Beruflich Dokumente
Kultur Dokumente
Kathleen Gaffney
December, 2012
1. Introduction
The need of physicians, nurses and other clinical staff for data entry and access into the electronic medical record (EMR) at the point of care (POC) has become a particularly challenging issue for hospital IT departments. This is because IT must implement and support an increasingly wider variety of point of care devices than ever before, including mobile workstations, wall mounted screens, thin-client devices, mobile devices, healthcare-specific tablets and smartphones. Furthermore, IT must ensure that the POC solutions provide users with the continuous 24/7 availability, flexibility and security they require. One of the first challenges IT faces is selecting the most appropriate end user device for the clinical need. It is likely that stationary workstations have been deployed for entering orders and viewing census, test results and PACS images. As an institution deploys computerized physician order entry (CPOE) and bar code medication administration (BCMA) the demand for POC devices dramatically increases. There are many types of mobile computer devices available to deploy. Each of these devices has both advantages and disadvantages for the clinician. It is important to understand that a mixture of mobile and non-mobile equipment will need to be deployed in order to best meet the multiple needs of end users. The decision on the types of devices to deploy is based on many factors including; staff preferences, cost, size, durability, ergonomics, facility issues such as electrical circuits and data closets, the ability to integrate into the institutions technical infrastructure and maintaining city and county codes. Additionally, institutions must determine the number of each device type that is needed.
Clinical and administrative workflows Walking patterns; where clinicians walk, sit and stand to perform their daily tasks o Patient, visitor, and information flow patterns o Medical procedures being performed o Location of data access, input and administrative activities such as logging in, chart review and documentation Determine space constraints, facilities, Fire Marshall, and Joint Commission requirements Document infection control and prevention protocols for fomite disinfection, isolation patient requirements, and the antimicrobial and germicidal agents used
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Allows for eye contact with patients Enough devices for all clinical users at peak staffing times (including teaching rounds) Ease of use and provision of the optimal device for each role The ability to support the institutions clinical software
Document the form factor requirements including: o Ergonomically correct o Easy to clean, infection control o Ruggedness o Secure o Weight o Large screen o Camera o Space/storage o Reliability o Battery life o PCU electrical capacity o Scanner or Bar Coder
Later, the selected devices can be piloted among a small group of users. Have vendors supply samples for use by the hospital staff for a 4 to 8 week test period. During this time, clinical and IT staff create future state processes that reflect best practices for embedding mobile devices into new workflows. The institution should also be thinking about the placement of special cabinets for storage and charging of devices when not in use and research and evaluate these vendors as well.
Once the committee has compiled the list of performance, functional and form factor requirements they will then move onto identifying the various vendors and devices most appropriate for their institutions environment.
networks. That is why it is important that an institution concurrently plan for the assessment and upgrading of the wireless network infrastructure.
POC Interfaces The architecture of the wireless network and its integration with the wired network must be designed to minimize risk. POC devices should use thin-client, zero client, and virtualized desktop interfaces to minimize the need to download and locally control sensitive and critical data. Security Strategies The optimal infrastructure also needs to support HIPAA security standards for preventing hacking and loss of protected patient information. Institutions need to take a multi-layer approach when securing patient data in wired and wireless environments to be certain that Wireless LANs (WLAN) are providing the same level of access control and privacy as wired LANs. This allows you to achieve a broader approach to your compliance initiatives and provide maximum protection for protected health information (PHI). Examples of strategies that can be implemented include: Installing and maintaining secure firewalls Encrypting across open, public networks Establishing a zoned network architecture Ensuring that network traffic is encrypted by implementing Wi-Fi Protected Access (WPA2) encryption Another security strategy is to develop wireless security policies that govern both how employees behave and how wireless technology is used and integrated into the enterprise. Network access control policies should be put in place requiring that users authenticate themselves with passwords, and the actual devices must be authenticated by network servers before granting WLAN access. Additionally, cryptographic keys used to access the WLAN must be changed frequently. Intrusion and Monitoring Detection Along with security strategies, intrusion prevention and end-to-end monitoring are key components in avoiding PHI leaks that IT will need to plan for. Intrusion and monitoring detection are an effective means for discovering wireless vulnerabilities, detecting intruders and attacks, and keeping watch over the overall security of a WLAN. It is recommended that an institution have a Network Penetration test performed to show the gaps in security. Wireless monitoring should include 1) real-time monitoring for rogue APs and ad- hoc networks; 2) detection of events that could indicate wireless intruders; and 3) wireless LAN management tools to manage wired network performance and security.
