The 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 and settings.

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. Clarinet provides 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.

Duke 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 menus.

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 patient choice.

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.

Lessons Learned:

· 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


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