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Copyright © 2013
INSIDE THE CURRENT ISSUE
|2011 Carts & Workstations Buyers Guide||
integration moves carts, workstations forward
by Jeannie Akridge
Healthcare workers and clinicians are constantly on the move, and you’ll likely find them pushing or dragging a cart or mobile workstation along with them, that houses all of their necessary supplies, medications, and increasingly, patient’s electronic medical records (EMRs).
Manufacturers are rolling out advanced options that help caregivers improve workflows and enhance patient care. Just like new hybrid electric cars are designed for efficiency, hybrid models of medication and storage carts are helping clinicians to be more efficient in their daily caregiving tasks.
Metro’s new 1760Rx hybrid medication workstation integrates the best in secure medication delivery solutions from Metro’s Lionville product family with the best from the MetroMobile (Flo) point-of-care computing system to create a fully-integrated workstation and medication delivery vehicle, noted Erick VanLaningham, director of healthcare marketing.
With the introduction of the new Savvy mobile medication system, Omnicell Inc. has focused on integration and interoperability to help improve workflow efficiencies and improve patient safety. "I think the industry is really evolving though from mobile carts to where we feel like we’re taking things to the next level with a product such as our Savvy Mobile Medication system," said Len Hom, product marketing manager, mobile medication solutions, Omnicell. A comprehensive medication management system, Hom described Savvy as "much more than your traditional computer on wheels, or even a computer on wheels that has drawers."
Shannon Kennedy, marketing director, Stanley InnerSpace, commented, "For maximum efficiency and privacy, patient charting should be conducted at the bedside. The AE community has taken note and is allowing space for bedside carts in new patient room design, but that leaves an even greater number of hospitals out there that have smaller patient rooms with no plans to renovate in the near future."
"Our line of bedside carts, including the InfoLogix ST7 cart, has a small footprint and a range of configurable options such as drawers, barcode scanner holder, and a customizable work surface and keyboard tray."
Ergotron offers a selection of wall mounts, mobile cart solutions and sit-to-stand workstations for single displays and multiple displays to meet various healthcare requirements. "Our products are designed to support three progressive ergonomic phases: comfort, productivity, and wellness, offering customers the ability to configure products to their unique computing needs while ensuring easy adjustment and positioning—tilting, side-to-side, up and down, portrait to landscape and front-to-back," said Collette Crumb, product director, Ergotron. "This ability to meet caregivers’ ergonomic needs accommodates their physical comfort and greatly reduces and eliminates neck, back and eye strain and other musculoskeletal disorders."
Ergotron carts and wall mounts include a minimum 20" of keyboard height adjustment, with independent LCD tilt, pan and height adjustment to cover the majority of caregivers for seated or standing use, from roughly 5" to 6' 1" tall.
"Single-motion fluid sit-to-stand adjustment is crucial," Crumb emphasized. "It frees caregivers from having to take time to adjust multiple components in order to reach their personal zone. ... If a caregiver has a comfortable workstation, they have a greater access to a healthier and more productive computing experience, whether standing or seated. If they are in this zone, the natural benefits can include less structural strain, lower energy spend, and reduced fatigue."
"There seems to be a growing list of requirements for bedside carts," said Kennedy. "Ultimately, healthcare facilities need to determine their priorities and find a cart system that suits their needs with minimal compromise. Consider the cart’s overall footprint, weight, monitor mounts, keyboard tray, scanner and mouse holders, battery run time and recharge time, for instance. IT stakeholders may also want to understand the internal and external cord management system. Besides computing, understand what other functions the cart may serve in the room. For example: will storage space for meds and general nursing supplies reduce the number of trips made to supply carts down the hall? Eliminate unnecessary motion and ensure that the patient is served as quickly as possible."
Kennedy urged facilities to consider strategies such as LEAN that can not only help organize supplies but help improve workflows for nurses and clinicians. "Clinical teams don’t want to waste precious time during the day managing supplies. Nurses want to be caregivers, not inventory clerks or supply chain experts. One way to improve departmental efficiency is to implement Lean strategies such as 5S and Kanban methods. By imploring Gemba (go and see), supply chain specialists can get to the heart of the matter and really start to understand department pain points. Visit the department, conduct a walkthrough, and get a grasp on the work flow. Value stream maps are great for this purpose.
