One rapidly expanding category of healthcare carts is the mobile computing cart, also known as the wireless PC cart, mobile clinical workstation, point-of-care cart, or even a COW (Computer on Wheels). As more and more patient care processes become automated, and information technology becomes a normal part of the clinical workflow, mobile computing solutions that bring enhanced functionality to the bedside are becoming more of a "must-have" than a "nice-to-have".

"The continual advance of computing technology is pushing the development of mobile computing carts forward every year," said Todd Ross, marketing and business development director for Artromick (Columbus, OH). He adds, "Artromick has continued to stay with this advance in technology by introducing a new solution every year for the past three years."

Many of today’s workstations are a flexible platform from which users can run their own configuration of information system, infrastructure and hardware devices – from laptops, to thin client solutions, to desktop computers.

Artromick’s latest mobile computing cart, the MC30 WorkStation was designed to meet multiple user needs, accommodating popular hardware devices including an option for Artromick’s all-in-one processing solution. The Artromick WorkStation can be fully customized with accessories such as chart holders, waste receptacles, cup organizers, storage units, sharps containers and bar code scanner holders.

"For nursing, the Artromick MC30 WorkStation offers a lightweight and simple-to-maneuver design that ensures simple use and welcome product adoption. For IT, the MC30 gives the facility an open platform to design the computer solution that best meets its specific requirements," said Ross. "Through a consultative product selection and implementation process, Artromick ensures each facility is set-up to gain the most effective workflow advantages from their new system."

New from Flo Healthcare (Norcross, GA), the Flo 1800 mobile workstation is an open platform that can house any software system and virtually any hardware solution, plus offers users greater flexibility to configure the workstation to their unique specifications. With the ability to seamlessly integrate a variety of peripherals – from bar code scanners to vital sign devices – the Flo 1800 offers a building block for present and future applications.

Strategically placed "attachment points" manufactured into the trim-line Flo 1800 platform allow facilities to hand-pick features such as storage capacity, vital signs capture and other accessory options. "We call it mass customization." said Keith Washington, vice president and general manager, Flo Healthcare. "Our 1800 workstation is the same cost as our [previous model] 1750 workstation, it just gives you some more flexibility over time to add functionality when you need it." 

Washington stressed the importance of designing mobile computing solutions that work with a facility’s current workflow. "We take the experiences learned at a nurse’s station where most nurses have been using these computers for a number of years. They’re very comfortable and familiar with it, and we’ve created that same level of functionality in a mobile platform."

After consulting with clients to determine the best workstation solution for their unique needs from a process, technology and budget standpoint, Flo tests the completed carts, with all peripherals and accessories, and delivers them fully assembled, ready to roll right out of the box. "We make sure everything works together, that it’s seamless and overall works very easily for the user, which is primarily the nurse." He adds, "as you’re getting increased rates of adoption the type of user that’s getting involved now has less and less technology experience. You’ve got to make it very easy to use or you’re not going to get majority use in the facility."

JACO (Franklin, MA), also designed its new Ultra Series wireless PC cart as a "universal platform" to accommodate nearly any PC device. "The Ultra Series Carts can be equipped for use with laptop, thin client or desktop computers from most popular manufacturers, which lets IT staff designate their preferred brand, without worrying about having to support proprietary, non-standard computers," said Gary Brayton, national sales manager, JACO.

The iPoint point-of-care cart from Lionville Systems (Coatesville, PA) supports all software and a full range of hardware options and includes a choice of secure, articulating laptop and keyboard trays, mounted on multi-pivot swing arms or lazy susans that allow almost infinite positioning, and provides an unobstructed work surface.

Many mobile workstations are also blurring the lines between medication delivery and clinical documentation, morphing the two applications into one multi-functional cart.

With a choice of secure storage options, Lionville’s iPoint can serve as a combination workstation/medication cart with security features such as keyless entry, automated relocking, individual patient drawers, and a patented locking system that assures that drawers that look locked are locked. The i/8 Med Cart from Lionville is available with up to nine tiers of medication storage drawers.

Artromick’s Mobile Computing MedServer merges mobile computing and wireless data management with the latest medication security, all in the small, easily maneuverable footprint of the Artromick WorkStation. With medication control supported by a keyless access and an auto-relock security system, the MedServer features user access audit and secondary access requirement option (such as mag stripe or bar code card). With wireless cart management, all Artromick carts in the facility can be accessed and programmed from a single PC.

"The Artromick MedServer is a product specifically designed to work in conjunction with medication dispensing cabinets on each floor," said Ross. "The MedServer serves as a bridge between the dispensing cabinet and the patient, greatly enhancing security, organization and control of the medications."

