Opinion

Taking ehealth to the hospital patient

Warren Kressinger-Dunn, JAOtech

Momentum behind ehealth in Europe is accelerating on the back of a recent Europe-wide agreement to align national ehealth systems. The smart terminals installed at hospital bedsides around the world are the ideal solution for taking ehealth to the hospital patient. However, vendors need to ensure that their terminals meet the very demanding hygiene, security and accessibility requirements if they are to form the front end of an ehealth revolution.

Ehealth momentum

In the UK, David Cameron, leader of the Conservative Party, has made electronic patient records an election issue, pledging: “It’s the patient who’ll have the power in our NHS. You’ll be able to check your health records online in the same way you do your bank account.” [1] The pledge is in line with European thinking on the issue. In February 2009 in Prague EU Healthcare State Secretaries agreed to form a new formal body aimed at aligning national ehealth systems.

Whilst making these records accessible to doctors and nurses at their desks is relatively straightforward, taking them out to the hospital ward poses greater challenges. Patient consultations normally take place at the bedside, so the records need to be available at that point. The current system requires hospital staff to print off documents before their round, and then update them afterwards with observations and treatment recommendations — negating the potential efficiency benefits.

The hospital ward is an extremely demanding environment for IT systems. First and foremost, the growing concern over MRSA and similar infections requires hospital staff to clean the units regularly with aggressive detergents. The second major requirement is for security that is both effective and convenient. Many hospitals already issue staff with security cards of one sort or another — so ideally the terminals can be accessed using this technology. The third is accessibility — a flexible and convenient user interface.

The terminals

Bedside multimedia entertainment terminals are already in place at the majority of hospital beds in the UK, and demand is increasing in Europe, USA and further afield.

Using the latest technology, these terminals can be readily integrated into the hospital IT infrastructure, and are software compatible with other PCs in use around the hospital. They are available in a range of screen sizes, offering outstanding reproduction of images such as X-rays at the same time as presentation of the latest movies. The best provide a large scale, graphical touchscreen interface giving easy access to all clinician and patient functions. Options such as wireless keyboards allow the terminals to be readily used to update records — and cameras can allow patient monitoring and remote consultation.

Such terminals can offer clinical staff instant access to the records for the right patient at the point of care: the bedside. However security is the second key issue, and given the frequency with which staff move from terminal to terminal password access is simply too cumbersome.

Fortunately, there is a raft of effective secure access technologies available, including magstripe and smartcard readers, biometrics, infrared, barcode and RFID. Often, hospitals already have systems for identifying staff, patients, medicines and paperwork, so terminals need to optionally support all of these. Ideally, a doctor should be able to log in, instantly switching the screen containing the medical records, which then vanish after logging out, returning the patient back to the game or movie he or she was enjoying before the interruption.

A particularly interesting development is the Sonitor technology based on ultrasound transponders that can be used to identify staff, patients and other assets. This technology potentially opens up a whole new range of applications for the terminals, allowing them to be the front end of an asset-tracking system that eliminates the time staff waste looking for equipment or the scenario where equipment is tucked away in wards and store rooms and not being utilised.

Hygiene-focused design

Bedside terminals on hospital wards need to be regularly and thoroughly cleaned like everything else to reduce the risk of cross infection. They need to be enclosed and free of gaps and crevices where bacteria can collect, and fully sealed to withstand hospital cleaning agents such as alcohol, methylene chloride, methyl ethyl ketone and acetone.

These requirements are unique in the technology market so attention to detail is imperative. Tooling needs to be built to exceptionally high standards and tolerances to keep gaps between adjoining plastic panels to a minimum. Most standard desktop PCs have a fan to keep them cool, necessitating a grille to allow the warm air to escape. Bedside terminals need cool running processors and other innovations to ensure that they can operate reliably without this form of cooling and therefore heat sinks are deployed to meet this.

Sealed rear access doors are needed to allow users to upgrade storage or memory and add further peripherals like WiFi or video, without damaging the integrity of the case. Novaron Anti-bacterial plastics are the ideal material in which to construct the case to reduce risk of infection — but moulding in this material gives special challenges which manufacturers need to address. The touchscreen needs to be water tight, which is hard to achieve without compromising touchscreen sensitivity.

This is a heavy shopping list of demands. The volume PC manufacturers supplying the general office and home market can’t justify the investment to develop a specific product for a market that is by their standards small. On the other hand, the volumes are too large for the small specialist, who is often unable to address the global scale of the market.

There is an emerging breed of terminal manufacturers addressing specifically this market however, large enough to invest in the development of products that are fit for purpose, but small enough to operate successfully in this niche market. Manufacturers like JAOtech are able to continuously evolve their products, leveraging developments in technology and innovations in peripherals and access control as they become available to adapt their products to the changing needs of the broad spectrum of healthcare users.

Attractive economics

Improved use of clinical staff time isn’t the only benefit that bedside terminals can bring. There is also scope to use them to streamline hospital operations, allowing patients to select meals for example.

 Differentiated staff calls can save further valuable time — allowing patients to indicate whether their need is medical or simply assistance with movement ensures that an appropriate member of staff can respond. There is also anecdotal evidence that the entertainment services for which the terminals are usually installed in the first place reduce the number of times that patients call on hospital staff.

The growing importance of ehealth is further accelerating the trend for the introduction of bedside smart terminals in hospitals. The emergence of units packaging the latest PC technology in a form fully compatible with the hospital ward environment supports this growing trend.

Warren Kressinger-Dunn, CEO JAOtech

Footnote

1. The pledge is made in David Cameron’s speech in January this year launching the Conservative NHS manifesto which appears here:
www.conservatives.com/News/Speeches/2010/01/
David_Cameron_ill_cut_the_deficit_not_the_NHS.aspx

I can’t find any actual reference to online patient records in the manifesto draft itself — the only reference to records (bottom of column 1 page 7) alludes to them being portable but doesn’t say online. See the manifesto here:

www.conservatives.com/News/News_stories/2010/01/~/media/
Files/Downloadable%20Files/DraftHealthManifestopdf.ashx

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