"Our storage and inventory consultants understand what it takes to prepare a supply room for maximum efficiency, and our HIA and Delta consulting teams take an even deeper dive to showcase EMR, revenue cycle and strategic cost management strategies," she added. "It’s not enough to put a new cart into the OR core and hope that supply management improves overnight. Supply chain and end-users need to assume equal responsibility to foster staff buy-in and implement initiatives that can be sustained and continually monitored for additional improvements. The carts themselves are engineered to support these workflow efficiency goals. Look for carts that have modular features, like interchangeable accessories, and removable trays with divider and label options. Also, you should understand in advance the level of cart security required for your facility. With more options available than ever before, the process of picking a cart standard to meet your needs has become that much harder. Select a vendor that has a number of cart height options, an abundant number of accessories to meet procedural needs, and a variety of security options to choose from."
In addition, continued Philippe, "the 2BIN-iD stock rotation feature substantially lessens the risk of using expired products, thus enhancing patient safety and reducing inventory wastage."
Philippe explained how the Logi-D system works: "In a ‘two-bin’ system, a target quantity of a given SKU is divided into two batches in bins that are only refilled when one of the bins is empty. While the first bin is awaiting replenishment, the supplies in the second bin cover usage requirements during the refill cycle.
"In the Logi-D RFID-enabled 2BIN-iD system, when the primary batch is consumed, users transfer a location tag, which contains an RFID transponder, to a "reader" board," he continued. "A replenishment signal is automatically captured by a middleware application that associates the product’s location tag with the quantity of supplies to be restocked in a specific storage location. This data is then electronically transmitted in real time to the hospital’s materials management information system, which in turn generates a replenishment request for stock items or a requisition for direct purchase products."
"This enables materials management rounds on the floors to be cut by at least 50%, as the demand chain is automated and the rounds only executed to deliver supplies," added Philippe. "As storage units in some areas of the hospital—examination rooms and the OR, for example—may be difficult to access for materials management personnel, the use of the RFID-enabled 2BIN-iD replenishment system prevents disruptions to the front line of service."
"In addition to managing general supplies with 2BIN-iD, Logi-D’s iD suite also includes the CC-iD solution, which tracks high-value or consignment supplies from the receiving dock to their point of use with limited human involvement. For a case environment such as the OR, Logi-D offers CIRCUIT-iD, which integrates replenishment, data collection and preference card management automation to reduce both the involvement of clinical staff in supply related activities and the manual updating of incomplete or obsolete procedure and surgeon preference cards. Logi-D’s iD suite also helps improves warehousing and distribution with SOLID-iD, a best in class WMS, and PTL-iD, a batch picking cart utilizing pick-to-light and voice-recognition technology that provides similar efficiencies as carousels and completes the replenishment cycle with a voice-directed put away solution," Philippe added.
Carts and workstations are also playing a key role in improving the safety of medication administration at the point of care.
Providing a balance of functionality and ease of use, the MetroMobile 1760Rx can be integrated with virtually any type of accessory that a customer may need, ranging from additional storage to barcode scanners to Metro’s SecureRx Med Module. "For those customers requiring enhanced medication management during the last 100 feet of patient care, the combination of our MetroMobile workstation with our SecureRx Med Module would allow for downstream [medication administration] from an automated dispensing cabinet for up to 12 patients to help with workflow efficiency gains," explained VanLaningham.
The Savvy System integrates with Omnicell’s automated dispensing cabinets and the hospital’s HIT system to allow nurses to safely and securely transport medications from the dispensing cabinet to the bedside, helping to address patient safety requirements such as the Institute for Safe Medication Practices (ISMP) Core Process 10 for safe transport of medication.
