by Irene Fried

Medically certified workstations bring information systems safely to the patient bedside
Today’s working world demands that we be everywhere and still stay connected, all in an instant. In a fast-paced, high-stakes health care environment, this carries special importance.

pc01.JPG (10519 bytes)Planar’s Invitium TN4 with the mobile cart option

     Point-of-care diagnostic products are judged by their ability to deliver speed and flexibility against the rigorous standards of a more controlled laboratory environment. Point-of-care computing platforms can be judged in a similar framework. Why bring LIS capabilities for entering orders and retrieving data to the point of care? In principle, the more a clinician can accomplish with eyes on a patient and up-to-the-minute information at hand, the less chance there is to make an error or forget a detail. But while laptops and PDAs offer portability, they are not designed for the harsher field demands of the bedside, and their performance can’t compare to what’s expected in a “core” environment.

     Planar, a medical equipment company experienced in the manufacture of patient monitors and surgical displays, designed its computer workstations from the ground up to address the challenges of space, durability and safety at the point of care. The Invitium Tn4 is Planar’s newest ‘thin client’ lower-cost alternative to computer workstations, meeting the performance requirements of applications such as physician order entry and clinical charting at the patient bedside. The workstations are UL 2601 and IEC 60601 certified for the highest standards of use in medical settings, and consist of a computer and flat panel monitor that can be mounted on desk stands, mobile carts, arm mounts or wall mounts for flexibility and optimal use of space. A touchscreen option is available.

     With the Invitium Tn4, healthcare staff can access a patient’s medical record at the bedside (by password through programmed levels of restriction). Current medications, test results, medical history and allergies can be viewed, and software can be loaded to alert staff to possible adverse drug interactions. New tests can be ordered from the lab, potentially with the aid of “just-in-time” clinical decision support software.

The bottom line
Computerized test ordering at the point of care also promotes billing capture of correctly coded, reimbursable services, and lessens the lab’s need for follow-up phone calls and re-dos. That’s good not only for the lab’s bottom line, but for the financial health of the institution as well.

Designed for safety in the real world
The UL 2601 standard to which the Tn4 was designed is specific to medical devices. It carries the assurances that one device will not cause electromagnetic interference with another device; and that there is no current leakage that could shock a patient. The IPX1 standard, also carried by the Invitium TN4, assures there are no points at which liquid ingress can occur. The Tn4 medically certified workstation can withstand hospital grade cleaners and endure extreme physical shocks, while the rounded edges and softer construction of both monitor and keyboard reduce risk of impact injury, which is of particular concern in a fast-paced environment where many people may need to move around in a confined space. Further, the Tn4 is designed with a fanless cooling system that both reduces the spread of bacteria that fan-cooled systems can promote, and resists dust and clogging. For patient comfort, the monitor includes brightness control so patients won’t be disturbed in the middle of night, and an integrated keyboard light enables use in a darkened room without turning on overhead lights.

     As Kevin Renner, director of product management for Planar explains, “A number of key factors converged to drive the development of this product line. The market’s ongoing adoption of point of care products was well established over the last decade, and there has also been an acceleration of interest in more robust clinical information systems. New HIPAA requirements posed challenges in terms of auditing access to patient information, and concerns over patient safety and reduction of medical errors have been brought to the foreground. These elements came together to push for the adoption of clinical information system applications at the point of care. What was missing on the market was a platform to run those systems. The interest was clear, but for the software vendors, it was like trying to sell a Palm operating system without the PDA for it to run on. The hardware being shown with the systems was not medically certified, and it was designed to run eight hours a day, five days a week in a safe and sanitary environment, rather than the 24-7 high impact environment in which it was needed. In reality these point of care computing platforms are likely to be hit by gurneys and mop handles, pushed out of the way in an Emergency Department or code situation, and subjected to spills, leaks and chemical disinfectants. An ordinary laptop could be expected to last perhaps nine months to a year under these conditions. This led to the development of the Invitium clinical workstation, the name Invitium being a shorthand derivation from the Latin signifying ‘infinite life’.”

Model features
The Invitium has a rugged exterior to withstand impact, and a fluid-resistant enclosure to protect the system from spills and leaks. As modular systems, the workstations can be upgraded as needed with a faster CPU connected to the same display. The flat panel of the display causes less eye fatigue, and the unit is more highly reliable, more durable and lasts longer than a laptop on a cart. The system incorporates a locking connector to keep power, video and peripherals attached and operational at all times. The monitor is a 15-inch color active matrix liquid crystal display, with an acrylic overlay for protection from punctures or scratches, and optional touchscreen operation.

     There are a variety of ports for connecting peripheral devices such as barcode scanners, biometric devices, ID card readers and patient monitoring devices. The unit can be powered by a single power supply or an optional battery system.

     The Invitium Tn4 operates Windows on a 400 MHz processor and supports data storage on a central server or mainframe computer. It boots from flash memory and runs applications in RAM. It offers greater system durability by providing data storage through a flash drive instead of a hard drive. Modular construction of the systems allows for a change in configuration, upgrading the CPU or replacing the display as needed. The system is neutral on application software, and can be wired or wireless. It is a new technology, sold through larger systems integrators who bundle the hardware together with information systems to be placed in hospitals. The original Invitium was developed with McKesson as a sponsor, while the new Tn4 thin client version was developed with sponsorship from Cerner, but the systems themselves are vendor neutral.

Responding to today’s needs
Issues of medical record privacy and reduction of medical errors have been on everyone’s monitors in healthcare systems these days. “HIPAA concerns,” says Renner, “are addressed largely by the advent of the newest generation of electronic medical records (EMR) systems. This may seem counterintuitive if you assume that computerized records leave people more vulnerable to privacy violations, but in fact digitizing information allows the creation of audit trails that will account for who has had access to a record. The EMR has been driving the success of hospital information companies, and the ability to incorporate point of care systems makes a company’s hospital information software more viable.”

     With these computing platforms, access to information is controlled by logging in and logging out, and information does not stay up on the screen. A filter can also be added to the product so that only the person immediately in front of the screen can view the information on the screen, straight on. And because the Tn4 thin client has no disc drive on the system, it isn’t possible to download data and take it away.

     It is the unit itself that offers all the advantages of portability, and brings the power of the LIS/HIS to the patient bedside. The clinician is able to accomplish computer entry and retrieval of information right at the point of care, protecting the integrity of the intended test and treatment orders, and gaining speed in placing those orders and receiving results. A nurse, for example, will not have to be back at the nurses’ station to send orders through to the lab. And as applications continue to develop for these point of care systems, greater possibilities emerge for bringing wireless or networked, Web-based or customized decision support informatics and reports to the full range of mobile deployment options, landing the LIS right where it’s needed the most.

Irene Fried is a freelance writer based in Raleigh, North Carolina.