Point of Care Computing Device Review
Yours truly was quoted in this story on point of care computing devices by Neil Versel. In this review, Neil looks at all the various devices used at the point of care and more generally in care delivery areas like nursing stations. After talking with providers and vendors, the conclusion is there is no “one size fits all” solution. Here's what I took away from the story:
- Don't get locked in to any one solution, stay open systems and standards based.
- Healthcare delivery is inherently mobile, don't tie users to a limited number of locations. And don't forget your WLAN – coverage is important, but so too are capapcity (the number of devices per AP) and latency. If users are truly mobile, make sure hand-offs between APs and subnets works well.
- The choice between device deployment types (alcoves, COWs, bedside) should be driven by your situation – and remember situations vary among clinical areas.
- The market is transitioning from paper to paperless and both workflows must be supported. Don't forget things like the ability to print to the closest printer from a wireless device.
- Don't forget the basic health care requirements: water resistance, qualified for harsh disinfectants (find out which ones), ruggedized (1 meter drop on linoleum covered concrete), supports 8 and 12 hour shifts (battery life, swap and recharging), display and input devices must be consistent with applications – both now and during the expected life of the computing device.
- Technology roadmap – these are general purpose devices, so plan ahead (5 years at least) and consider all the different point of care automation and patient safety initiatives planed in your hospital. Otherwise, you'll be replacing more than you need to in the future.
- Consider infection control implications and develop policies and procedures to minimize risk and measure performance.
- Don't forget to consider these applications: point of care charting, meds administration, vital signs data acquisition, alarm notification and surveillance for patient monitors, smart pumps, and ventilators.
Read the whole thing.
USB Drives Pose Security Threat
The Universal Serial Bus (USB) as rapidly replacing RS-232 connections on medical devices. As more device vendors adopt general purpose operating systems like Windows CE, it becomes very easy to leverage USB for connectivity.
When faced with complex connectivity requirements, it is very tempting to just push those requirements off on the user by providing a USB port and thumb drive. Besides the fact that reading and writing data to a USB drive only just barely qualifies as “connectivity” (resulting in manual error-prone workflows),USB drives pose a substantial security threat. Standard USB drives have no built in security.
Anyone can bring a widely available USB drive to a device and download or upload data. Also there is no way to tell if the USB has executable code that will push a Trojan horse or other malicious code onto the target device. This is especially worrisome if your device is running a general purpose operating system like Windows – but even Linux would not be immune to this.
All of this came to mind after reading this brief paper by Adam Wright and Dean Sittig, both of OHSU, in the current issue of Annals of Internal Medicine. Their paper describes the security threats posed by USB drive based personal health records. If you don't have a subscription, you can read the PDF file here.
We modified the programs on the devices so that, when connected to a computer, they gave the appearance of normal operation but surreptitiously searched for and copied data from the computer to a hidden location on the USB device.
USB drives have become so ubiquitous that there are now many novelty drives such as the shuumai (a steamed wasabi pork dumpling) pictured right.