"Often times, what people refer to as ‘the last 50 feet of medication management’ kind of gets forgotten," Hom explained. "They do such a great job of securing all of the meds from the dock all the way through the pharmacy up to the nursing floor, and ultimately into an automated dispensing cabinet – but once the nurses remove those meds from the cabinet, I think there’s opportunity that we’re trying to address through Savvy to where we can improve safety."
Hom described how even with the best of intentions, nurses face constant distractions that can interrupt their workflows and can compromise the safety of medication administration. "With all of the interruptions that occur on a daily basis from the nursing community it’s very rare that they get the opportunity to remove the medication from our cabinet and go directly to the patient’s bedside for administration."
In addition, having the ability to pull more than one patient’s meds at a time out of the cabinet greatly reduces the amount of time caregivers spend walking back and forth between the automated dispensing cabinet and the patient’s room. "Our beta sites have actually shown that nurses spend close to 33 – 35 percent less time in front of the cabinets retrieving meds," said Hom.
The Savvy system can also help facilities comply with the Centers for Medicare and Medicaid Services (CMS) expectation that drugs are to be administered within 30 minutes before or after the scheduled time, a best care recommendation that poses a particular challenge for time-strapped caregivers who are pulled in many directions, Hom explained.
"A lot of nurses feel like [the rule] is promoting unsafe practices and a lot of workarounds," he said. A survey conducted by ISMP showed that more than half (59%) of respondents were infrequently or only sometimes compliant to the CMS "30-minute rule" and only 5% were always able to comply with the policy.
Along with the rollout of the Savvy system, Omnicell announced its fourth generation Omnicell G4 platform that includes 11 products to advance medication and supply automation management. The new platform offers a single unified database across the continuum of medications maintained in automated dispensing cabinets with a new intuitive user interface across the products. Users are not required to change out their Omnicell cabinets in order to upgrade to the G4 platform, Hom noted.
Omnicell’s Anesthesia Workstation G4 has been redesigned based on customer feedback to be more ergonomic and conducive to anesthesiologists’ workflows. A compact, yet high-capacity design with a reduced height, as well as monitors positioned on articulating arms versus being fixed-mounted, allows users to comfortably access the workstation from a seated or standing position. The Anesthesia Workstation G4’s upgraded console features Omnicell’s new Touch & Go G4 biometric ID system for fast and secure access.
Hom noted that the implementation of electronic health records have been a key driver for transitioning to mobile systems. "As hospitals introduce EHR systems, e-MAR systems, CPOE systems, all these things are very conducive to running on a mobile station."
Omnicell recently announced that its G4 platform has achieved ONC-ATCB certification as a Modular Electronic Health Record (EHR). According to the company, Omnicell is the first stand-alone automated medication system to receive this certification, supporting its customers in achieving their meaningful use objectives to qualify for federal funding incentives as outlined in the American Recovery and Reinvestment Act (ARRA).
"[Metro’s] new hybrid, secure medication management workstation addresses a critical need for hospitals that are implementing barcode med administration (BCMA), while complying with the HITECH act of Meaningful Use demands of enhanced digital communications and clinical documentation. The Metro SecureRx system fits well with those customers at Stage Three of the HIMSS adoption model that want secure medication management and need barcode med administration at the point-of-care," explained VanLaningham.
Alternative form factors
Equipped with two cameras and touch and digitizer pen optimized, the Motion CL900 is ideal for clinicians who move on and off the hospital floor and need access to critical patient data, charts and information, noted Mike Stinson, vice president, marketing. "Since it is powered by the Intel Atom processor to support extended battery life, The CL900 is ideal in ‘cloud optimized’ or constantly connected environments, or for workflows that only require the need to run one or two applications simultaneously."
"The C5v is the first tablet PC that was specifically designed for healthcare environments," Stinson added. "As a result, it is rugged, powerful and fully sealed to ensure compliance with infection control protocols. With stylus input, the C5v is ideal for data acquisition and capturing signatures and comes with two cameras, RFID reader and barcode scanner. The C5v offers a hot-swap battery feature and enhanced remote management capabilities, ensuring patient data is secure, without ever leaving the patient’s side."