In health care institutions a successful POC device implementation strategy has as much to do with the stability of the infrastructure as the selection of appropriate devices.
Wireless Characteristics A contributing factor to the overall performance of POC devices is based on the RF characteristics of the wireless client. Many of these devices have varying levels of RF performance and as a result have very different outcomes depending on the wireless hardware implemented. Another factor is receiver sensitivity which is the ability of an RF receiver to detect the 802.11 signal given the receivers noise floor. The better the receiver sensitivity, the better the performance and overall availability and throughput. A third factor is the implementation of the roaming algorithm which allows for roaming at the right time and not experiencing throughput degradation. Additional aspects that can affect POC workflow include power conservation techniques and QoS capabilities such as availability (uptime), bandwidth (throughput), latency (delay), and error rate. Prior to a large POC deployment many institutions have a wireless site survey performed and then build or reconfigure a network based on the assessment findings.
Budget
Adding more POC devices creates new demands on device procurement, activation, asset management, IT support and device retirement. This can lead to an increase in costs. Each institution needs to identify budget dollars to be allocated for the initial deployment and for the planned replacement of obsolete and lost equipment, including devices, carts and batteries.
2. Summary
In health care institutions a successful POC device implementation strategy has as much to do with the stability of the infrastructure as the selection of appropriate devices. The challenges IT faces in a POC deployment include understanding how mobile technologies can be used to support new and existing processes at the point of care; selecting the most appropriate end user device for the clinical need; and managing POC devices so that the necessary processes do not interfere with the delivery of patient care. In addition, the network has to be designed to never go down, to perform at the desired level, and to accommodate the workflow and security requirements specific to health care institutions. An institution should utilize a best practice methodology to help guide them through the many steps and to help ensure that the end solution is tailored and deployed to their unique business needs.
http://www.pointofcarecorner.com/critical-issues-inmanaging-point-of-care-devices/ 5. Enterprise Mobility Solutions, Maximizing your Mobile Investment ttp://downloads.deusm.com/enterpriseefficiency/En terprise_Mobility_Solutions___Whitepaper.pdf 6. Wireless (In)Security for Health Care. Version 1.1 January 10, 2003, Dr. Dixie B. Baker, Corporate Vice President for Technology, Enterprise and Health Solutions, Science Applications International Corporation, http://www.himss.org/content/files/WirelessInsecuri tyV11.pdf 7. Network Security in Healthcare: How The Right Technology Enhances Quality Of Care, Prepared for WatchGuard Technologies, Inc. by Reymann Group, Inc. https://www.watchguard.com/tipsresources/grc/wp-network-security-in-thehealthcare-industry.asp
References
1. How to Select End User Clinical Data Entry Devices, Rush University Medical Center Develops Tool to Identify the Quantity of Devices Needed for the Implementation of a New EMR and CPOE System. HIMSS JHIM volume 24 / number 3, SUMMER 2010 2. Wireless Technology Still Emerging in Healthcare, John Andrews, Contributing Writer, Dec. 31, 2009, http://www.healthcareitnews.com/news/wirelesstechnology-still-emerging-healthcare 3. Cisco Network (MGN) 2.0 - Wireless Architectures http://www.cisco.com/en/US/docs/solutions/Vertical s/Healthcare/MGN_wireless_adg.html#wp246550 4. Critical Issues in Managing Point of Care Devices, February 2012