Wireless mobile-computing workstations are instrumental in bringingthree dialysis facilities together for videoconferencing.
Wireless mobile-computing workstations are instrumental in bringing three dialysis facilities together for videoconferencing.
In a typical day at the Dialysis Center of Lincoln (DCL), in Lincoln, Neb., doctors and nurse practitioners examine dozens of patients during dialysis treatment. While accessing the patient’s electronic medical record (EMR), they carefully check the patient’s skin color, the point of access for the dialysis equipment and other health conditions related to the patients’ kidney disease.
It sounds routine – except that many of the patients are 80 miles north, at DCL’s Columbus facility, or 45 miles south at its Beatrice clinic. The visual exams and documentation are completed using DCL’s telehealth system, which utilizes wireless mobile-computing workstations.
“We wanted to create a system that would place less travel demands on our patients, doctors and nurses, while ensuring top-quality care,” says Larry Emerson, DCL CEO. “By reducing travel, we free up the doctors and nurse practitioners to visit with the patient more often and provide more one-on-one care.”
For residents of rural communities, geographic isolation can provide a significant barrier to receiving quality, timely care. Nebraska is among the most sparsely populated states, with a density of 23 people per square mile. Many people live on remote farms that may be 50 miles from even a small town, and even further from a hospital or health clinic. Geographic barriers to care are especially critical for patients with kidney disease, who often need dialysis treatment at least three times per week to remove fluid and filter impurities from the bloodstream.
Just after the state of Nebraska launched the initial phase of a statewide telehealth system for connecting hospitals, DCL began looking for the most-effective way to adapt two-way video and audio connections to improve care for its patients. Emerson visited healthcare facilities around the country to study systems that were proven under conditions similar to DCL’s requirements. He also talked with computer and video-camera manufacturers to explore potential solutions.
During a visit to an outpatient surgical center, Emerson noticed several wireless mobile-computing workstations from the Metro Flo Series.
“We were putting a fully computerized EMR system in place, and we saw the potential to implement mobile workstations that would allow our staff to document care at the same time they were interacting with patients,” explains Emerson. “We thought the best approach would be to mount videoconferencing equipment on workstations to ensure our staff could be mobile, and we were impressed with Metro’s flexibility and creativity in adapting its workstations to meet our needs.”
With numerous positive recommendations for the workstations, DCL acquired two Flo 1750 units that were configured to support mobile videoconferencing. After several months of work to integrate the telehealth system onto Metro workstations, one unit was placed at DCL’s main clinic in Lincoln, while the second unit was placed in its Columbus clinic. After some fine-tuning, a third workstation was added at its Beatrice location.
“Metro stepped up and helped me build something that didn’t exist before,” says Dale Gleaves, chief technology officer for DCL. “We were able to design from the ground up to the specs we needed.”
The workstations feature a mobile power solution combined with enhanced wireless connectivity, allowing DCL’s care teams to move the units around the clinics, as needed, for patient consults or educational sessions. The workstations’ wireless system links to DCL’s network to transmit audio/visual data and provide access to patient records in the EMR system.
The Flo 1750 is an integrated workstation with computer, monitor, power system, keyboard and other accessories. To adapt the workstations for DCL’s videoconferencing needs, Metro evaluated several camera providers. The solution: Each mobile-computing workstation is equipped with a 19-inch monitor and a Polycom videoconferencing system, including a camera, microphone and codec.
“The Polycom codec compresses and encodes signals, allowing us to communicate with small bandwidth, while giving us the resolution we need,” says Gleaves.
Adapting the Polycom codec to the Metro Flo Series workstations required several modifications to meet DCL’s specific needs. The Polycom codecs are built for AC power, for example, while the Metro Flo Series workstations are built with a DC architecture. To adapt, Metro installed power inverters that convert DC to AC.
In addition, DCL needed continuous wireless connectivity. The Polycom codecs, however, are only built for wired communications. As a solution, Metro installed a wireless client bridge onto the workstations to ensure a continuous connection to the server. Metro also added a switch to allow the caregivers to change easily from viewing the PC image to the video conference.
To support mobile operation, the workstations are powered by nickel metal-hydride (NiMH) battery technology. NiMH offers higher-capacity per-unit volume, which enabled Metro to provide more power in the same small form factor.
While operating the telehealth equipment and inverter, the workstations have a run time of about two-and-a half-hours between charges. The workstations operate for up to 10 hours between charges when the telehealth and inverter are not in use.
Initially, all units were linked to DCL’s network with fractal T-1 lines running from 756 K up to 1.5 MB. As part of a wider upgrade to DCL’s telecommunications, the Lincoln-to-Columbus connection was recently increased to a 5-MB fiber-optic connection.
The workstations feature a mobile power solution combined with enhanced wireless connectivity, allowing DCL’s care teams to move the units around the clinics, as needed, for patient consults or educational sessions.
During implementation, a key challenge was gaining acceptance of patients and staff. “We have a couple physicians who were real eager to try this technology and a few who were hesitant,” explains Emerson. “Initially, patients were not too sure, but after they experienced it, they realized they would get more interaction with their doctor and nurse practitioner and receive better care.”
Today, at DCL’s Beatrice and Columbus facilities, patients receive dialysis in an open treatment area. While the patient receives treatment, a nurse brings the Metro Flo Series workstation to conduct rounds. The physician or nurse practitioner located in Lincoln conducts the telehealth exam, reviews lab results and talks with the patient about the treatment. The nurse can focus and zoom in as needed to support the exam. Because the workstation carries its own power supply, there is no need to plug in, which eliminates hassle and safety issues.
“Workstation mobility is important because our patients are confined to the chair during treatment,” says Emerson. “Metro helped us design a system that enables us to bring the cart to them with a camera on it.”
The mobile-computing workstations also are used for patient education and staff training. A Lincoln-based nurse with expertise in diabetes education, for example, can talk with patients at the Columbus and Beatrice facilities during their treatment. For staff training, a Lincoln-based nurse responsible for infection-control procedures at all facilities can make a presentation to the staff in Columbus and Beatrice to ensure consistency and save time.
“The quality video enables me to interact effectively with the patient, and the integration with the computer system makes it easy to access their EMR during the exam,” says Mary Churchill, APRN with Lincoln Nephrology and Hypertension, the nephrology group that works with DCL. “It’s easy to use and is convenient.”
DCL is adding a fourth Metro Flo Series unit. In addition, DCL is using more than 10 Metro Flo Series workstations. These units are not equipped for videoconferencing, but provide a mobile solution used for clinical documentation.
DCL also is exploring several opportunities to extend the service to a broader area of the state. Gleaves notes, for instance, that DCL will soon complete the process of connecting to the Nebraska Statewide Telehealth Network, which provides broadband connections to community hospitals across the state.
“Once that system is in place, our doctors and nurse practitioners can talk to any hospital on the network,” says Gleaves. “Patients that prefer home dialysis could go into the local community hospital, which may not have a nephrologist on staff, and instead be examined via telehealth connection with a doctor in Lincoln.”
For its caregivers, as well as hundreds of patients that use the Columbus and Beatrice facilities, the telehealth system has eliminated distance and travel time as a barrier to quality care, Emerson says, resulting in increased doctor visits and overall improved treatment. In addition, Emerson predicts a long-term positive ROI for the project based on improved efficiency for the DCL staff, improved quality of care and other operational
benefits.
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