Carts, workstations drive
Meaningful Use, e-MAR
by Jeannie Akridge
harboring medications and supplies, carts and workstations increasingly
serve as point-of-care gateways to patients’ electronic medical records (EMRs)
and electronic medication administration records (e-MARs).
Stage One Meaningful Use (MU)
criteria from the Centers for Medicare & Medicaid Services requires
facilities to employ major functionality of a certified EMR, documenting set
percentages of visits, diagnoses, prescriptions, immunizations and other
relevant health information electronically; use clinical support tools
(warnings and reminders that will be included in certified EMRs); share
patient information; and report quality measures and public health
information. Proposed Stage Two Meaningful Use criteria additionally
requires physicians and caregivers to use an EMR to send and receive
information such as lab orders and results.1
"It’s really about access
points to the EMR," said Alissa Kubera, senior product manager,
Rubbermaid Medical Solutions, of how carts and workstations can help
facilities meet certain components of Meaningful Use criteria. "Whether it’s
a wall-mounted workstation or mobile workstation, both are considered access
points to the EMR."
"The drive to use mobile carts
now includes ‘Meaningful Use’ requirements that first compensate hospitals
for implementing electronic tools and penalize hospitals who do not in later
years," said Eric Schuldt, vice president, sales and marketing,
LogiQuip. "Bar code
labeled and checked medication distribution (BCMA) is a requirement of MU,
so our customers appreciate the patient-labeled screen icons as they become
familiar with the new workflow."
workstations permit instant access to patient records, medical information
and the hospital’s internal information system," Schuldt added. "A small
footprint permits using the mobile workstation in patient rooms."
Todd Jackson, executive vice
Stinger Medical, commented, "Mobile devices today are a critical
component of enabling the clinician to complete real-time documentation
which is paramount in this marketplace. With Meaningful Use, and with
providers both inside and outside the hospital trying to access data,
clinicians need the ability to be able to complete documentation at the
point of care. They need a tool they can trust and rely on in order to be
able to complete that."
"The rules have changed,"
Jackson added. "Clinicians must get data in the record. And in order to do
that they have to have a device that’s available when they need it."
Through its own integriti
Vitals application, Stinger Medical has offered automated vital signs
capture for the past eight years. It becomes even more relevant today amid
MU requirements and other EMR and quality initiatives, assured Jackson.
"It’s a really hot topic right now with C-suite initiatives and Meaningful
Use. Integriti Vitals provides clinicians the ability to automate vital
signs capture and eliminate data latency allowing vitals signs to be
immediately entered into the EMR."
Stinger SydeKick with MOBIUS POWER
According to Jackson, the
integriti Vitals application can reduce the time it takes to get data into
the record by more than an hour. A Stinger Medical observational study found
nurses taking 83 minutes on average from vital signs reading until the data
was entered into the patient record. With integriti Vitals automated vital
signs capture data is entered into the EMR within a minute, he said.
The integriti Vitals solution
enables caregivers to capture, complete and submit vital signs at the point
of care with a solution that is integrated into the Stinger workstation.
"It’s about streamlining documentation at the bedside, to make it more
simplistic for clinicians to get data into the patient record. We’re
facilitating real-time documentation, we’re driving meaningful use at the
point-of-care. "We’re getting data into the patient record so that when a
physician goes to write an order, he or she no longer needs to call the
department to track down the nurse tech to find out the last set of vitals."
Rob Sobie, vice president of healthcare
described how the Emerson/Metro group is seeking to help evolve mobile computing
workstations to serve as more active and deeper conduits for data
transmission. "The workstation has often been looked at as the hardware, or
the vehicle to help integrate applications on a single workstation and to
give mobility. We’re trying to add even more service value into that
medication management module by looking at how we can host those
applications and looking at workflow and arrangement of how information is
being electronically transmitted back into the host systems. Longer term
we’ll provide more information back into those systems to help drive our
organization further into the Meaningful Use space."
Erik VanLaningham, director of
healthcare marketing, Metro,
described how Stage 2 Meaningful Use requirements announced at the HIMSS
(Healthcare Information and Management Systems Society) 2012 conference
emphasize the use of closed-loop medication administration. "We’re able to
support whatever model of med distribution you have in your facility, to be
able to have computing and power and to be able to upgrade your current
fleet of workstations to make them support critical eMAR activities at the
bedside." VanLaningham sees Metro’s role as an innovator to "partner with facilities
to help support meeting these mandates and timelines."
