Hospitals Face Tricky Hardware Decisions
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You think your choice of computers is tough? Try picking one that will survive doctors' rounds, patient infections, long hours on nurses' stations and a lot more risks than the sodas and coffee spills office users pose.The grand vision of health information technology is that electronic tools will help banish medical mistakes, boost the effectiveness and efficiency of clinicians, and make health care more accessible and convenient for patients.

Achieving that vision will require the solution of any number of strategic business, technological and legal issues.

But for hospitals struggling to move forward one baby step at a time, the potential of technology comes down to tactical nuts and bolts issues such as what kind of device clinicians will use to supervise and document care.

Office environments have engendered only a few physical layouts for workstations, largely because of the consistent presence of environmental variables like desks and chairs. Offices also lack the kind of extraordinary requirements often found in medical settings, such as the need to function in rooms that are sterile, or in which all the furniture is on wheels so it can be moved around daily to allow for various procedures.

Those requirements have bred a surfeit of options, even for the basic form factor of medical-IT devices.

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Some 20 vendors make tablet PCs—portable computers with touch screen technology—for example.

But besides tablets, which are designed to run on batteries while connecting via wireless networks, hospital IT groups also have the option of placing computers on futuristic carts that take up about as much space as a standing person. The tops hold a computer monitor and keyboard and can be adjusted to fit a clinician of almost any height, whether seated or standing. The bottoms hold long-lasting batteries and a wheel base so the machines will run through a whole shift, and to various beds or rooms in a hospital unit.

More convenient still are handheld units clinicians can carry in a pocket and update with a stylus.

Less dynamic, but often more stable layouts call for computer terminals to be scattered throughout nursing stations, hallways and patient rooms.

Decisions about form factor often rely on efficiency and efficacy, but just as often on their ability to work smoothly with a hospital's existing applications and networks.

Tablets and PC-like computers, for example, can support "thick client" software that relies on the tablet or PC to handle most of the computing load, and use networks only to trade data. "Thin clients," which are practically required on handheld devices but are often run on more powerful machines to simplify the maintenance of the software, present what is essentially a dumb terminal that serves only to pass information back and forth to the clinician's screen, while doing all the processing on a centralized server.

After the hardware is chosen, the IT and clinician team has to decide who gets their own devices, how many clinicians can share a device, and what types of mice and keyboards they should use to prevent theft and to keep infections from spreading throughout hospitals.

To figure out how IT executives make hardware choices within these complex environments, Ziff Davis Internet spoke with five decision-makers at four institutions, ranging from the CIO at one of the country's largest health networks with 27 hospitals to the director of IT at a hospital with 25 beds.

Sutter Health Network

The Sutter Health Network is made up of 25 hospitals along with dozens of other centers. Procedures and drugs administered at hospitals are checked at patients' bedsides using bar codes, and this requires computers in patients' rooms; the computers are generally on carts.

Next page: Wireless makes medicine easier.

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