“Less running around, less paperwork, more time for patients,” is how nurse Solveig Elbinger summarizes the advantages of the mobile computers that she and her colleagues in Ward Seven of the University Clinic in Jena have been using for the past few weeks to carry out the bulk of their documentation and administrative work. The small, portable computers together with SAP’s Mobile Healthcare solution form a mobile workstation, which the clinic implemented at the beginning of October 2002 in the accident surgery unit. Since then, the 24 nurses are rarely to be seen at the PC in the ward office. Previously, the nursing staff had to fill out up to twelve forms per shift; today most of the information can be entered on the mobile computer – in real time, and, if necessary, directly at the patient’s bedside. This is not only easy and time-saving, it also increases the accuracy of the information, because with the new settlement system based on diagnosis related groups (DRGs), which comes into force in Germany in 2004, the hospital will reap the rewards of the exact proof of services in hard cash. The same goes for the documentation of secondary diagnoses which affect the categorization of care: if they are not documented, the hospital loses out on income.
With the help of text modules and selection fields with checkboxes, nurse Solveig and her colleagues can enter all the care services they provide on the PDAs. In the underlying SAP System for patient data management, which the mobile devices communication with using a wireless local area network (WLAN), the data is then processed further – for example for billing to the health insurance companies. In addition, the system categorizes the care in accordance with the nursing staff rules (PPR). However, the portable computers are not just used for documentation tasks. The mobile workstation also provides an overview of the most important data for each patient – master data, admission, diagnosis, risk factors – and an overview of beds occupied and the expected and planned discharge dates for patients across the whole ward. Thanks to the connection to the central patient data management system, patients can be moved to other wards across the whole hospital.
Data processing is carried out in the background system
The main difference between SAP’s solution and those of other providers is that the mobile device is connected with the central patient data management system online via the WLAN. While SAP also offers offline scenarios with periodic data synchronization, the online variant has been shown to offer a series of clear advantages at the Jena clinic. For IT manager Dr. Jürgen Garschke, the decision was easy: “Data is only ever completely up-to-date in an online system. As up to 50 percent of patients may be moved to other treatment areas during the morning visits between 7 a.m. and 10 a.m., it is extremely important for us that the data is up-to-date. Data synchronization carried out at long intervals would inevitably lead to collisions in the documentation process.” The online solution has another distinct advantage, however, namely that no special software needs to be installed on the mobile device. Only a web browser is required alongside the operating system and Internet access. The PDA is the input and output medium; the actual data processing takes place in the background system. Basically, the mobile computer has the same functions, data models, and authorization concepts as the stationary PC.
In principle, it is a smaller, streamlined – that is, tailored to the role of the nursing staff – version of the stationary workplace. The solution is therefore not restricted to a certain type of device. As long as the operating system is Windows CE or Pocket PC 2002, any computer can be used, from an organizer right through to a webpad. In addition, the solution is easy to maintain, as no special application software needs to be installed. It is user-friendly, as most of the processes are the same as those on the SAP System in use. The approach also offers security advantages, as no sensitive data is stored on the mobile devices. As soon as the user logs off or exits the reception area of the WLAN, the computer is “empty.” During radio transmission, the data is naturally encrypted.
Once the basic functionality is up and running, various enhancements are planned in the form of add-ons. For example, in future, users will be able to call up shift plans, lists of medicines, and findings, or order materials. This is made possible through the typical SAP usage of open Internet standards. The only requirement for connecting up additional services is that the information is web-enabled and adjusted to the PDA format. At a later stage, doctors shall be given a similar, compatible system. It is another step on the route to electronic patient records, a route that the clinic is systematically following, particularly with the startup of the new building at the University Clinic, Jena, which will commence operation in April 2003, and is to be fully fitted out with a WLAN infrastructure.