Rubbermaid recently introduced
a non-powered, lightweight and maneuverable mobile workstation, the M40, as
well as a unique MTC (mobile technology cabinet) that blends cabinet-style
aesthetics with the flexibility of a mobile computing cart. Kubera noted
that customers have used the MTC, which houses a computer, monitor, keyboard
and mouse and is available in a variety of finishes and colors, for
"outside-of-the-box" applications such as the new trend towards "self-serve"
Capsa MX medication
is introducing its MX Series Medication Workstation this summer specifically
designed to meet the needs of medication management at the point of care,
with configurable onboard storage offering up to 500 different combinations
of bins and drawers of various sizes and shapes.
The MX Series is based on an
open platform to allow for any type of computing hardware, from thin client
to all-in-one systems or laptop configurations, and can be run on either an
AC or DC power platform. Capsa’s PowerWatch system acts as a "fuel gauge"
and also a diagnostics tool to help resolve power performance issues related
to battery operation. Additional features of the new Capsa MX Series
Medication Cart include lighting packages, such as a base light for easy
maneuverability at night as well as independent keyboard and work surface
lighting; push-button work surface height adjustment; slide-out tray for
work surface and/or mediation prepping; and easy-to-clean antimicrobial
For a medication cart to be
beneficial, "you need to be able to configure the storage to exactly meet
the workflow of the clinicians and the distribution model for the pharmacy,"
said Todd R. Ross, marketing & communications director, Capsa Solutions LLC.
"To be able to intelligently understand the medication management process
within the healthcare facility and understand what the clinical and pharmacy
staff need out of that medication management system has been part of the
Capsa heritage for 50 years. The medication management process is not as
easy as saying, let’s put a couple of bins on a computing workstation and
away we go. There’s a little more to it than that. There are many different
models for how medication is delivered. That’s why you need configurability
and flexibility to be able to make the cart to fit your workflow model,
whether it’s the pharmacy’s distribution of the medication or it’s the
clinical workflow of how they get medications and distribute those
Security and accountability
are also of paramount importance to any medication workstation, he added.
The Capsa MX Series includes CartWatch support software, an advanced
security system that allows for keyless access and automatic relocking as
well as allows for remote management of carts, users and user groups, access
codes and re-lock times. In addition to securing access to medications,
"it’s very important to have a system in place that you can audit that
information, and that you can control access codes," Ross emphasized. "From
the clinical side it needs to be easy to use; you need to be able to
organize it with accessories that help support efficient, accurate
medication pass," he added. For example, accessory options from Capsa range
from scanner brackets and file baskets to holders for medication dispensing
cups and disinfectant wipes.
"Security and storage are
primary, but anything that would support the workflow is also extremely
important. Our product configurability is completely flexible and modular.
And from an accessory standpoint, if we don’t carry it ourselves, we have
the means to accommodate whatever it is they want to put on it," offered
AC and ACi Cassette Medication
Carts from Capsa Solutions are high-capacity carts that can be useful in
high volume areas where nurse-patient ratios exceed 12 to 1.
Describing the LogiQuip
workstations on wheels (WOW) offerings, Schuldt noted, "although the safety
aspect of confirming the medication delivery via bar code scanning is
paramount, the system also improves the accuracy of charge capture."
"Stinger Medical’s SydeKick is
a compact, lightweight solution that functions in any medication
distribution model," noted Jackson. "Whether that model involves meds being
delivered directly to the patient room or to a locked box right out side the
patient room, clinicians simply scan medications at the bedside without the
need for drawers. Or, if medications are delivered to an automated
medication dispensing cabinet such as a Pyxis or Omnicell system, they can
be put into a drawer or multiple drawers labeled for individual patients.
"[Locked drawers] allow the
clinician to get the meds from the [medication dispensing cabinet] to the
bedside in a secure manner while still allowing them to function in their
multi-tasking environment," said Jackson. "Clinicians are doing fifteen
things at any one point in time so to prevent them from having to go
directly from the [dispensing unit] to the bedside, you can give them a
locked drawer to store meds so they can continue to multi-task along their
"If we can streamline that
process by giving them a solution that enables clinicians to complete
multiple tasks, then that would eliminate the manual labor-intensive process
and afford them more time to do what they really want to do at the bedside,
which is caring for the patient," he said.
