The categories used on this site (see the left hand column) to organize posts by topic has been pretty stable for several months now. But after HIMSS, I've got to add one that deals with workflow automation at the point of care (POC).

The point of care is a very challenging work environment, with many different systems and devices competing for a caregiver's attention. Revolving around the caregiver and patient are the following:

  • Nurse call systems provide communications between the patient and central station. Of course the objective is to provide communications directly between patient and the caregiver assigned to that patient. Problems with traditional nurse call systems include today's trend to private rooms can isolate patients, and lean nurse to patient ratios that let nurses spend less time at the central station.
  • Overhead pages interrupt everyone on the unit with a request from one individual to another - inefficient and disruptive.
  • Phones are usually limited to the central station. There are two problems with phones: the caregiver that's needed is rarely standing next to it when it rings, and the person the caregiver is calling (attending and consulting physicians, respiratory therapist and other roving techs, case manager, and social worker) is rarely standing by their phone - the result is lots of phone tag.
  • Medical devices are increasingly found in general care units providing surveillance, delivering therapy, or both. Telemetry and patient monitoring systems have central stations so alarms are generated at the device and at the nursing station and/or central monitoring room - problems include missed alarms at the central station or the high operating costs of a "war room." Infusion pumps and ventilators don't have central stations, so caregivers must rely on local alarms on the device. The safe use of all medical devices is challenged by locating devices in patient rooms where they can be sequestered behind closed doors and manipulated (reset, alarms canceled, etc.) by irritated patients or family. All medical devices suffer from alarm fatigue generated in caregivers who must respond to alarms (many of which are false positive) and filter different alarm schemes that vary by device and manufacturer.
  • Vital signs capture is really a different animal. Rather than providing continuous surveillance or therapy delivery, vital signs monitors take spot readings from patients at intervals ordered by physicians. Using manual methods to get accurate vitals information into the chart in a timely manner are the challenges.
  • POC information systems from the usual suspects (Cerner, McK, et. al.) generate work lists for caregivers and can help with shift change.
  • Meds administration systems are also appearing on nursing units in greater numbers. Whether as part of an infusion pump solution or intended for caregiver administered meds, these systems are intended to improve patient safety.

Many of the above product categories have related systems and gadgets that serve as data entry, look up or communications devices. If a hospital were to adopt all of today's point of care systems, caregivers would need both a tool belt and a bandoleer to carry the phones and multiple PDAs. Neither caregivers nor hospitals are going to go for this duplication of POC systems in any big way - you would think this is obvious, but given what I saw at HIMSS, and products that are in development, many vendors don't think much past the use of their own products. Single vendor solutions are nonexistant at the point of care. All of this makes for a messy situation where market needs compete with established vendor strategies.

Starting now, posts dealing with point of care products and issues will be available in the POC Communications category in the left hand nav bar.