The days of accessing patient health records via a clipboard and keeping drugs stored under simple lock and key are unceremoniously coming to a close. As healthcare IT paves the way toward a future run on data and interoperable systems, “smart” workstations are popping up in practices all over the world, streamlining workflow and creating a safer environment for clinician and patient alike.
Health Management Technology talks with two of the leading manufacturers of automated systems and mobile workstations to discuss how they are changing the way providers and patients experience healthcare services.
Q: More and more we’re seeing telehealth being conducted using mobile workstations. How can a workstation help facilitate a successful telehealth experience as adoption of the practice continues to grow?
When you start looking at telemedicine, you start talking about integrating data and patient analytics within that experience. So, for example, I could be having a telepresence conversation with a physician, but there’s a nurse practitioner with me and they have a digital stethoscope, and the doctor on the line could say ‘I need to listen to your heart.’ The nurse puts the stethoscope on my chest, and (the doctor) is now listening to my heart through that telecommunication. There may be need for an EKG, so you hook up the electrodes and, in real time, that physician who is miles and miles away could be engaging the information about my body. He could be looking at CO2 levels – all kind of information.
Where (Ergotron’s) products come in with that is we allow that integration of the technology within the cart. Anyone can do a Skype conversation; anyone can go down to Best Buy and have an engagement with a physician.
But when you start integrating other technology, you want to make it easy for that provider. So, our carts have ports for that diagnostic equipment to be plugged into and stored. We allow for height adjustability in camera mounting, so that if a patient is in a bed, I can wheel that telemedicine cart up to the bedside, adjust it to their height, adjust the camera, and have that patient engagement.
Q: We look at other tech industries, and they have trouble adopting standard inputs for their gadgets. As more digital diagnostic devices are developed, how do you assure the workstation you’re using can handle the next generation of products?
There is a standard that a lot of the diagnostic equipment is going to, and that’s straight USB 2.0 and 3.0. Previous medical diagnostic equipment wasn’t USB – you had all of these different cables and different pinnings.
We put USB ports in the drawers of our carts, which are connected back to the computer that’s on the cart. … They simply open up a drawer and there’s already a USB port exposed, plus two extra USB ports on the outside of the cart where I can then plug my medical device in and utilize it.
Some of the older stuff is out there, which we still integrate into our carts. … Because of those weird inputs, they’re usually a special card that has to be plugged into a computer in order to get plugged in. So, trying to integrate that into the full cart is too much of a challenge. What we’ll concentrate on is doing the actual cable management, to make the older cables more organized and accessible to the actual user.
Q: Some of these diagnostic devices are essentially apps. With the Internet of Things, more and more clinicians are taking their work on the go. What does a workstation need to make it easy for the user to utilize various mobile devices?
The use of Bluetooth and portable solutions is going to be big, but having the software that ties it all together is going to be the bigger thing. On the hardware side, [Ergotron’s workstations] can handle it all. I have no qualms or issue with the amount of devices I can handle, because everything is going wireless. The issue is going to be does the software actually provide the necessary needs to view all of that while engaging the patient at the same time
Q: When patients interact with technology instead of other people, sometimes they feel as if they’re not getting a personalized level of care. Can a workstation help mitigate that in order to promote a positive telehealth experience, or is it viewed as just another barrier?
I know exactly where you’re coming from. You want to make (a telehealth workstation) as unobtrusive as possible, but in the end it’s a piece of technology, right? And people may get intimidated by it. What’s funny, though, is that all of the latest studies are pointing to that the use of technology – especially the telemedicine – is having a [positive impact]. People are getting a higher degree of satisfaction out of the quality of their care because they are able to stay in their homes.
A good example is, one of our telemedicine carts may be put into a physician practice and have a dedicated area where this telemedicine cart is. And let’s say we’re dealing with an elderly patient in his 90s, and he lives 20 miles from the clinic – some of these health systems are actually putting cameras and PCs into that patient’s home so he doesn’t have to do that travel. And [this patient] connects with his physician once a month. … The feedback from where this is happening is that that patient feels like they’re getting a high level of care, they don’t have to travel, and they have set appointment times.
Q: What do you think the next generation of ‘smart carts’ will look like?
It’s going to be just becoming more ‘slim-lined.’ As these devices become more and more handheld and wireless and have their own power solutions, we’re going to be able to reduce the bulk of this cart’s power system, because the need for power won’t be as necessary.