The C5v can be disinfected with traditional wipes or sprays, or with germicidal light, such as Motion’s ReadyDock:UV. "Offering chemical-free, general-purpose disinfection of the C5v, ReadyDock:UV applies germicidal light consistently to 99 percent of the tablet’s surface area in just 105 seconds," said Stinson.
The Motion J3500 features a touch screen option that makes scrolling through long documents or navigating the task bar quick and easy, while the digitizer pen enables clinicians to complete forms, capture patient signatures or input handwritten data securely. Additionally, the 12.1" screen makes utilizing the tablet as a desktop replacement possible and supports nearly any software application.
Wall-mounted workstations are taking their place alongside mobile workstations as an integral component of many hospitals’ EMR implementation strategy. "We’ve been noticing the trend that it takes a combination of not only fixed—but also mobile solutions—to meet their needs," VanLaningham confirmed. "Workstations on wheels are still the preference, in terms of how nurses do their documentation and how they round, but wall arms [may be preferable] in certain situations, when you have space constraints, or need other type of form factor."
The new MetroMount Wall Arm solution sits just seven inches flush from the wall, yet can extend out to 55 inches for access from a variety of positions. With a compact footprint, the MetroMount Wall Arm is able to support up to a 40-lb. capacity. "It’s able to support the all-in-one computers that a lot of hospitals are standardizing on," said VanLaningham. The MetroMount system also has the unique ability to be mounted directly to the dry wall without the need to locate a supporting stud.
The new wall-mounted workstation from Rubbermaid has an electronic lift with 15 inches of height adjustment to accommodate a variety of users in the seated or standing positions, described Chochinov. In addition to the electronic lift, the adjustable height wall cabinet offers: Enhanced security through a PIN code locking system and a proximity sensor that detects when the user walks away and automatically closes the workstation to prevent unauthorized access; ample space for documents and supplies due to a generous sized work surface; ergonomically designed features such as a task light that illuminates the work surface to reduce visual strain and improve usability as well as an extra-large mouse pad that makes point and click software applications easier to use; and choice of 21 best-in-class finishes to complement any facility’s décor.
"Driven by an aging population, increased requirements in remote locations and the need to control rising healthcare costs, the world market for telemedicine is growing at 7 to 8% per year and is expected to exceed $18 billion by 2015 according to Global Industry Analysts. Growth in the US market (currently $9.5 billion) has been further stimulated by federal grants to encourage telemedicine and develop telecommunications infrastructure, Chochinov shared.
"Rubbermaid has expanded into the telemedicine space with the availability of the MEDI PORT solution. The solution is made available through a collaboration with C PORT Solutions. MEDI PORT is a line of powerful mobile computing platforms that combines high-definition video, audio and web conferencing, and interactive white board technology onto a single mobile device that can be rolled anywhere – the OR, ER, hospital ward or outpatient clinic. The device allows remote medical specialists to view patients and provide expert counsel, especially important for rural clinics and field hospitals with limited medical staff. Live surgeries can be shared remotely for purposes of mentoring and training and better diagnoses are enabled via bedside access to patient data and web based resources."
"The gap between the procedure room and access to the information and expertise required to ensure quality patient care often leads to delays in treatment, additional costs and potentially compromise patient outcomes", continued Chochinov. "The MEDI PORT solution bridges that gap allowing doctors and other medical experts to collaborate, communicate and apply their knowledge to those who need it at a time and place where they need it most."
Metro is building upon its comprehensive line of storage and transport carts, procedure carts and medication administration workstations to launch its Metro Monitor Dashboard System this month at the AHRMM Conference in Boston. "The focus is on establishing a common design and architecture across all of our software systems. MetroMonitor will provide a foundation for future application growth, while supporting power system analytics for our point-of-care computing product line," explained VanLaningham.
The MetroMonitor Dashboard System provides a web-based power management system that delivers visibility into a facility’s fleet of workstations to support readiness and reliability, explained VanLaningham. "For example, IT professionals would pull up our dashboard from one central location and gain visibility across several locations on the power status of all workstations. If set parameters like battery capacity or cycle count hit a certain threshold, automatic alerts would be immediately generated to notify IT staff allowing for real-time monitoring and preventative maintenance."
