clinical mobilitycsohio.himsschapter.org/sites/himsschapter/files/... · discussion paper –...
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© CSOHIMSS 2011 Slide 0 Health Care Quality, Security and HIE Synergy 2011 October 21, 2011
Clinical Mobility
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© CSOHIMSS 2011 Slide 1 Health Care Quality, Security and HIE Synergy 2011 October 21, 2011
Clinical Mobility
Mobile Computing Secure Wireless
All we need to enable clinical
mobility right?
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© CSOHIMSS 2011 Slide 2 Health Care Quality, Security and HIE Synergy 2011 October 21, 2011
Clinical Mobility
Source: Billian Health Data
and Porter Research – Aug
2011
Most mobility
strategies are
still in their
infancy.
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© CSOHIMSS 2011 Slide 3 Health Care Quality, Security and HIE Synergy 2011 October 21, 2011
Clinical Mobility
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© CSOHIMSS 2011 Slide 4 Health Care Quality, Security and HIE Synergy 2011 October 21, 2011
Clinical Mobility - Drivers
CPOE
eMAR/BCMA
PPID
Patient Transfer
PPID
Specimen
Collection
Respiratory
POC
RFID
Telemedicine
Patient Discharge
Admissions
ePrescribing
Patient Monitoring
Many Drivers to
clinical mobility
Voice
Home Healthcare
HIE
PatientScheduling
RTLS
Document Mngmt
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© CSOHIMSS 2011 Slide 5 Health Care Quality, Security and HIE Synergy 2011 October 21, 2011
Hospitals are aggressively moving toward level 4, CPOE.
A new state law in Massachusetts will require hospitals and
community health centers to adopt CPOE systems by 2012,
and EHRs by 2015
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© CSOHIMSS 2011 Slide 6 Health Care Quality, Security and HIE Synergy 2011 October 21, 2011
Everything Depends on Mobility
Mobile Point of Care
Secure Guest Internet Access
Patient Terminal
Asset Tracking
Digital Signage in the lobby
Hot-desking for ad-hoc
personnel
Electronic Prescription
Personnel / Patient
tracking
Medical equipment
Tracking
VoWiFi
Video Surveillance
ColubrisN E T W O R K S
TM
outdoor
Mobile kiosks
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© CSOHIMSS 2011 Slide 7 Health Care Quality, Security and HIE Synergy 2011 October 21, 2011
Clinical Mobility – Current State
Most clinical workers are frustrated with
current deployments.
Many combinations of technology have
been tried unsuccessfully.
New clinical technologies are highlighting
weaknesses with current strategies.
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© CSOHIMSS 2011 Slide 8 Health Care Quality, Security and HIE Synergy 2011 October 21, 2011
The daily workflow associated with
the clinicians job function, and
patient flow should drive the overall
solution. Most CNO’s report they do
not have decision making power for
final solutions.
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© CSOHIMSS 2011 Slide 9 Health Care Quality, Security and HIE Synergy 2011 October 21, 2011
Clinical Mobility - Current State
A study conducted by the Robert Woods Johnson Foundation identified 327
workflow issues for nurses and 766 unique processes requiring
improvement to enable nurses to spend more time delivering patient care.
Many of these issues would be addressed by not only applications but the
underlying technologies utilized to access these applications
“We must make it attractive for doctors to enter the digital world. Financial
incentives would help, but the most important factor is to reduce acquisition
and running costs (of technology). We must also simplify the EMR and
make it easier for doctors to learn and use.” IT and Primary Care
Discussion Paper – Harvard Pilgrim Healthcare Inc.
“Reliable, transparent, simple hardware and software lowers the cost of
adoption, maintenance, and use while simultaneously increasing the
likelihood that providers will purchase and employ them. Wide spread
adoption of sophisticated handheld devices and the development of
technologies and systems for making interoperability simple, straight
forward and reliable will increase the attractiveness of HIT among
physicians and hospitals. - Health Information Technology in the United
States: The Information Base for Progress
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© CSOHIMSS 2011 Slide 10 Health Care Quality, Security and HIE Synergy 2011 October 21, 2011
Case Study – UCSF Medical Center, Motion Computing, Intel
Has technology eliminated paper or writing on gloves?
“Nurses would take vital signs using the GE DINAMAP, collecting blood
pressure (B/P), pulse (P) and oxygen saturation (O2Sat). Temperature was
taken separately, and respiratory rate observations were done manually. All
data elements were then written down on paper and carried by the nurse until
they were entered into the EMR system.”