Rubbermaid’s medication carts
feature highly configurable and fully swappable drawers to accommodate any
number or size of storage needs based on departmental specifications and
pharmacy workflows. PIN code locking drawers provide secure access to
medications. Push-button electronic lift provides easy positioning for
seated or standing use.
Convenient mounting options on
the Rubbermaid medication carts are designed to neatly arrange needed
supplies. "Most facilities require storage of peripheral accessories, such
as bar code scanners, on their medication carts," said Kubera.
efficiencies in medication administration through well-appointed carts and
workstations "comes down to easy access to the meds and the supplies needed
to deliver the meds," she said. "The meds, barcode scanner, cups, pill
crusher, syringes, there are a lot of smaller supplies that are needed to
help with workflow."
Sobie described Metro’s new
Flo Series 1770 advanced clinical workstation as a fourth generation product that has
been integrated with Metro’s SecureRx Med Management Module and
features a choice of advanced power systems.
The Flo 1770 workstation includes
accessory options such as a rail system to accommodate monitors and other
ancillary equipment, baskets and storage containers. Metro recently designed
a customized chart-holder based on customer requests, noted Sobie. An
advanced lighting system softly illuminates the keyboard area at night.
Ergonomic advancements on the 1770 such as strategically placed handles
offer comfortable use for an increased range of users.
VanLaningham added that users
of previous Flo series workstations can also now upgrade to SecureRx for
secure bar code medication administration at the bedside. "You can now upgrade
the entire fleet of workstations when a facility is ready to meet stages 3-5 of the HIMSS
adoption model to support closed loop med administration. "We also have
the ability to integrate dual monitors for a variety of applications, such
as PACS imaging and radiology."
"We see the future as the
ability to automate that process and bring it closer to the bedside so that
we can tie it into the safety system that exists with BCMA, pharmacy and
billing systems for recording and reorder, the patient records for updates
so nurses aren’t doing the same thing multiple times, and then lastly tying
that all together and driving interoperability," said Sobie.
wall-mounts blend utility, aesthetics
either in the traditional cabinet styles or arm-mounted styles, provide
fixed stations for EMR and computing access that take up minimal space when
not in use but still offer flexible positioning for optimal patient
Most hospitals and healthcare
facilities will be well-served by a mix of mobile carts and fixed-mounted
workstations. "Where there is a need for carts, there is probably a need for
wall mounted products," Schuldt proposed.
Compared to legacy
wall-mounted workstations, today’s versions are sleeker, more aesthetically
pleasing, more ergonomically functional with completely integrated
components and hidden cabling.
"As technology has changed, so
too has the product that supports technology changed," said Lisa Elson,
Western regional director, ALTUS. "A basic wall mount has gone from a large,
boom and arm style supporting large keyboards and heavy computers, to
smaller, flush mount systems that offer compact support but accommodate all
the cabling and accessories that are necessary for providing quality patient
"Point-of-care solutions are
not only an integral part of patient interaction, but allow for clinician
and nursing efficiencies by allowing a care giver to input data on the spot
versus note taking and re-interpreting data into a file later on," said
Elson. "It has become an opportunity to create a much more accurate
environment and eliminates duplicate work on the part of the nursing staff."
"We are seeing a demand for
better cabling/wiring solutions that offer compact support of technology
products," she continued. "Wall space is another patient room commodity that
has to content with many critical care components, so in order to maximize
space but allow for clinician comfort, there are many new requirements
expected in the technology support market. Specifically: true sit-to-stand
height adjustment for better ergonomics; true stand-to-stand height
adjustment; solid construction with materials made to last; and
Altus INPUT and INPUT/LINK
workstations provide unique point-of-care solutions with compact
space-saving designs, solid, die-cast aluminum construction (not plastic),
which are made to prevent bounce and a healthy posture, Elson added.
INPUT/LINK from ALTUS
"Caregiver and patient
interaction is critical and that is why in room, wall-mount solutions have
become a growing market for many healthcare applications, she said.
