Information technology is one of the fastest growing functions in healthcare. In large part, this is due to an increased demand for mobility.
In 2010, spending by healthcare and social services was just under $16 billion, with wireless comprising 40 percent of telecom spending.1 This trend is projected to grow in the coming year, largely due to increasing adoption of smartphones by clinicians. Manhattan Research predicts that 81 percent of physicians will be using smartphones by 2012.2 As the IEEE 802.11 standards have evolved and advanced, workstation on wheels (WOW) manufacturers have had a hard time keeping pace with wireless technology. Here, we’ll examine the shortfalls of the current designs, propose an ideal re-design and evaluate alternatives.
Uses & Features
WOWs have a wide variety of uses, ranging from clinician rounding to intake and discharge. Some of the earliest WOWs to emerge in healthcare were simply laptop stands with wheels. Over time, these evolved into more sophisticated carts. Manufacturers began including features like additional battery capacity, external monitors, work surfaces, file storage pockets, keyboards and mice. Some of the more advanced models integrated a lift mechanism, locking wheels and power status indicators.
The average age of registered nurse (RN) is projected to be 44.5 years by 2012, with female nurses in their 50s expected to become the largest segment of the nursing workforce, accounting for almost one quarter of the RN population.3 Considering that nurses are one of the main users of WOWs, it is surprising that some of the heavily adopted units can weigh up to 150 pounds.
With the low friction wheels, moving these can be manageable, but maneuvering around tight obstacles at the patient’s bedside is extremely challenging. Choosing not to roll the cart into rooms may result in meaningful use violations. To try to adapt to these challenges, some WOW manufacturers are moving away from using heavier lead acid batteries to using lighter, more efficient, lithium batteries.
Diane Carroll, manager of enterprise desktop engineering at Henry Ford Health System, Rochester Hills, MI, has worked closely with nurse and department managers looking for a better form factor. Diane indicated that “the hospital staff is looking for three primary things. A lighter more manuverable device that is reasonably priced.”
After receiving a call from a physician reporting that the signal strength was low on one of the WOWs in the ICU area, we were surprised to find that the device relied on an internal wireless card in a laptop computer tucked into a metal drawer on the cart. A laptop computer is typically not designed to be used with its lid in the shut position. The antennas typically run parallel to the screen resulting in a mismatch in antenna polarization. This is not an ideal situation for healthcare environments that often contain challenging building material properties.
Revamping the WOW Cart
The existing WOW cart leaves much to be desired. All these design issues lead to a failure of the hospital staff to adopt the carts. When this occurs, carts are abandoned in what we affectionately refer to as the WOW corrals.
Many hospital systems are beginning to evaluate in-room patient terminal solutions as opposed to WOWs to leverage role-based access for clinicians and patients. With this model, doctors and nurses can use the terminals to access patient records without the burden of rolling carts in addition to their other tasks into each patient room. These units also have the additional benefit of supporting patient entertainment and educational services. The WOW model does not allow for this level of flexibility.
For hospitals or clinics interested in rolling out WOWs, there are several key elements that, based on our experience, we believe should be part of the device.
From a hardware perspective, the current WOWs are bulky and have an abundance of subcomponents. We believe that these can be simplified to include the following:
- A touch screen, ultra-lite, maneuverable tablet-type interface/display.
- The ability to be easily cleaned and disinfected.
- An ultra-light mobile stand.
- Two modes of operation: removable and docked.
The main drawback from a power perspective is the charging dependency on physical wiring. This is not in line with the mobility concept and can be simplified in the following ways:
- Integrated wire free charging ability. Cart can be rolled onto a platform which automatically kicks off battery charging with no need for power cables.
- Hot swappable, extended 16-hour battery life with quick-charging capability.
One of our major observations is that the wireless capability has not kept up to date with the IEEE standards. The WOW should meet the following wireless requirements:
- Enterprise class specifically complying to, 802.11i, 802.11e, 802.11r, 802.11n, and WMM support.
- The chipset should allow for antenna diversity.
Security design features to decrease liability:
- Encrypted solid state hard drive.
- Integrated RTLS tag to locate device.
- Standardized hardened OS platform
- Device should support remote wipe capability.
A WOW design with the features above would be extremely handy for clinicians and can introduce significant workflow improvements and efficiencies.
1. August 1, 2011, “Healthcare to Spend $518 Million on Infrastructure as a Service in 2015”, In Stat Research, September 10, 2011, http://www.instat.com/newmk.asp?ID=3219&SourceID=00000512000000000000
2. Dolan, B. May 5, 2010, “72 percent of US physicians use smartphones”, mobihealthnews, September 10, 2011, http://mobihealthnews.com/7505/72-percent-of-us-physicians-use-smartphones.
3. Buerhaus, P. “Health Affairs.” The Recent Surge in Nurse Employment:
Causes and Implications 12 July/August 2009: w657-w668.
Doug McDonald is the wireless team lead for Henry Ford Health System in Rochester Hills, MI. He is an employee of Siemens Enterprise Communications working in a dedicated capacity for the healthcare provider. He holds a number of certifications, including CWNA, CWSP, and ITILV3. Ali Youssef is a biomedical solutions architect with Siemens Enterprise Communications working in a dedicated capacity for Henry Ford Health System. He holds a CWSP, PMP, and ITILV3 certifications.