Hi Alexander, Great questions and thoughts.
Have copied and pasted some of your queries here for ease... > Do you happen to know such a device ? Is it already existing ? > What do you mean by "hot swappable power" ? I invest in one company so i wont mention specific products but there are many off the shelf components available and more coming on line - in the next year I would expect that many options will exist and we ought to be prepared for that. So for a planning cycle of say 1-3 years for system devellopment and implementation I think that battery life and weight and bulk may cease to be major obstacles. Hot swappable would mean that the device could have its battery changed without losing its memory of its current status - flash memory may be a good option for such devices vs a hard drive - that would also reduce power consumption, bulk, and weight. PDAs and even some wearable computers are really 'old transitional technology' at this point and likely to be quickly replaced with far better solutions as memory devices are increased in capacity allowing operating systems and data to be stored in much smaller spaces. "had to install 5(!) or more WLAN-access points in a bureau > area > of not more than 100 square meters to assure for connection from > every > workplace." "> Yes, but cabling is manual work, old-fashioned craftmanship. It needs > careful planing and high-quality delivery . Thats why everyone likes > WLAN so > much..." one time purchases of equipment and one time installation costs are cheap - continuing diminished utility is expensive. In each individual situation a specific solution (hardwire or wireless) will be most cost-effective. The real point is to avoid trying to make one size fit all. In some hospitals the plumbers may be able to guide the installation of the network or maybe the electricians - following the standard routes used by those systems. in other facilities it may make more sense to run lan wires through hallways, ceilings, or even outside the building with appropriate safety/cosmetic covers to protect patients, staff, and visitors. So i would not be concerned with what it takes to get the network operating but with the efficiencies to be gained by having it working which would continue in perpetuity. I would also be inclined to do such an installation in a manner that the components could be easily upgraded in the future but also recognize that anything that is done may wind up being used for 10 - 20 years before it is replaced. After all, there are still hospitals with M$-DO$ based MIS data entry systems. How archaic can you get? "> Isn't that an illusion ? A reduction of documentation time by may be > 10-20%, > wouldn't that be more realistic ? To my opinion, first thing to > eliminate > would be double/triple/+++ entering of redundant data, like patient > name, > birthday, etc.. and the automatic creation of patient specific > documentation > forms, where only the relevant data are to be entered." No - I think that reductions of the magnitude of 10 - 20% are inadequate. In some areas in the states 60% of a nurse's time is spent doing paperwork. As I often say - the appropriate analogy is to the way data clerks did spreadsheets 30 years ago. Data clerks are hundreds of times more efficient than they were 30 years ago while nurses paperwork tasks are many times less efficient than they were thirty years ago. Any useful system has to radically alter the way nurses work because nurses make up a large (if not the largest) segment of the healthcare workforce. A system that reduces documentation time by 10 - 20% is not a real innovation, it is incremental change - a system that reduces documentation by 90 - 95% will fundamentally alter the way people work much like the electronic spreadsheet fundamentally altered the way data clerks worked. Redundancies often go to 5, 6 or more replicated activities - charting things on wallboards, charting in patient records, entering data into MIS, recording notes at bedside, filling out referrals to other services, recording data in room charts and also at the nursing station. Also, the level of redundancy differs for simple things like patient ID numbers which may need to be entered dozens of times in a shift or specific write-ups - such as a referral for PT which may need to be written on a specific referral form, a note entered into the chart, a call made to a physician or NP or PA... Nope, 90 - 95% should be the minimal reduction in documentation time - if a system doesn't achieve that order of efficiency it ought to be considered deficient and unacceptable. A system that achieves that order of efficiency will have very little trouble being implemented. Your comments on Voice vs OMR OCR data entry There are ways to prevent background noise from contaminating the quality of dictation. Directional microphones will help a lot. Also, the