"Point-of-care solutions are not only an integral part of patient
interaction, but allow for clinician and nursing efficiencies by allowing a
care giver to input data on the spot versus note taking and re-interpreting
data into a file later on. It has become an opportunity to create a much
more accurate environment and eliminates duplicate work on the part of the
Kubera pointed out that the
Rubbermaid Wall Cabinet Workstations are designed to be especially
easy-to-install, are available in a variety of finishes and include keyless
entry. Rubbermaid Wall Arm Workstations include Slim Line and Tandem Arm
styles that feature height-adjustable keyboard and work surfaces for
comfortable seated or standing positioning.
Cabinet styles with a
flexibility of finish options are often used in units such as Labor &
Delivery, "where they pay very special attention to aesthetics," said Kubera.
Even Rubbermaid Wall Arm Workstations offer hidden cable management to
reduce clutter and allow for easier cleaning.
Hospitals are asking for fully
integrated wall systems with composite or wood grain finishes. In addition
to cabinet type workstations such as those seen in high-end labor and
delivery suites, for example, Metro is also just entering the wall-arm
workstation space. With the ability to accommodate up to 40 pounds to safely
hold all-in-one computer systems and dual monitor applications such as in
cath labs, for example, the Metromount Wall Arm line also includes a Slim
Line version that extends just four inches from the wall when not in use.
"Wall arms have become an
alternative option that allows hospitals to deploy technology fast,"
postured Sobie. "It is an alternative compliment to workstations
and facilities will not face some of the issues they have in
the past relative to power, mobility or otherwise."
Stinger Medical’s full line of
fixed-mount solutions includes the flexible Fluid wall mount workstation
that is available in light and heavy duty models to accommodate various
computing solutions from laptops to all-in-one computing systems. "These are
important because there are areas of the hospital that don’t facilitate a
mobile kind of workflow," said Jackson, "where there really is no space at
the bedside to get devices in there, such as older wings of hospitals."
Telemedicine takes off
"Telemedicine is gaining a lot
of traction right now," said Kubera, Rubbermaid. She described how rural
healthcare facilities are using telemedicine carts to give patients access
to specialists who may be based hundreds of miles away in the city. If a
nurse is looking at a patient’s ultrasound, for example, the doctor using a
telemedicine cart can view images at the same time. "The doctor is seeing
everything the nurse is seeing, live, real-time, and is virtually there,"
That type of time-saving use
scenario is just the beginning for the expanding telemedicine market. "There
are so many other applications. That’s probably one of the easiest
applications to quickly explain, and one of the ones we’ve had some good
success with. We’ve also seen telemediecine used in e-ICUs," another growing
trend in many major hospitals, she noted.
telemedicine cart accommodates a variety of different types of cameras, PCs,
and other technology. "Whatever technology the hospital prefers, we can
accommodate it with our telemedicine product," said Kubera.
Metro, along with partner
Reach Healthcare, launched a new lightweight, portable and integrated tele-health
cart at the HIMSS12 conference with an upgraded platform that allows for
dual monitors, advanced power and data analytics systems, video technology
that "allows clinicians and physicians to interact with other clinicians and
physicians around the world," said Sobie. "We feel that this is an important
and integral part of healthcare as we’re seeing more and more demand for
In addition, Metro recently
introduced an integrated stroke telehealth cart along with Reach Healthcare.
The system allows physicians "virtual" bedside access to patients in remote,
rural locations, allowing them to interact with the patient and other
caregivers on site to perform stroke evaluations and make recommendations
regarding patient care and treatment.
"What they found is a
significant increase in the rate of recovery for stroke victims," said Sobie.
"That’s one example. We’re also starting to see remote evaluations between
stand-alone care centers and physicians located at primary sites. We enable
an interactive communication system via our cart, by putting a cart at both
locations and then a linkage between them. It’s almost the example of
teleconferencing, the difference being information regarding the patient’s
specifics, vitals and more can be transmitted as well for viewing on the
This type of telemedicine
application could help shorten lead times versus the current healthcare
delivery model, for example for seeing a specialist, Sobie reasoned. With
the ability to view patient records online at the same time that the
specialist can interact with the patient, tele-health moves beyond video
conferencing in terms of benefits to healthcare workflows. "Tele-health
allows us to view and interact with the patient, the caregiver and the
physician while viewing vital medical information to help assess the patient
and provide a better outcome. People ask, ‘why didn’t you just put a video
camera on it?’ Because the interaction is lost without the patient care
information that they want to have readily available. They can easily and
seamlessly scroll through while interacting with the patient. We see it as a
key part of the future."
