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         Clinical intelligence for supply chain leadership

 

INSIDE THE CURRENT ISSUE

August 2012

2012 Carts & Workstations Buyers Guide

New Technology

Restoring mobility to medical carts and workstations:

Strategies for reliable oper-ation without plugging in

by Mark Bohacs, business manager, Hoffman Engineered Systems

Mobile medical computer carts and workstations are a significant investment for any healthcare system. But when selecting the right cart for a facility, decision makers should look not just at the cart’s purchase price, but also at the quality of the components that make up the system. The sticker price of the least expensive cart does not forecast ongoing operating and maintenance costs.

Computer carts are available with or without onboard power systems. Unpowered systems either plug into nearby outlets or operate off the internal battery of the devices on the cart. Powered workstations include a battery management system and batteries to run the computer and display for extended periods of time without recharging.

Early generations of computer carts were notorious for their poor battery charging, disappointing run times, loss of patient data and fleeting battery life. Batteries would run the computers for a few hours, then computers would shut down without warning or backup. Because early battery management systems did not charge the batteries to manufacturer requirements, battery life was very short and replacement was an ongoing logistical problem and expense. For many workstations, batteries were replaced only by the cart manufacturer, leading to significant downtime and expense.

Battery management technology has improved dramatically over the years and today’s carts are more reliable and mobile than ever. But basic battery management systems still undercharge batteries, shortening run times, reducing battery lifespan and causing frustration among cart users. The average mobile workstation in use today runs for about 6 hours without recharging. To ensure the safety of patient data, medical professionals continue to leave these carts plugged in and charging.

If the cart is not plugged in prior to the battery discharge, most computers will shut down unexpectedly without saving data. Such carts are no longer efficient tools, but time consuming burdens that nurses must babysit to the detriment of patient care and hospital work flow. But workstations that feature high performance battery management systems allow the user to easily determine the battery’s level of charge and the time remaining before discharge. Onboard computers perform an orderly automatic shutdown to back up data before the battery discharges.

For a small percentage of the overall cost of a cart, healthcare facilities can retrofit a high performance battery management system onto workstations when the original system is underperforming. These systems optimize the longevity of the battery and the length of time between charges. They use battery power efficiently to ensure the cart runs as long as possible. And systems that run solely on DC power instead of converting to AC can provide 30 percent longer run times between charges.

Many cart users experience battery problems within the first year of the workstation’s service life and must replace batteries every 3 to 6 months. Carts with sophisticated battery management systems and the right battery technologies consistently provide minimum run times between 10 and 12 hours when operating a typical 45W load with 40AHr of battery capacity.

To communicate state of charge, basic battery management systems offer displays similar to cell phones, with a minimum of LEDs or bars. The second half of the charge goes very quickly and the user has no way to tell the exact amount of charge remaining.

High performance battery management systems feature intuitive displays similar to an automotive fuel gauge. With 15 to 20 LEDs, these gauges precisely estimate the battery charge, with time to discharge often estimated in hours and minutes. These systems also estimate the overall health of the battery and inform the user when the battery needs to be replaced.

High performance systems protect the safety of patient data by warning the user several times as the battery approaches full discharge. After these low battery warnings, smart systems provide an orderly automatic shutdown to preserve data. To ensure the safety of the end user and the patient, these systems are IEC 60601-1 compliant and feature safety interlocks to protect batteries from outgassing, overheating and failure.

High performance battery management systems not only ensure the mobility of the cart, they also make carts easier to use, safer and more reliable. When healthcare workers become more confident in the reliability of their equipment, they are more willing to trust the carts to be fully mobile tools designed to increase productivity and ensure the safety of patient information.

 


 

Metro 1770

Carts, workstations drive Meaningful Use, e-MAR

by Jeannie Akridge

Besides 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."

"Lightweight mobile 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 president, sales, 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 marketing, Metro 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" admission kiosks.

Med administration mobilized

Capsa MX medication workstation

Capsa Solutions 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 surfaces.

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 medications."

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 Ross.

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 way back."

"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 mobile workstation

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.

Improving workflow 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.

Re-styled wall-mounts blend utility, aesthetics

Wall-mounted workstations, 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 interaction.

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 care."

"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 compact/space-saving designs."

INPUT/LINK from ALTUS

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.

"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 nursing staff."

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," she said.

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.

Rubbermaid’s compact 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 telehealth applications."

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 cart."

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 www.pointofcarecorner.com.

Batteries, 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 commercial marketing, 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 life."

"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 Anton/Bauer (known 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 added.

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," explained Jackson.

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 break/fix process."

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 record."

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.

Counting 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 telehealth solution.

"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," she said.    

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

Reference:

1. http://www.practicefusion.com/pages/ehr-meaningful-use-criteria.html