Electronic Health Reporter

Guest post by Steve Reinecke, CLS/MT, CPHIMS, AVP Ergotron Healthcare.

Today, healthcare organizations are being challenged to provide quality care while improving accuracy, efficiency and accountability. With the additional strain of staff reductions, space constraints, budget cuts and technological advancements all competing with new regulations, there is almost a perfect storm of workflow changes for clinicians to address and adopt. While most focus on the immediate challenges of electronic health records, they may not think through all the implications when implementing the technology used to access it.

Amid the widespread adoption of EHRs, caregivers are equipped with a multitude of devices to access electronic reports – including tablets, handhelds, wall mounts and mobile carts. Furthermore, the logistics governing electrical, phone and network cabling, not to mention physical “real estate,” can stretch the ability to cope for some facilities. It’s not surprising to find cutting-edge IT equipment being used in cramped, stuffy rooms with inadequate furniture, mounting surfaces and storage. At the recent HIMSS conference, we presented to dozens of clinicians and explored how the enterprise-wide application of ergonomic principles within a hospital setting can help manage and sustain all of the often overlooked aspects of clinical workflow.

Ergonomic Factors

Ergonomics is the application of scientific knowledge to a workplace to improve the well-being and efficiency of workers. Ergonomic design considerations begin with human abilities and limitations and how they affect the work process. An ergonomic workplace increases workers’ efficiency and productivity, while helping to reduce fatigue, exertion, and musculoskeletal disorders.

Studies have shown that a good ergonomics program also favorably influences reduction of workplace injuries and absenteeism, and contributes to overall employee wellness.

Technology has created improper ergonomics in many clinical settings and nurses, as well as clinicians are seen leaving the profession because of injury. The goal should be to chart at the bedside of patients, but poor ergonomics and cookie-cutter implementation of technology is creating a barrier to doing so. Nurses spend between 13 and 26 percent of their time completing documentation[1], and 12 percent of nurses leaving the profession report back pain as a main contributory factor[2].

Ergonomic efforts should educate employees on how their behavior and lifestyle contribute to their wellness; provide ergonomic computer support equipment and the proper environment; train employees to safely use the computer and support equipment; and provide ongoing monitoring and metering of employees to account for changes that may affect their well-being.

Addressing Triangle of Care – Patientricity

Effectively integrating technology into all aspects of the healthcare environment without compromising the patient experience requires an effective positioning all the players—the patient, the caregiver and the technology, into a more favorable alignment, a Triangle of Care, or what we call Patientricity.

Creating a patient-centered environment inclusive of technology, must be done with sensitivity to the needs of the patient and medical staff alike, whether documenting at the bedside or reviewing radiology reports in the lab. Done right, it promotes increased interaction, satisfaction, safety and efficiency into the patient-caregiver exchange. The patient receives the benefit of the face-to-face connection with the caregiver, while the technology becomes a partner to the exchange.

Achieving this balance involves a combination of computer technology and display mounting and mobility solutions properly placed at the point of care. We recommend exploring these factors:

• Avoiding inappropriate or cumbersome placement of technology that impedes the efficiency of care.
• Considering adjustable options that allow caregivers to sit or stand while accessing or inputting data to offer a new level of work flexibility.
• Not skimping on key ergonomic considerations in terms of helping users achieve proper computing postures, and adjustability when manipulating the equipment.
• Evaluating and understanding the human interaction that needs to take place within the digital workflow.
• Understanding space constraints to determine whether fixed, permanent and dedicated equipment is required, or whether a mobile solution best serves the care-giving requirements.

Addressing Power Issues with Mobile Solutions

One of bigger pitfalls in implementing a point-of-care computing system is the lack of understanding and education of power requirements and power needs for cart-based computing. And the largest problem is the lack of testing. Implementation should be focused on these best practices:

• Hardware requirements: Take the time to test many different PC platforms (small form factor, ultra small form factor, tablet, laptop, slimline PC, all-in-one and thin client) on the cart solution you pick to see what gets the best run time in a real-life environment.
•  Power management: To get the most run time out of a battery and to keep the battery healthy, it is important to understand power management. Note that the same configuration for power management for a desktop PC is usually not ideal for a mobile point-of-care solution.
• Certification requirements: It is important to understand whether the product in question has undergone redundant safety features, special abuse tests, both component and full system level certifications to all government standards.

There are many benefits to exploring ergonomics, patientricity and addressing power challenges including having more satisfied employees and patients, as well as increased access to technology, and long-term cost reductions and decreased injuries because of poor ergonomics.

A medical technology and information systems veteran, Steve Reinecke brings more than 20 years of experience to his current role as assistant vice president of Ergotron Healthcare, where he leads a North American Healthcare Team. As on one of the premier experts in healthcare IT point-of-care technologies worldwide, Steve travels year-round to educate organizations on issues around implementing point-of-care. Early in his healthcare tenure, Steve spearheaded efforts to implement one of the first wireless cart-based point-of-care projects in North America. In 2008, Steve earned the designation of Certified Professional In Healthcare Information and Management Systems (CPHIMS).