VanLaningham noted that many
leading facilities are doing trials for telehealth applications. Metro
offers a new Point of Care Corner online blog. For a post, "Four keys to a
successful launch for telemedicine," visit
support systems optimize uptime
Choice of battery chemistry
can make all the difference in how carts and workstations operate and how
they’re ultimately accepted by nursing and clinical staff.
HES Rover battery management system
Michael Mardis, director of
Hoffman Engineered Systems (HES), described current battery chemistries
available to power mobile workstations, and their associated costs and
performance capabilities. "The new Lithium Iron Phosphate chemistry provides
the potential for far more cycles of use than Sealed Lead Acid (SLA). The
new Lithium batteries can provide from 4 to 10 times the cycle number in
comparison. This means 4 to 10 times longer between battery replacements.
The decision then becomes straightforward; if the Lithium battery is three
times more expensive but last four times longer, it saves money over its
"The current pricing for
Lithium batteries vary substantially since they are configured very
differently across different manufacturers but typical pricing might be 3 to
4 times more expensive than similar capability SLAs. They are very roughly
about breakeven with value but the pricing is trending downward."
"One of the keys to using
Lithium batteries however is that the Battery Management System takes
advantage of the technology and manages the charge/discharge profiles to
optimize the number of cycles through its life. Not all Battery Management
Systems are equivalent in this regard; especially those that were initially
designed for SLA. Some SLA systems will work with Lithium batteries but will
not optimize the life of the Lithium battery unless it is specifically
designed to take advantage of the differences."
Mardis described key
considerations for a battery management system. "The battery management
system must have the sophistication to recognize the difference across the
various chemistries available as well as the specific configuration of the
battery. Many battery management systems claim to be applicable to a wide
variety of chemistries but don’t have any means to adapt to the battery to
be used. This is a clear sign that the battery management system is not
capable of recognizing and taking advantage of the performance capabilities
or deficiencies of the battery attached."
"If the battery management
system is not taking full advantage of the battery’s performance
capabilities or not even conforming to the specific type of battery in use,
the user will get results that reduce the charge capability (translating
into run time/uptime) as well as battery longevity. Both parameters affect
cart performance and overall cost of ownership," he added.
HES’ Battery Management
Systems were designed to accommodate the performance needs of current and
future technology but, as importantly, were designed to maximize the
investment and long term utility of mobile carts, described Mardis. "The
Rover system is designed to be used to provide power to an unpowered pole or
other unpowered cart. This allows the continued use of existing hospital
owned assets rather than investing in all new assets simply to implement the
requirement of adding mobile power. The transition is made much easier as
key product design focus was both (1) installation simplicity and (2) ease
of initial use."
"The Power System Upgrade kits
that we offer are kits that simplify replacement of older, underperforming,
Battery Management Systems and their associated batteries," said Mardis.
"These are a series of kits each designed to replace a specific existing
system found on current carts."
"Both of these alternatives
provide a simple modification to existing assets that both (1) provide a
lower cost alternative to protect investment budgets and (2) to provide the
performance and capability necessary to dovetail into a nurse’s normal
routine as well as take full advantage of the most demanding current
computer and peripheral technology demands."
Metro has partnered with
for their work in audio-visual commercial applications such as powering
video cameras for the NFL for example), for a swappable battery system that
Sobie describes as "industry standard". "We worked with Anton/Bauer to
develop a swappable power supply in various durations to allow users to swap
power onto the cart and it can drive up to and beyond 24-hour run times on
these carts by swapping the battery."
For a swappable battery system
to function properly, "you have to be able to notify the users of the
systems when the battery needs to be recharged and allow a fast and
efficacious way to remove the battery, get it charged, be notified of when
it’s charged and get it back onto the system," Sobie explained. "Otherwise
batteries are limited by their cycles and life. You can be cycling batteries
when you don’t need to thereby degrading life cycle and that can add expense
in the long term."
"By working with Anton/Bauer
we integrated our intelligent monitoring system called MetroMonitor
Dashboard System," offered Sobie. "It
allows us to monitor battery cycles, battery life and the workstations
themselves. Also, it provides connectivity updates, alerts and alarms for
pro-active system management and robust reporting analytics."
