Bedside computing chugs along on a shoestring budget

The push for a paperless healthcare environment, including bedside computing, has collided with the stigma of expense, especially for smaller institutions. The experience of one small hospital may ease this conflict, however.

Pioneers Memorial Healthcare District (PMHD), a 99-bed center in the desert town of Brawley, CA, recently implemented a complete bedside computing system on a hardware budget of $38,000, according to Douglas Darby, director of IS.

With a return on investment of less than one year, PMHD's system is already helping to reduce lost charges and increase revenue for the hospital, Darby said.

"In its first year, bedside computing was partially responsible for the capture of an additional 12% in patient revenue that was lost due to lack of documentation, failure to post charges, and incomplete billing," he said.

PMHD was able to keep its costs down by self-sourcing equipment and materials and using in-house IT staff for training. It now has bedside computing wired to patient rooms and point-of-delivery monitors throughout the facility.

"The new system has resulted in greater access to patient data, standardized and improved documentation, increased revenue capture, and enhanced patient care, while providing a new level of data access for all PMHD clinicians," Darby said.

Prior to bedside computing, PMHD's solution was standard paper-based patient charting, fraught with limitations:

?Only one person could access the chart at a time to record and review data and develop treatment plans
?Access to the chart was limited to the patient's room or the nurse's station, so clinicians could not check files remotely to review progress or anticipate the next step
?Sometimes information was not entered on the chart immediately, creating potential for inaccurate or forgotten data and affecting patient care and administrative processes such as scheduling and billing
?Analysis of handwritten data was cumbersome
?Sharing information with remote specialists or other facilities for a patient consultation required time-consuming, manual transfer of files via copying and mailing/faxing charts

The PMHD system consists of over 400 nodes including computers in patient rooms, nursing stations, and clinical areas. The transition to bedside documentation required a reengineering of certain procedures. Nurses now use the computer to document all orders, results, notes, and any other information previously put in a patient's paper chart, Darby said. They were encouraged to incorporate the computer into their patient care process as well. Nurses now enter vital signs directly into the computer as they are taken, instead of waiting until after leaving the patient's room.