The Artromick IMC Mobile Computing Medication Cart is a fully-configurable computerized medication and supplies storage cart. The IMC security system features auto-relock and options such as remote cart management, audit trail, and proximity card access reader.

"Some areas of the facility may want a medserver; some may only need workstations; some may need full size medication carts with integrated computing. The facility should partner with a provider of mobile computing solutions that provides the widest array of mobility platforms so they can standardize on product functionality (so nurses going from one area to another will know how to use the equipment), and maintenance," said Ross.

Armstrong Medical’s (Lincolnshire, IL),new Optional Proximity Reader, available with all of its auto-locking carts, allows hospital personnel to access the cart simply by waving a programmed ID badge (prox card) in front of the cart. The Proximity Reader will read most low-frequency HID Prox Cards (125 kHz) or extra cards can be ordered. Other features include a master code for all programming, an access code for normal, daily use, a master manual key override for emergency access, and the ability to accept up to 250 user codes. Optional software allows for access log of users by date and time of entry.

Armstrong’s battery-operated Aluminum Auto-Locking Carts available in five- or six-drawer configurations, feature SureSeal drawers that close automatically once within approximately an inch of being shut. The Auto-Lock timer can be set from 1 to 998 minutes, or can be shut off so the cart never auto-locks. Armstrong’s A-SMART Aluminum Push-Button Cart features a push-button lock with key override. The ClearView Security Drug Box comes with push-button lock with key override and allows for a clear view of inventory. The ClearView can be used as a stand-alone security box, can be mounted on any A-SMART Cart with an Optional ClearView Shelf, or it can be mounted on a wall, or in a patient’s room.

The Starsys Medication Cart series from Metro Healthcare (Wilkes-Barre, PA) includes a flexible drawer divider system that allows you to organize the drawer to suit medication requirements. Overbridge accessories keep frequently used supplies handy, while swingouts provide ample worksurface. The Starsys Unit Dose Cart features an electronic touchpad and a locking drawer cover for narcotics storage. Swingouts provide both additional storage and extended worksurfaces when opened. To restock the cart, take the entire cart or simply remove the drawer totes or cassette for replenishment.

The new PalWOW Workstation on Wheels from Health Care Logistics (Circleville, OH), is priced starting less than $500, and can be adpated to serve as a medication delivery cart with the additon of a two-tier locking cassette frame and 10 patient bins.

Flo Healthcare’s 2000 series Medication workstations are designed to be as small and lightweight as possible, with flexibility in storage configuration. Flo’s parent company, Emerson, recently acquired Lionville Systems. Washington forsees that the two companies will have opportunities to work together to combine Flo’s expertise in point-of-care mobile device technology with Lionville’s experience in the storage and transport of mediations to help hospitals improve medication administration and patient safety over the all-important "last 100 feet" of care.

The Flo 3000 Critical Care Workstation, with options such as high-resolution, dual-display, extra-large monitors perfect for radiology applications; and videoconferencing for remote tele-health capabilities, brings high-tech communication to critical care and even surgical areas. "There are certain processes in the critical care area that are starting to move towards a technology solution, particularly a mobile technology solution," said Washington.

The ability to integrate vital signs capture into the workstation is one feature that will go a long way towards improving nurse workflow, patient safety and quality of care. For example, explained Washington, "Flo’s partnership with Welch Allyn and the ability to integrate Welch Allyn’s Spot Vital Signs LXI monitor and various monitoring devices into the workstation helps to automate the process at the point of care. Information can be brought directly into the electronic medical record."

"Barcode scanners and other technology advances can be accommodated by the Artromick cart lines to ensure the facility offers the latest in patient safety and clinical efficiency," said Ross. "By serving as open platform for clinical technology, Artromick offers the flexibility to accommodate a wide array of technology solutions including bar-code scanners (hands- free, wireless, or cabled), vital signs monitors, and other point-of-care clinical solutions."

JACO’s vital signs monitor mounts will hold most newer, smaller vitals signs models that have IV pole clamps. JACO also offers custom  brackets/clamps for vitals models that don’t have an IV pole style mounting bracket.  

The StyleView cart from Ergotron (St. Paul, MN) integrates EnovateIT technology by attaching a Welch Allyn Vital Signs monitoring system to the back of the cart for bedside patient diagnostics. With programmable, auto-locking electronic keypad medication drawers, StyleView can also serve as a medication delivery cart.

New choices are also emerging in OR supply and procedure carts – including suture, catheter, and implant carts – all providing an array of mobile storage options while helping facilitate processes.

"Dedicated procedure carts are an excellent way to maximize space," said Shannon Bennett, event marketing and training manager, InnerSpace Corp. (Grand Rapids, MI). "Instead of stockpiling clinical supplies in all procedure rooms, end-users should instead set-up dedicated carts for each procedure line, i.e. LAP cart, Vascular cart, Cysto cart, etc. Procedure carts can be rolled into place as needed with each cart being clearly labeled. Optional keyless entry should be taken into consideration for procedure carts."