voice recognition systems are reasonably good. Reporters used to use devices over their mouths 30 - 40 years ago for speaking on phones where they were all crowded at a table sitting next to each other so that the other reporters voices wouldn't be heard nor would theirs. I think this is a solvable problem. As to the OMR/OCR - remember that it takes time to fill in the form and then take the form to the reader - Remember what I have alluded to above - many 'new' systems change how the inefficiency is achieved rather than achieving efficiency. Having nurses walk back and forth to a reader and then potentially deal with feed and recognition problems and then have to put the paper document somewhere since it contains client data - that all introduces new inefficiencies while only potentially eliminating old inefficiencies. Also, if these systems only have a reliability of 99% I suspect that is inadequate for clinical data. It also suggests that the nurse might have to do some verification that the data was actually read correctly - minimally that it is the right patient's data... I am not at all against OMR/OCR - but the manner in which it will be implemented has to be clearly more efficient than what it attempts to replace... multiple data entry locations are indeed a possibility - again - one time purchases of equipment - even if relatively expensive, are cheap compared to continued inefficiency - but this makes it all the more important that the increase in the level of efficiency be on a scale of 10 - 20 times rather than 10 - 20%. You can easily justify high expenditures for hardware if the expenditures for staff are going to come way down. Also, from a social good perspective - you have to consider the issue of nursing shortages and the costs to develop additional training programs - the MIS can address a lot more issues than how information is stored, retrieved, and processed... I agree that such systems can become revenue earners by providing content to patients - but i think it is more important that they should justify themselves on their impact on the work environment and the efficiencies they achieve there. as to disasters - i think we are talking about two different types. Yes, there are myriad disasters each day - those are eventually taken in stride and people learn how to cope with non-functioning equipment, inefficient personnel and procedures etc. When i refer to a disaster it would mean a complete absence of electrical power throughout the hospital making the MIS unavailable for an extended period. bear --- Alexander_H�lzel <[EMAIL PROTECTED]> wrote: > Hi Bear, > > I am coming back to our discussion about clinical data-access > devices. Here, > I put together some arguments from your recent e-mails and try to > give my > opinions. I find this discussion too important to leave. The > hardware, we > are discussing now, will be the hardware Care2x will/is to be > designed > for.... > > > Personally i do not like PDAs - They take too much time to interact > > with. My personal preference would be a wearable computer with > voice > > command capability and complete access to the MIS..... > .... > > .....be a device that recognizes where the nurse is and asks to > validate > > that the nurse wants to turn their attention to the patient in that > > room. > > > I think small, wearable computers could be built for a fraction of > > current products. power - if hot swappable, may not be as hard as > it > > may seem. > > Do you happen to know such a device ? Is it already existing ? > What do you mean by "hot swappable power" ? > > > I also suspect that the wireless lans are not as formidable > > an obstacle as might seem - many hospitals already have internet > access > > in each workstation anway and a wireless router may be adequate > within > > each unit. > > So, than I ask you to ask a technician about reliabilty of WLAN. In > general: > qulaity of copnnection is rather unpredictable. I know about > installations, > where they had to install 5(!) or more WLAN-access points in a bureau > area > of not more than 100 square meters to assure for connection from > every > workplace. > > > > retro-engineering this may not be that difficult in most hospitals. > > after all they already have a variety of tubing, plumbing, cabling > > going all over the place... > > > Yes, but cabling is manual work, old-fashioned craftmanship. It needs > careful planing and high-quality delivery . Thats why everyone likes > WLAN so > much... > > > > My own particular objective would be that the amount of time nurses > > spend documenting their activity should be reduced by 90 - 95% > > Isn't that an illusion ? A reduction of documentation time by may be > 10-20%, > wouldn't that be more realistic ? To my opinion, first thing to > eliminate > would be double/triple/+++ entering of redundant data, like patient > name, > birthday, etc.. and the automatic creation of patient specific > documentation > forms, where only the relevant data are to be entered. > > > > to have their needs anticipated by the system and an absolute > minimum > > of wasted keystrokes. again - voice activated commands would be a > lot > > easier to handle than a device that takes two hands (or one hand > and a > > surface) to use... > > Totally agree, what efficiency is concerned. But I have my doubts > about > voice driven data entry what privacy is concerned. (Everyone could > hear, > what is entered into the system). I also doubt about technical > feasibility > today. Think about 2-4 nurses dictating their data simultanuosly in > the same > place, eventually with additional people talking in the background. I > believe, that is overkill for every modern dictation system. > > I would rather propose paper based documentation by using OMR-forms > (optical > mark recognition), which would be inserted in a nearby scanner-device > for > automatic data acquisition. OMR systems correctly used are reliable > >99%. > > > > Generally agree. The only reservation is that locating interfaces > at a > > patient's bed introduces problems - the device is not available to > the > > nurse continuously - this means that the nurse has to be at a > patient's > > bedside or at the nursing station to interact with the system. > > It would be rather easy to have more data entry stations, may one for > the > patient room in general, one every 10 meters on the floor, etc.. to > create > quasi-continuity in availability. > > > > means that the nurse would have to log-in and logout every time > they > > went to see another patient - this is definitely a problem from my > > viewpoint. This could be overcome with some sort of scannable > device > > like a wrist ID randomly assigned when coming on duty but the need > to > > scan it and logout is still cumbersome... > > I would trust most on smart-card technology. Nurse is logged in by > entering > her/his card, is logged out by removing card.. Is that already too > cumbersome.? > > > > i hear you on the disaster issue - of course in disasters all hell > > breaks loose and it almost doesn't matter what life was like before > - > > everything is awry - the system is designed for efficiency and > utility > > As far as I know hospitals from my personal experience as M.D. there > is a > disaster near by every day..Additional use of a multitude of mobile > devices > (be it PDA are wearable) would potentiate the possibilty of "little > disasters", thinking only about additional logistics as mentioned > earlier. > > > > most of the time - not all the time. definitely agree on batteries > - > > but the more utility the sytem provides the more power it will > > demand... > > So, that is why I adhere to stationary solutions. You can easily > attach > cameras, microphones, mobile medical diagnostic devices without > "hoping" for > enough power.. > More than that: Stationary bed side device is self-financing, it is > the only > solution, I am aware of, which will pay back in rael cash all > investments > made in IT-infrastructure in hospitals. > > Citing myself, explaining the business model: > > > > Investment in this technologies could be -to some extend- > refinanced > > > by selling digital content to patients (movies, MP3) and > > > telecommunication services (VoIP, Internet, e-mail) etc, simply > by > charging them some > > > amount per day...In Germany hospitals it is normal, that you pay > for > > > TV-rent, Phone etc..If you charge 5 Euros a day, you "earn" 1500 > Euros a > year (if > > > bed is booked 300 days/year). > > > > > > In general, and not specific to your thoughts, the most important > > considerations ought to be (IMHO) how to reduce the tedium and > wasted > > time for nurses who must repeatedly interact with these systems > dozens > > if not hundreds of times each shift. > > 110% agree !!!! > > Not to forget the necessities of other personal besides nurses, first > of all > the doctors. Their work -at least here in Germany- consists to more > than 50% > of paper work, means documentation, reporting, letter writing.. > > Alex > > > > > > > > ------------------------------------------------------- > This SF.Net email sponsored by Black Hat Briefings & Training. > Attend Black Hat Briefings & Training, Las Vegas July 24-29 - > digital self defense, top technical experts, no vendor pitches, > unmatched networking opportunities. Visit www.blackhat.com > _______________________________________________ > Care2002-developers mailing list > [EMAIL PROTECTED] > https://lists.sourceforge.net/lists/listinfo/care2002-developers > ------------------------------------------------------- This SF.Net email is sponsored by BEA Weblogic Workshop FREE Java Enterprise J2EE developer tools! 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