"In combination with the MetroMobile point-of-care computing workstations, the MetroMonitor Dashboard System allows our customers to pro-actively monitor power systems and computing technology. The system is scalable and designed to meet the needs of virtually any healthcare facility, whether it has ten workstations or a thousand," VanLaningham added.
Metro is also in the beta testing stage with a new wireless security programming feature for its Flexline, Starsys and Lionville series carts and workstations, added Kristin Summa, a Product Manager for Metro’s Healthcare Division. The system will feature a wireless touch pad that links into the hospital’s wireless network to allow administrators or nursing managers to access locking records, add and delete users, add or change PIN codes, and more.
"Metro can do all of this remotely, so nurses won’t have to walk to each cart individually to synch the carts," Summa explained. "Remote access will also be especially useful if the hospital is using proximity card readers or magnetic strip readers, because programming a card for each nurse into every cart can be a lengthy process. With our system, all of this can be done through our wireless program."
Kennedy, Stanley InnerSpace, commented, "Increasingly, carts are being standardized throughout the hospital. Once a large cart order arrives on the receiving dock, the next question quickly becomes a matter of who is going to program the locks. Our Intelligent Locking System (ILS) allows thousands of prox card credentials to be assigned to the appropriate carts wirelessly, in a matter of minutes, via the internet. Individual users can be added or removed from ILS effortlessly, utilizing drag-and-drop features on a friendly dashboard, thereby minimizing the time required to administer cart security. ILS also has the ability to provide an audit trail, enabling you to track who accessed the cart and when."
Stanley InnerSpace has also released an upgrade to its SpaceTRAX software system to deliver enhanced item history features, improved search functionality, and more flexible administrative controls.
Ergotron’s StyleLink Software is included free with Ergotron StyleView powered carts. Users can install, access and manage fleet StyleView power systems and drawers from a remote location across WAN, LAN, or VPN. The three-part StyleLink software package maximizes IT tech-support time by giving real-time centralized control over carts across campus, the city, country, or the world. And now the new Version 7 software offers added drawer management capabilities with Ergotron’s StyleView PHD carts and enhanced enterprise management.
Power solutions should be carefully selected to provide the level of performance and runtime needed to support the variety of computing and hardware solutions being run. "Facilities implementing a cart standard to facilitate and meet EMR requirements must discuss in advance their level of mobility requirements," said Kennedy. "While some carts are on wheels simply for ease of cleaning within the room, many facilities require mobile carts that will be in motion all day long, which makes battery life of the utmost importance. Our ST7 LiFe battery provides optimal performance, requiring only a single hour for recharge, which can enable clinicians to achieve more than 22 hours of runtime in a 24 hour period."
A new advanced nickel metal hydride (NiMH) power system from Metro was announced in April to help meet the demands of a 12-hour shift. The battery provides 2,000 cycles, compared to Metro’s traditional nickel metal hydride offering that peaks at around 1,000 cycles. "It offers double the cycles for a facility for nearly the same price," VanLaningham noted. Metro’s breadth of battery solutions also includes a lithium nano power solution that can provide up to 5,000 cycles, as well as swappable battery options. As part of their site assessment, Metro will work with a facility to tailor power supply options to their unique requirements across the facility.
A 41-year old company, Anton/Bauer’s batteries have been used on medical carts and workstations for years, but the company is just beginning to offer their products direct to the hospital end users, Ney explained. By working direct with Anton/Bauer, facilities have the advantage of choosing virtually any available battery chemistry on the market – from nickel metal hydride to lithium ion and lithium iron phosphate.
Anton/Bauer’s strong partnerships with battery cell manufacturers gives the company a unique competitive advantage and means they source the highest quality battery components with very strict tolerances, said Ney. "We work very closely with our battery cell manufacturers to help make the best battery cell possible. It’s important to have these partnerships otherwise the overall quality and lifespan of the power system is compromised."