InnerSpace’s pull-out Cath Managers keep catheters and other hanging items organized, making them easier to find and retrieve. Depending on catheter packaging, up to 800 catheters can be stored in one of InnerSpace’s full-size carts. Cath Mangers are available with six or eight hooks and are equipped with double glides for maximum strength and durability. They are adjustable from side-to-side to accommodate wider catheter packages.

"We’ve found with hanging supplies, often times the simplest accessory can make a big difference. Our inventory control clips keep hanging supplies from slipping off the hook, and our adhesive backed hang-up tabs can be applied to torn packages that need to be returned to the hook," said Bennett.

InnerSpace also has a wide range of dedicated suture storage options, including enclosed or open-frame suture carts. Pull-out suture modules and gravity feed trays may be used in any full-size cart or QuickStore open access carts. 

IRSG (Woodinville, WA) offers a range of standard and customized carts, including catheter carts, linen carts, patient care carts, orthopedic supply carts, procedure carts and suture carts, just to name a few. Features include high-quality casters and carts that can accommodate a variety of adjustable shelving and shelf divider options. Carts are built to fit individual department’s needs including canister holders for oxygen tanks, drawers and padlock-ready doors for patient record security carts.

IRSG Catheter carts are designed to hold a wide variety of sizes, styles and lengths of catheter packages. Catheter hooks and bars can be adjusted to accommodate specific storage requirements and shelving enables staff to transport the necessary supplies along with catheters for catheterization
procedures.

IRSG Suture carts enable maximum inventory control and quick access to sutures. An adjustable slanted shelf design allows for gravity flow of suture boxes and easy restocking. Open-wire construction allows for easy suture identification and reduces dirt and dust build-up.

"Peel-pak carts and orthopedic supply carts enable the surgical staff to remain in the OR suite during a case, rather than having to leave a case to hunt for supplies. These carts can either be rolled into the OR or kept just outside the door for easy access. The Peel-Pack cart is flexible enough to accommodate any size of peel-packed item, from small gauze pads to bulky instrument packs. The orthopedic cart allows OR staff easy viewing of and access to surgical implants during a case, as well as providing a storage system for implants when not in use as well as keeping all supplies well organized and easy to restock," explained Lise Van Deusen, marketing coordinator, IRSG. "Buyers can greatly enhance their success in purchasing carts by collaborating with suppliers in the planning process prior to purchase." Van Deusen adds, "identifying the functionality, work flow and flexibility requirements in advance allows the supplier to accurately identify the appropriate cart and provides the opportunity for the supplier to deliver innovative and effective designs. Most often this benefit to the buyer is achieved at no additional cost resulting in the perfect purchase."

Interchangeable solutions allow for users to quickly adjust storage configuration for future applications. "InnerSpace’s line of storage and procedure carts are equipped with modular cell panels that allow quick and easy interchangeability of shelves, trays and/or baskets. Optional cath managers and suture racks are also available to increase the cart’s functionality. An InnerSpace cart configured as a Vascular Cart can be easily converted to a GI Staple Cart, for example," said Bennett.

Metro’s new Starsys Secure IV cart is a system of polymer components that offers security in a flexible storage solution. Removable totes allow for the creation of an inventory replacement system with pre-stocked totes. Full extension shelves allow for solution bags to be stored standing up or laying down while providing complete access to the entire product. A locking clear door is in compliance with JCAHO’s medication storage standards and provides for visual inventory while contents are secure. Solid enclosure panels and door protect contents from splashes and potential contamination.

Stainless steel case carts from Suburban Surgical Co. (Wheeling, IL) are designed for dependability and long life in demanding hospital conditions. Low profile or tall models are available in many sizes and shelf configurations. Suburban Surgical’s carts are manufactured with full recessed door jambs, so doors close and lock every time. Independent, rolling stainless steel chassis design guarantees true alignment and cabinet durability. 

Ergonomic issues are playing a more prominent role in cart and workstation engineering, resulting in carts that are user-friendly, lightweight, easy to maneuver and feature flexible positioning.

JACO’s Ultra Series carts are equipped with foot-activated pneumatic cylinders that let any user quickly and easily adjust the work surface height for comfortable use in either a seated or standing position, or make minor vertical adjustments to achieve preferred viewing and reaching distances. The keyboard tray offers an ergonomically correct plus or minus 15° tilt and pivots to provide the correct working relationship for each user. The new carts offer a larger work surface and a greater range of motion than previous models, while maintaining its small footprint. The Ultra ZXP from JACO features easy single-handed height adjustment.  

