient in the same way anywhere that I want it," he said.