But (in terms of) engagement and the actual interface, (Ergotron is) always looking at the trends that are happening within the industry to make sure that we’re addressing both the ergonomic concerns, but also the flexibility of that product to deal with whatever you throw at it.
Q: How does an automated pharmacy system cut down on medication dispensing errors? After all, it’s the same basic process – the same nurse still gains access to the meds from a dispensary.
From a nursing standpoint, they have so many things going on in their day that, a lot of times, nurses are trying to remove more than one patient’s meds at a time – and quite frankly that’s outside of hospital policy. The typical policy is one patient at a time … but because nurses are challenged for time, often times they’re looking to be more efficient.
So, maybe they’re taking care of three or four patients on their shift, and if they want to remove more than one patient’s meds, when they do that it’s not a safe practice, and that’s why hospitals frown upon that. It’s not a safe practice, because now I’ve got a bunch of medication I’ve removed and I’ve got to segregate which ones (are for which patient), and that can be a complicated process from a nursing standpoint.
Well, that’s where the Savvy Mobile Medication System comes into play. Omnicell has a tool to where we have patient-specific locking drawers in the Savvy. Now when medications are removed from the cabinet, they can place them safely and securely in patient-specific drawers for transport to a patients’ bedside for administration. This allows for a safe practice of nurses being able to go one time to the cabinet, remove very systematically all the patients’ meds – maybe three or four patients’ meds at one time – place them in patient-specific locking drawers, and they go to the bedside to administer, patient to patient.
From a nursing standpoint, I’ve [now] got that peace of mind that I’ve got all my patients’ medications segregated in patient-specific drawers that lock and unlock individually, so when I go to administer my patients’ meds, I can confidently know that I’m going to get these meds from this particular drawer that’s assigned to that patient and administer them safely.
Q: How do you assure that those drawers are patient-specific? Is a nurse assigning the drawer on the fly?
We have an automated way to assign those patients to a particular drawer. It’s a whole prescriptive process that we’ve developed for med administration.
So, imagine if you will, I’m a nurse using a Savvy to access an electronic medical record on that Savvy system. … I have the ability now on that computer workstation to pre-select these meds for retrieval at the cabinet. So, I’m in the patient room, I’m talking to my patient and doing my patient assessment, I’m working within the AnywhereRN application on the Savvy, and choosing the medications I need to administer to my patients. Within that process, I have an automated way to assign the patients that I’m talking care of on my shift to specific drawers on the Savvy. Literally with one or two button pushes, I’ve assigned a particular drawer to a patient.
So, now that I’ve pre-selected the medications, I go physically take my Savvy to the automated dispensing cabinet, I use biometrics to log into the cabinet, and the cabinet will now tell me that I’ve already pre-selected meds (and ask me) if I’d like to retrieve them now. The nurse will say ‘yes’ and it would start to dispense those meds, patient by patient systematically through our system. The nurse retrieves those meds, places them in the patient-specific drawer that’s been automatically assigned to the Savvy, and (repeat that process) for each one of his/her patients.
Q: You mentioned that many med errors are a result of nurses being rushed. How does the workstation save them time? Is the automated system adding another obstacle to go through in order to complete their med pass?
Actually, this is a much more efficient way. One way is to go to the cabinet multiple times for each patient; so if I’m taking care of four patients on my shift, I’m going to go to that cabinet four times to retrieve those meds. That’s a lot of walking back and forth, right? So, with this Savvy system, you’re able to pre-select the meds in the privacy of your own space or in the patient’s room – someplace the nurse can really focus. They can pre-select the meds using our AnywhereRN application … so when they go to the cabinet, it’s a single trip to the cabinet and they can now retrieve all four of the patient’s meds at the same time, and then place them into the patient-specific drawers. It’s a much more efficient process, and it saves time for the nurses.
Q: What type of logging information do you gather related to the workstations use? Is there data that practices can analyze in order to improve their workflow by seeing how long it takes a nurse to use the various functions?