"We see it as a core
application in those areas where maximum run time and virtually zero down
time can be tolerated, for example, areas like the emergency department," he
In addition to the Anton/Bauer
swappable power system, Metro also offers standard sealed lead acid, nickel
metal hydride, and mid grade lithium ion battery power supplies. To help
further drive efficiencies and run times components including monitors and
computing solutions are run on DC power versus AC power.
"Stinger Medical’s MOBIUS
POWER Swappable Power System was designed from the ground up to work in a
24/7 mobile workstation environment," said Jackson. "It was designed
specifically to address the fact that utilization levels are skyrocketing
because of the requirements on clinicians today to complete real-time
documentation, and to complete multiple tasks at the point of care. We’ve
seen utilization go from 20-30% six to eight years ago to upwards of 70 or
80% of the time nowadays. With that much use of the system, clinicians can’t
plan for downtime, they can’t plan for recharge time."
"With the MOBIUS POWER system,
when a clinician swaps out the main battery, the system transfers over to a
back up battery which keeps the system up and running without interruption,"
Added Jackson, "We understand
that when a clinician, caregiver, or patient tech walks to a workstation,
they care about one thing and only one thing – Is that workstation working?
It’s that simple."
When caregivers encounter dead
batteries due to the previous worker leaving the workstation unplugged,
they’re forced to leave it tied to the wall for hours while it’s recharging,
"creating workarounds and inefficiencies for caregivers, and impacting their
ability to care for patients effectively," said Jackson. "About 70% of
hospital departments function in a true 24/7 environment and they have an
inherent need for a solution that can function alongside that. And that’s
what Mobius power offers."
Jackson described how Stinger
Medical’s new CAST (Clinical Adoption Support Technology) application brings
automation into the "break/fix process" for mobile workstations. Through the
surveillance component in the CAST system, Stinger’s IT technical support
team automatically receives information regarding the device in the field as
to where it’s located and how it’s being used, with the ability to track
utilization trends by department. When there’s an issue, the system
"validates that there is an issue, very quickly bringing the appropriate
resolution," said Jackson. "Whereas before you were stuck in this long,
manual, labor-intensive, error-prone process of trying to troubleshoot what
was going on. It was very difficult for us to be able to effectively
troubleshoot what was going on with the device."
He added, "We had been living
in a reactive mode waiting for the phone to ring. We all know that’s too
late." With CAST, "we know when there’s a problem often before the clinician
knows there’s a problem with the workstation. The system is so intuitive,
that we are now in the predictive state. We can actually predict problems
are going to happen before they happen, because we’re looking at
condition-related information. The system learns that ‘x + y + 1 + 2 + z’
equals a bad DC to DC board."
The CAST solution helps get
workstations back up and running quicker while also taking responsibility
off of the caregiver, noted Jackson. "This solves two big, historical
frustrations with mobile devices. One: caregivers being forced to stop what
they were doing to call and report problems. Two: Prevents the IT department
or desktop support side from becoming frustrated trying to manage the
Jackson noted that Stinger
manufactures its own computing solutions and flat panel monitors including
all-in-one computer systems and a small form factor computer designed to be
mobile technology friendly, meaning it doesn’t consume a lot of power, he
said. "They all also incorporate what we call our NurseSensor, which
eliminates wasted power and creates a true green solution. When the
clinician walks away, it turns the monitor or all-in-one computer off
independent of the clinician having to do anything. The NurseSensor is also
a huge plus in the fact it supports patient privacy in the event a clinician
gets quickly called away on an emergency while documenting a patient
Stinger is adding a 22-inch DC
powered monitor this August, in addition to its current 19-inch wide screen
offering, he added.
Rubbermaid offers both sealed
lead acid and lithium ion batteries. "Since lithium batteries have entered
this marketplace a few years ago, they are a better option. They are meant
for this workflow because they hold their charge longer and can handle the
discharge/recharge cycle that happens in hospitals," Kubera explained.
Sealed lead acid batteries require being plugged in for longer time periods
and while initially the sealed lead acid battery might offer run times of 8
to 10 hours when properly charged, towards the end of its life cycle the run
time might be as short as one to two hours before it needs to be recharged.
"Sealed lead acid batteries
are the lower cost option, however they’re not designed for the type of
workflow that nurses have." Plus, with a three-month warranty for sealed
lead acid batteries versus a three-year warranty for Rubbermaid’s lithium
ion batteries, "you’re going to end up buying several sealed lead acid
batteries in the same lifetime of one lithium battery," said Kubera.