He added, "most medical cart manufacturers only offer a sealed lead acid (SLA), [Similar to a battery used in automobiles], or lithium iron phosphate (LiFE). Anton/Bauer provides all chemistries and recommends a power system based on the end-users performance and budget goals. We focus on designing and manufacturing mission critical mobile power systems because that is what we do best."
Anton/Bauer’s MPS-4 is the first power system on the market to accommodate any cell chemistry with a single electronics package and charger. As battery technology evolves, with a simple firmware update, the MPS-4 technology automatically adjusts to future chemistry charging requirements. The MPS-4 multi-chemistry compatible power system offers hospitals several benefits, including the ability to simultaneously charge batteries while the carts remains usable; 400-800 Watt-hours of continuous runtime; and seamless integration with battery management software.
The all-in-one MPS-4 gives the user the ability to choose a power system based on current power requirements and desired run-times. As the requirements change, the MPS-4 is easily adaptable. "For example, a hospital can select a lithium ion system that meets today’s performance/budget requirements but then as technology evolves and batteries need to be replaced, the user can plug-and-play new battery cells of any chemistry. The adaptability of the MPS-4 is very unique to the industry," said Ney.
He explained how both the technology – such as the computing system, monitors and other hardware that is being used– as well as the type and capacity of batteries play a key part in determining a system’s run time and cycle life. "There are many different parameters that need to be evaluated when determining which power system will work best. To keep it simple, the battery can be viewed as the gas tank while your technology (computer/monitor) is the engine. Your runtime will depend on the capacity of the gas tank (battery) versus the needs of the engines (computer)."
Anton/Bauer also provides HotSwappable power systems that Ney describes as being "second to none". "The HotSwap system is a 4 battery system that allows the cart to be available 24/7. Many hospitals prefer Anton/Bauer’s HotSwap because the cart never needs to be plugged-in to charge. When a hospital uses a HotSwap system, the cart becomes completely mobile which reduces hallway clutter and the associated risks of crowded hallways. Joint Commission and fire marshals tend to like that. From a financial perspective, HotSwap systems improve the ROI of the cart by eliminating cart down time due to charging." HotSwap batteries only need to be swapped once per shift.
In addition to being extremely durable, other benefits of Anton/Bauer’s HotSwap system include that they are easy to clean and will not collect dust, dirt, or fluids, which is important for infection control. When asked about battery durability, Ney said, “The caregiver is usually very surprised when they drop the battery and find it to be in perfect working order. When we attend a tradeshow and someone asks about durability, we hand over a battery and tell them to drop it. Anton/Bauer is confident in the design and performance of every power system sold.”
Two hot-swappable batteries included with Omnicell’s Savvy allow for 18 hours of continuous runtime, offered Hom. "What we have always heard in the mobile world is that nurses are always very frustrated with the fact that their batteries don’t last very long. It requires them to plug them in constantly, and after a period of time the ability of the battery to hold a charge is greatly reduced. So that’s a frustration for nurses. And just imagine if they’re doing a med administration and they’ve got an e-MAR running on their mobile system, and all of a sudden their battery dies and it deletes their whole session. That interruption in workflow is pretty severe and it can be pretty frustrating and a time consuming endeavor to get back to where they may have started from."
Another distinct advantage offered by Anton/Bauer, said Ney, is the exceptional warranty Anton/Bauer offers. "Many battery companies claim to warranty their batteries for 7,000 – 8,000 cycles," said Ney. "Other companies don’t tell the customer that they define a cycle as a discharge of some nominal percentage of capacity.
"Anton/Bauer keeps its warranty simple," he continued. "The Dionic-160 for example, if within the warranty period, the battery operates with less than 60 percent of new capacity, we replace and repair it regardless of the number of cycles. Customers are usually pleasantly surprised because they do not have to comply with 30 pages of terms and conditions to determine if their battery is under warranty."
Anton/Bauer also has a certified recycling program where, at no charge, the customer has an opportunity to return their used batteries for proper handling, offered Ney. "Protecting the environment is a priority, so much that we have processed competitors batteries when a hospital selected Anton/Bauer to retrofit their fleet."