Yeah, we have full logging capabilities. We have a lot of capabilities about logging timestamps on, let’s say, when a nurse logs into our cabinet versus when the medication is dispensed, etc. – or how long they’re spending interacting with our cabinet system to dispense the meds. We have some studies that show that using our remote queuing capabilities, or AnywhereRN, nurses save 33 percent of the time they would typically spend in front of the cabinet, because it eliminates a lot of button pushes, a lot of interactions at the cabinet. So, it’s a much faster process. But we have all kinds of logging capabilities, reporting capabilities within our system overall.
Q: Does the system automatically count the meds throughout this process to make sure a caregiver isn’t assigning more meds than they should be?
Yeah, throughout this process we only allow the amount of medication to be dispensed that’s been approved by pharmacy. So, the doctors put in the orders, the pharmacist reviews those orders and verifies them, and [only] once it’s verified will our system allow the nurse to retrieve those meds. So, it’s very prescriptive in terms of how much medication they can remove from the cabinet.
Q: Is there any specific tracking that is done on the drugs themselves in order to improve drug safety and possibly reduce the abuse and theft of narcotics?
When I think about tracking, I’m thinking about what pharmacists will look at to [spot] potential diversions, things like that. Take for instance, we have a set of drawers that we call high-security locking drawers, and these are the types of drawers where hospitals would lock up and store all their narcotics in. So those are the ones you’d really want to track, right? And they’re all locked.
But through the process of authentication into our system, we unlock specific drawers for specific users to have access to remove certain narcotics for a patient. … But let’s say the nurse tries to open a drawer that has not been unlocked – our system is going to track that activity. So, if we see potentially – hypothetically – that there’s some type of a pattern with a particular nurse that has been trying to access drawers that are locked, that may lead to a suspicion that this nurse is trying to open drawers they shouldn’t be. Might that be an indication of diversion? Maybe, maybe not. But this is some of the tracking we do within our automated dispensing cabinet.
Data security is often discussed in terms of encrypted drives and firewalls. But with the proliferation of computer workstations and mobile devices, a growing threat to privacy could be prying eyes standing right over your shoulder. Patricia Titus, Council Member, Visual Privacy Advisory Council, takes a moment to discuss the ways practices can keep important patient data safe from eavesdroppers and “visual hackers.”
What type of innovations are out there to help reduce instances of visual hacking?
3M has come up with some software that uses facial recognition. You can use it on your laptop. The Visual Privacy Council has been piloting it and providing feedback. They have an enterprise version of this where it uses facial recognition and it learns your face, and when you look away from your monitor it blurs the screen. So, someone couldn’t just walk up behind you if you got up and left and see what you’re working on.
Tech geeks know from using other software that facial recognition often doesn’t work and can be irritating. Is this something doctors will want to use and not neglect using because it’s frustrating for them?
That was the feedback I gave 3M on the software … it needs a period of time to learn your face. That’s going to be a little more difficult where you’ve got roaming profiles. So, you’ve got a doctor that’s moving from workstation to workstation potentially, looking at different monitors. If you’re in your primary care office and you’ve got a couple different people using [a workstation], you’re going to use the initial login for yourself and the software would kick in after that. … That is something that definitely has been going back to [3M] as feedback.
If I have to share information with a patient that’s displayed on a workstation monitor or tablet, would the software hinder my ability to share that information freely?
In that instance, you can actually turn that capability off – you can put it on pause, it’s got a pause button. So, I’d be able to share with a patient. To me, that little acknowledgement of pushing the pause button is my acknowledgement that now I have a different problem. Now I need to be paying attention to who’s around.
Short of having security software, what basic steps can hospitals take to
assure that data on workstations remains private?
There is the privacy filters that you can put on, where you’ve got to be looking directly at [the screen] in order to be able see the information. If you go off a little bit to the one side or to the other, it does blur the vision of what’s on the screen.
Today I had a bunch of labwork done, and in the new lab areas they have these retractable computer [screens] that come down on an arm so that the lab tech can actually sit there and fill out the information – and then push it up, get it out of the way so they can use a smaller space. But I could see everything on that screen – and it wasn’t all my data, because she was bouncing between my information and someone else’s. … It would be good to have privacy filters in those instances.
Since workstations use monitors of various sizes and even a lot of mobile devices, are there enough privacy filters available to cover all the screens that contain important patient data?
Yes. They have them for all the different devices, from tablets and the smartphones. They have a light adhesive on the back, so it sticks right to the device itself. … In my mind it’s helping protect it as well; it’s helping [to] protect that screen.