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© CSOHIMSS 2011 Slide 11 Health Care Quality, Security and HIE Synergy 2011 October 21, 2011
Case Study – UCSF Medical Center, Motion Computing, Intel
nurses can log in as many as 50 times per shift
Logon latency? = 20 seconds
Source: USFC Medical Center
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© CSOHIMSS 2011 Slide 12 Health Care Quality, Security and HIE Synergy 2011 October 21, 2011
Case Study – UCSF Medical Center, Motion Computing, Intel
Reduced the chance
of transcription errors
from 12 down to 2.
Vitals process went
from 5min to 1min. Source: USFC Medical Center
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© CSOHIMSS 2011 Slide 13 Health Care Quality, Security and HIE Synergy 2011 October 21, 2011
CPOE Implementation
CPOE Software
Device Selection
Workflow Study
Encryption
Wireless Network Performance
Application Availability
Change Management
& Education
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© CSOHIMSS 2011 Slide 14 Health Care Quality, Security and HIE Synergy 2011 October 21, 2011
Clinical Mobility Strategy
Mobility Strategy:
Clinician workflows and work areas for
care and documentation
Patient and information flow patterns for
each clinical area
Space constraints, facilities, Fire
Marshall and Joint Commission
requirements
Infection control and prevention
protocols
Staffing models and ratios by discipline
and shift
User device preference
Clinical Application Access
Hospital Owned
Non-owned devices
Support for affiliated staff
Wireless network
Security
Encryption
Theft protocol
PHI
BioMedical Devices
Medical Applications
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© CSOHIMSS 2011 Slide 15 Health Care Quality, Security and HIE Synergy 2011 October 21, 2011
Over 8,000 devices
are registered by
the FCC in the
same spectrum as
802.11 a/b/g
The majority of wireless
networks are installed
incorrectly. Full spectrum
wireless assessments are
needed.
802.11n has
much higher
capacity and less
interference
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© CSOHIMSS 2011 Slide 16 Health Care Quality, Security and HIE Synergy 2011 October 21, 2011
Clinical Mobility - Wireless
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© CSOHIMSS 2011 Slide 17 Health Care Quality, Security and HIE Synergy 2011 October 21, 2011
Massive changes or design
considerations are needed for a
multi-service wireless network
Data Only
Multi-Service
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© CSOHIMSS 2011 Slide 18 Health Care Quality, Security and HIE Synergy 2011 October 21, 2011
The majority of wireless networks will
not support VoWLAN.
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© CSOHIMSS 2011 Slide 19 Health Care Quality, Security and HIE Synergy 2011 October 21, 2011
Clinical Mobility – Application Access
Panasonic T8
MotionCL900
MotionJ3500 iPad
MotionC5v
Panasonic
H1
HP 2760
HP Elitebook
& Probook
Fujitsu
Lifebook
Ultra Mobile Specialized Tablet – Cvrtbl Laptop Handhelds
Intermec
Motorola
Client devices need to paired with the overall mobility design.
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© CSOHIMSS 2011 Slide 20 Health Care Quality, Security and HIE Synergy 2011 October 21, 2011
How you access the medical
application drives the device
Special App
Full Client
Virtual
Desktop
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© CSOHIMSS 2011 Slide 21 Health Care Quality, Security and HIE Synergy 2011 October 21, 2011
Clinical Mobility - Workflow Study
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© CSOHIMSS 2011 Slide 22 Health Care Quality, Security and HIE Synergy 2011 October 21, 2011
Accessories
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© CSOHIMSS 2011 Slide 23 Health Care Quality, Security and HIE Synergy 2011 October 21, 2011
Clinical Mobility –
PC/Client Services – Non
supported devices
Customer Knowledge is
based on traditional client
server computing
Clinical Departments want improved
support, and find mobile experience
tedious
Senior management knows mobile
device solutions are key but uncertain
in how to proceed
Help desk services are bombarded with
mobile device support issues
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© CSOHIMSS 2011 Slide 24 Health Care Quality, Security and HIE Synergy 2011 October 21, 2011
Clinical Mobility - Telemedicine
• Broad Band Considerations – remote locations and
roaming specialists
• WAN Design – MPLS
• Wireless roaming performance
• Quality of service – multi-service design
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© CSOHIMSS 2011 Slide 25 Health Care Quality, Security and HIE Synergy 2011 October 21, 2011
Clinical Mobility
Network
Devices
Workflow
BioMed & Emerging Technologies
Applications
Support System
Security & Compliance
Integrated Strategy