Ergotron’s line of StyleView Carts with Constant Force (CF) patented motion technology, allows users to adjust the workstation 20 inches up or down, with smooth one-touch vertical motion, for comfortable, ergonomic data entry sitting or standing. The StyleView also offers an additional 5" of independent monitor height adjustment and 25° screen tilt (on flat panel configurations), which benefits all users, including those who wear progressive lenses. A keyboard tray provides up to 12° of negative tilt for an ergonomic typing position that reduces the risk of repetitive stress injuries.

Artromick’s WorkStations and MedServers feature a motorized height adjustment feature to position the monitor and keyboard at the perfect height for comfortable use, whether the user is seated or standing.

Lionville’s iPoint features one-handed push-button height adjustment.

Natrually, the lighter the cart the better for the nurse, but at the same time, slim designs allow carts to go everywhere a nurse needs to go. For example, among Armstrong’s lightweight aluminum cart offerings is a Narrow version that can fit into the tightest of spaces.  

Though carts are generally getting smaller, they’re also incorporating larger work surfaces. "We’ve found that having this large work surface with a convenient place to work on multiple tasks allows nurses to stay in the room at the bedside and be more productive," said Washington of the Flo Healthcare carts.

To help healthcare workers effortlessly move even the heaviest cart loads, consider IRSG’s iMover ergonomically-designed tug. With the iMover any user can pull up to a 2,000 lb. cart easily and safely through tight spaces, helping to reduce employee back injuries. With a footpad of only 24" x 21", the i-Mover takes a minimal amount of storage space.

"Most of our products are designed with the correct ergonomic standards as a basis, which then is modified to accommodate a specific employee profile," said IRSG’s Van Deusen. "Reaching, bending, pulling, pushing and even eye strain are very important design elements that are considered in addition to functionally and ease of use."

As with any equipment purchase, it’s important to look beyond the initial purchase price and consider the "total cost of ownership" when investing in new workstations and carts. This includes looking years ahead to gauge future needs and how the cart will stand the test of time. This means they need to be durable, cleanable, and adaptable, among other things.

"Once you start mobile devices you’re going to be using them for a long, long time. You don’t want to have to change every few years," said Washington. "We see a lot of dysfunction where people are making decisions just based on today’s requirements and really aren’t thinking them through."

The ability to make future upgrades is just one part of the total cost of ownership. "When it comes time to upgrade, do you have to throw away your old system and completely replace it, or do you have choices? asked Washington. "With our system, it’s really very simple. Once the computer reaches the end of its life, all you have to do is replace the computer."

JACO’s Brayton stresses flexibility as an important consideration for cost of ownership. "Because we offer an open, universal platform, the buyer doesn’t have to worry about technology changes down the road. And if they change from one platform to another, say laptops to desktops and monitors, the carts are easily upgraded with new work surfaces. In fact many of our carts are well over 10 years old and have out lived three to four computer change-overs."

Total cost of ownership for a workstation also includes how often it must be serviced, both in terms of labor and the hardware cost.

"One of the key items we find that people often overlook is the battery," said Washington. "If they’re going to be replacing batteries frequently, there’s a very high cost associated with that, because you have to physically locate the devices, spend all the time to disassemble, to remove the old battery, the cost of the new battery, and all of the labor to reassemble and put in the new battery, and then if you’re going to have to do that every year or so it gets very expensive."

Flo offers several battery choices, including one made to last three to four years without having to be replaced. Washington notes that while the long-life battery initially costs more, "when you look at the total cost, it’s much cheaper to buy batteries that last a long time then to spend all of the labor to replace batteries frequently."

JACO’s durable steel and aluminum carts feature a robust power system designed for longer run times and quick recharge. Plus, the power system is mounted to the JACO Power System Ramp for quick, no hassle, no-lift battery service and replacement.

"From a service point of view this allows the user to take off and replace the JACO Power Systems in less than a minute without removing any hardware, or lifting the batteries out of a housing," said Brayton.

Stinger Medical’s Mobius mobile continuous power system lets users exchange power modules on the fly without interrupting clinical workflow. Batteries are kept on a charger and users can easily and quickly replace the old battery with a charged one.

Artromick’s carts are matched specifically to a powerful battery system to ensure extended running times of at least 10 to 12 hours.

"Simple to maintain and reliable carts are the keys to keeping the cost of ownership low," said Ross. "But most importantly, the complete education of the users is what truly keeps the cost of ownership low. Through education of all users and support staff with every implementation, Artromick ensures each facility is completely up-to-speed on how to get the most out of their mobile computing carts and ensure they are maintained to provide long-term, reliable service. This and willing user adoption by providing a high-quality and easy-to-use solution is what minimizes the overall cost-of-ownership."