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.
CIO John Hummel says the rise of wireless has provided the biggest boost to the project because rooms don't need to be specially wired. Not only is that inherently more convenient, he said, it frees up resources so IT can be more responsive to clinicians.
"We went from 'How are we going to get all these people on to the network?' to 'What's the most convenient for them?'" he said.
Sutter clinicians either carry devices from room to room or use more traditional machines on carts.
Which device they use depends on whether a clinician stays in a particular department or makes rounds throughout the hospital. "If a physician or nurse needs to walk around, we'll give them a tablet. If they're more stationary, we'll put them on the cart."
Computers on carts (both tablets and notebooks) are generally cheaper, said Hummel, largely because the tablets Sutter uses are ruggedized versions with a higher price tag than normal versions, a feature that lets them survive being carried on rounds. Though battery life is the biggest problem, the devices are usually good for one shift.
When Sutter began rolling out the bar coding initiative it used thick clients because they had better performance, said Hummel. Now, he's finding that thin clients can do the job. They are more convenient for IT and cost much less for repairs, he said.
"What we've done is started rolling out more and more of our Citrix thin clients, and we're also looking at Microsoft terminals." However, he added, not all best-of-breed vendors offer a thin-client option.
Hummel said that emergency rooms and operating rooms, where keyboards are likely to come into contact with body fluids, use specialized medical keyboards that can be rigorously protected.
Otherwise, computers are covered with plastic membranes and keyboards, and screens can be wiped down.
"You make sure that the device—no matter what it is—can be decontaminated." If there's a question, for a standard keyboard, you can throw it out. (People interviewed for this article estimated that in the volume they buy, they could buy five to eight standard keyboards for the price of one medical keyboard.)
Hummel said Sutter has used tablets from Dell, Hewlett-Packard and Toshiba, with the latter being the current "flavor of the week." Tablets with a swing top (a screen that spins around to reveal a touch keyboard) are more accepted by finicky staff than those that have the keyboard on the glass, he added.
Tablets have gone through a couple iterations at Sutter, and the technology continues to shift. In particular, Hummel thinks the use of BlackBerrys, with color screens and tiny keyboards, will become popular, though he admits the screen size needs to be larger.
And he's cast his eye further into the future as well. "My grandson was watching 'SpiderMan 2' on a Sony PlayStation2. The movie was stored on the device, and it was great color. The battery lasts for a long time, and it's cheap," he said. "If it's rugged enough for my grandkid, a nurse can't break it."
But he's not yet ready to write the purchase of hundreds of PlayStations into a corporate budget.
Russ Cucina is a clinical informatician and professor of medicine at the University of California San Francisco Medical Center. He is guiding technology adoption at two of the university's hospitals (with a total of about 700 beds).
The ideal situation, he said, would be to have a stationary computer at every doorway, with a real keyboard, a full-size mouse and a 17-inch screen. But limited space precludes that solution, especially at older hospitals with narrow hallways. Cucina said proposals to build computer cubbies in hallways were scuttled by fire codes and other regulations.
Cucina recommends COWs (computers on wheels). "Tablets have a lot of hidden problems," he said. Even a device that weighs only 2 pounds gets heavy when it must be carried around all the time, and he hasn't found any handwriting- or voice-recognition applications he thinks are ready for a hospital environment.