She added, "the weight on
these mobile workstations is very important to nurses. You take a lot of
weight out of the cart, improve run time, and the overall battery life by
choosing a lithium battery."
In addition to the choice of
battery chemistry, whether the cart runs on AC (alternating current) versus
DC (direct current) power will also affect run times and efficiency levels.
While AC powered products are more common, efficiency is lost in the
conversion process. DC power acts as a direct line of current from the power
supply to the monitor, for example. For the longest run times possible,
Rubbermaid recommends a DC-powered cart, coupled with a DC-powered monitor.
total cost of ownership
Mardis, HES, commented,
"Battery Management Systems greatly affect the ongoing ownership costs of
medical carts and workstations. Maintenance of batteries is a significant
burden for each hospital both in replacement cost as well as the labor to
attend to, not just replacement, but also to assess if they need
replacement. The impact to these costs should be a consideration on par with
the initial price of the system since these costs can dwarf the original
purchase price differentials from system to system."
"Second, the efficiency to be
gained from using carts and their inherent automation is optimized through
more usage," Mardis added. "The nurse needs to ‘want’ to use the cart to
fulfill all of the potential efficiency gains. This means eliminating the
burdens to its use and making it an extension of their normal processes and
procedures. The battery management system has a significant influence on the
ease of use and how intuitive the cart becomes."
When considering total cost of
ownership for a cart or mobile workstation, it’s important to first of all
select the appropriate cart and computing technology for the job at hand,
Sobie advised, whether it’s a non powered laptop cart or a fully integrated
"The power options are one of
the things that adds the most cost onto the cart," Sobie emphasized. "So the
selection of batteries should be done based on the unit where it’s going to
be placed. For example, my preference would be to offer swappable systems
for emergency rooms. Other departments might want to put short-run sealed
lead acid batteries."
Sobie urged buyers to consider
all of the hardware components required on a workstation before selecting a
power system, from monitor, mouse and keyboard to lighting systems and
barcode scanning. "We look at that in totality to ensure we integrate all of
those components to drive maximum run time, and extend the battery life."
Considerations for a cart or
workstation’s total cost of ownership, noted Kubera, include looking at the
power system and how it will fit the department’s workflow. Service plans
and warranties should also be evaluated over the entire life of the cart
beyond the initial purchase price.
Ergonomics also play a key
role in end-user satisfaction and safety. For example, "the handles of the
cart, the adjustment features, whether its height adjustment, or keyboard
tray adjustment or monitor adjustment, all of those things factor into good
ergonomics and keeping nurses healthy," she said.
Ross highlighted adaptability
as a key feature to consider when weighing total cost of ownership for a
mobile workstation. "Hospitals are making an investment and it needs to be
able to adapt to changing workflows so that they don’t have to necessarily
buy new carts if they’re making a change to workflow or hardware platforms."
Ross noted that Capsa is
looking at technologies for swappable power battery options, as well as
options for wall-mounted workstation solutions on the horizon. Also
launching in September is a new line of value-priced medical carts called
the iSeries that feature removeable isoTray storage trays as well as key
functionality of other Capsa carts.
"It’s really important that
you assess needs departmentally to understand each department’s workflow and
infrastructure." Stinger Medical’s Slimline solution, for example might be
used in the emergency department, OR or NICU where space is at a minimum but
users still require advanced, 24/7 computing capabilities. "You can’t push a
MedSurg solution out to ED when they have very crowded bedsides, little
space in the hallways, and they have a completely different workflow from a
medication delivery model," he said.
Kubera offered the following
advice for those making cart and workstation purchasing decisions. "When a
hospital is selecting carts they should definitely try them. Vendor fairs
are common and they have nurses and IT staff and pharmacy walking around
looking at carts, but if they can really try them on one unit I think that
helps the nurses and IT folks to make the best decision for their
situation." The end-user nurses and other caregivers are very important in
that decision. "They’re the ones that have to push it around for 12 hours,"
Schuldt commented, "Hospitals
rarely buy carts without it being part of a system upgrade-new building or
wing, new or enhanced IT component, replacement of existing fleet. The
budgets for these products are usually known months in advance of purchase."
Cart Vendors List