© CSOHIMSS 2011 Slide 0 Health Care Quality, Security and HIE Synergy 2011 October 21, 2011

Clinical Mobility

© 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?

© 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.

© CSOHIMSS 2011 Slide 3 Health Care Quality, Security and HIE Synergy 2011 October 21, 2011

Clinical Mobility

© 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

© 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

© 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

© 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.

© 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.

© 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

© 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.”

© 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

© 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

© 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

© 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

© 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

© CSOHIMSS 2011 Slide 16 Health Care Quality, Security and HIE Synergy 2011 October 21, 2011

Clinical Mobility - Wireless

© 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

© CSOHIMSS 2011 Slide 18 Health Care Quality, Security and HIE Synergy 2011 October 21, 2011

The majority of wireless networks will

not support VoWLAN.

© 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.

© 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

© CSOHIMSS 2011 Slide 21 Health Care Quality, Security and HIE Synergy 2011 October 21, 2011

Clinical Mobility - Workflow Study

© CSOHIMSS 2011 Slide 22 Health Care Quality, Security and HIE Synergy 2011 October 21, 2011

Accessories

© 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

© 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

© 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