Cutting Edge is Mobile
Today's healthcare abounds in knowledge and expertise that is spread
across a diverse spectrum and oft thought of as broken only into
administrative, financial and clinical functions. It seems to be
the norm for cross disciplinary work assignments. Every patient
contact lends itself to working partnerships and collaboration for
problem solving with the end result to improve delivery of healthcare.
Nursing has a unique opportunity to forge ahead with our current
knowledge base and expertise to enhance an outcome based approach
toward healthcare. To accomplish this broad task takes commitment
from each of us for self education in mobile solutions as new frontiers
present themselves for exploration. The newer working definition
by ANA of nursing informatics provides the broadened concept for
facilitation of data, information and knowledge to support patients,
nurses, and other providers in their decision making in all roles
The expanded ANA definition sets the ground work for this and future
articles that will address current solutions explaining their unique
functionality and utility in today's mobile environment. The following
two initiatives are being summarized by PDA Cortex as a real life
example of technology for today's health care enterprise.
Partners Health Care
Last year, a medical administration record (MAR) application
was delivered to Brigham
and Women's Hospital. This pilot initiative was run on a LAN,
(local area network) 802.11b connectivity. Linda Winfield, IS Project
Manager related that this unique application allowed nurses to access
and enter data related to patient assessment using wireless laptops.
An enhancement to the MAR, is under investigation that will support
wireless bar-coding for medication administration. A ruggedized
(Symbol) handheld may be used. As we all know those PDA with glass
screens can easily crack if dropped. Also included in this application
is the ability for nurses to sign in, obtain a list of patients
requiring medications, select the medication, and scan the barcode.
This will also allow the utility of auto updates that will synch
with each patient's medication record.
CareGroup also initiated an Emergency Department Dashboard (ED
Dashboard). This application allows nursing to track and manage
patient flow, bed movement and bed cleaning from entry to discharge
all on a wireless device. This allows Clinicians and Nurses to view
patients from the time they register, their triage acuity, chief
complaint, who has been assigned for their care in addition to completed
lab and radiology results in a real-time point-of -care modality.
They are currently utilizing wireless Palm VII's as well as the
Compaq iPAQ and laptops from Dell Computer. Upgrades will include
the Palm M500 and M505 and the Blackberry RIM will soon be available
as an alternative platform.
A move is anticipated for the future horizons with inclusion of
the 802.11a known as Wi-Fi5, which will operate at speeds up to
54 Mbps. To achieve the faster throughput 802.11a equipment will
draw more power than its 802.11b counterpart. The current technology
for the 802.11a is more suitable to desktop PC's that laptops and
PDA's. Once 802.11a equipment is widely available, the ease of developing
a wireless network should allow it to displace the dominance of
100BaseT Ethernet for installations.
Outpatient ambulatory care includes PatientSite.
The site offers patients full access to the medical records, appointment
making, medication renewal and secure messaging.
Handhelds utilize Blue Socket to protect 802.11b connection along
with GridLock to lock down the Palms.
IRDA synching is a must with the variety of handhelds being used.
high speed wireless network connectivity through a single access
point regardless of the user platform OS.
Both of these clinical applications are built on the CACHE post-relational
database from InterSystems
Corporation in Cambridge, MA. CareGroup Healthcare System has achieved
an edge in the e-business technology by adapting and utilizing the
trend-setting Care Web. This web-based medical records retrieval
system is based on the CACHE-DBMS (database management system).
Sodexho utilizes a one of a kind handheld solution
that has a direct impact on patient care and recuperation that addresses
the nutritional component for their hospital stay.
University Medical Center has implemented a cutting edge program
with the assistance of their foodservice provider Sodexho,
Early discharge being the norm in today's healthcare arena has produced
a less than adaptive environment for the nutritional therapeutic
component. According to Connie Ulrich, Associate Director of food
services at Duke Medical Center, the use of handheld computers for
patient meal selection has not only enhanced overall caloric count
from a therapeutic standpoint but has increased patient satisfaction
for meal selections by 30%.
The adaptation of using the Palm OS handheld has taken e-health
progress to the forefront, freeing nurses to provide their important
components of delivering care to patients instead of collecting
A new bundled menu allows patients to select their entrée
from 8 standard diets that has decreased the original menus from
120 down to 70. Complimentary side dishes come with each of the
main entries. The system creates an environment at the point-of-care,
permitting patients access in making informed nutritional choices
that provides improved flavor quality when the plates are rethermed
on the floors. Any parent would be ecstatic to have child friendly
finger foods for those oft finicky pediatric patients. Besides the
American favorite cheeseburger, there are options written in Spanish,
along with the Kosher and Muslim menus.
Eight full-time food technicians visit patients twice a day to
collect and download selections. The palm handhelds contain each
patient's name, room number, and information from the database on
any dietary restrictions. The tech enters each patient's meal selection
using the built in a built in drop down list to log or change their
choices. Once this is completed the hot synch selections are downloaded
and coded into CBOARD on a PC. Within 3 seconds, the download access
allows tray tickets to be printed and the order filled for the specific
This initiative is a year old and more changes are
coming. Additional benefits for human contact with another member
of the healthcare team cannot be stressed enough. They have real-time
contact to discuss the choices that provides an educational opportunity
not only for the patient but for the personal growth of this valuable
team member. Future endeavors will involve the ability to pre-order
lunch for the same day, along with adaptation for the Symbol technology
for a more rugged handheld. Utilizing the IR capability will allow
the foodservice department to scan their inventory for supplies
which will no doubt create additional ROI. Additional new users
will be the Detroit
Medical Center, Celexa in Jackson, Tennessee, and the University
of Chicago Hospitals and Health System.
· Equip the enterprise with tools that can produce
easy updates and restore service due to interruptions.
· Match the task with the appropriate mobile device.
· Not all Mobile solutions need to be developed in-house.
Seek out the experts and investigate the value added resellers.
· Take advantage of synchronization. It will save
connection time and entry will be at the point-of -care.
· Choose a handheld based on the functionality and
ease of use and get those end users involved to decrease
the likelihood that the chosen device and application will
not gather dust in a corner.
Sylvia Suszka Hildebrandt,
MN,RN, ARNP,CASNI , Editor PDA cortex