9 min readPC/Mobile Computing in Lab Environments

As information technologies reshape the healthcare sector as a whole, hospitals have become more comfortable with accessing and sharing electronic information. Real-time access to information is very critical for an effective healthcare. It has been proven time and again that the most efficient means of information entry and access is offered by a combination of computing devices. It is acknowledged that wireless networks, which will aid point-of-care decision-making, information access and clinical data entry, are coming up steadily. The possible devices that can be used with laboratory solutions include tablet PCs, personal digital assistants (PDAs) and other multimedia enabled devices, such as barcode readers, while the technology includes Bluetooth and wireless local area networks (WLAN). These solutions are used for the acquisition and distribution of laboratory information within a clinical setting, which makes them even more attractive to modern healthcare workers. Tablet PC’s are well suited for examining room and bedside scenarios with their full-sized keyboards, large displays and larger form. A wireless device like a smart phone on the other hand is compact and provides immediacy and convenience in accessing the patient records at anytime and place.

Since the introduction of Personal Digital Assistants (PDAs) in 1990s, mobile computers are gaining an increasing popularity as point of care tools. Industries such as logistics have long before realized the benefits of using the internet and mobile computing and had set their industry standards, while the healthcare industry has begun to explore the fine flank of it.  Today, the potential for wireless healthcare technology demands to enable mobility in healthcare. When the market for other technologies in healthcare-IT has already matured, it is the precise time to forge ahead and accommodate wireless technology in hospital labs. Internet technology is reorienting the way healthcare organizations function. The open and scalable nature of Web-based technology and services allows for easy addition of applications, provided they are compatible with Internet protocols. RFID (radio frequency identification) is promising to have major impact on hospitals by easily getting tied into information systems. The use of RFID is currently being driven on the consumer side for automatic tracking and identification throughout distribution systems. RFID technology in the laboratory workflow is used for everything from patient tracking to lab specimen tracking.

MOBILE COMPUTING PROCESS

Source: Frost & Sullivan

Process of Mobile Computing: Simple yet Sophisticated
Mobile computing is not a singular technology, but a range of solutions that enable user the mobility and access of data anytime and anywhere. The three components of mobile computing are: handheld mobile centralized information system, computing device and connecting technology. The connecting technology allows the transfer of information between centralized information system and the mobile device and back. Once the information is entered into the handheld device, the data is transmitted to the sites information system. The data is most commonly transmitted through wireless local area network (WLAN), data syncing and wireless web or internet. Today, ‘convergence’ is bringing the technology of voice communication and data access under one surface is catching up, in spite of cost being a constraint. And so are the applications such as speech recognition, video conferencing, language translators, imaging, and location based services etc that are progressing.  It is very important for any mobile solution to meet the requirements of response time, data access and data security of the healthcare providers. Browser based computer application using the wireless LAN technology meets these requirements, and so has become the most preferred technology today. On the other hand, data synchronization and wireless LAN application has been having its complexities over the years. Commercial vendors’ notice that tablet PCs, handheld PCs and PDAs, which uses these technologies, also suffer.

Technology that Prevents the Promotion of Mediocrity
In view of laboratory environment in hospitals, the clinical laboratory is the busiest department and the information processed from this sector is critical for other departments to execute their operations. There is a persuasive value proposition in hospitals for putting in place any business process where the cost of a mistake in terms of time, patient safety and cost is unacceptably high yet easily preventable. Laboratory costs accounts for nearly 5%-7% of the total healthcare cost.  Issues such as not receiving the lab test results or a delay in receiving them is directly attributed to incomplete laboratory forms and results in poor patient care.  Placing the wrong label on a specimen leads to a lot of chaos. The errors committed by caregivers become more obvious as the medical industry is moving towards creating an integrated health delivery system and managed care. These medical errors can cause a massive deal of human catastrophe ranging from lack of efficacy to permanent disability and even death. Errors in the medical institutions mostly occur in medications, laboratory and the blood bank. In order to reduce the medical error rates and enforce procedures, mobile handheld computers are being deployed in hospitals today. In the case of a laboratory that uses mobile handheld computers, all the procedures are programmed into the mobile computers. So the chances for error are greatly reduced, as the laboratory will not accept samples that do not follow the procedure such as proper labelling. In any endeavour human errors occur in 3% to 5% of repetitive operations. Since there is no issue of getting stressed, tired or confused, the mobile handheld computers always follow procedure as per the programme. The medical technician who uses the software has an internal control by the institution and thus eliminates the possibility of committing errors. Moreover, with the computer to automatically verify the procedures that are followed, the common requirement of second medical practitioner check is avoided.

Positive patient verification and identification largely improves the efficiency of the caregivers. Thus the role of laboratory information system (LIS) is highly appreciated in healthcare. It is usually found in the inpatient setting and aids to order lab tests and view its result at the point of care. A laboratory information system is an information technology (IT) enabled laboratory module in hospitals and small clinics that organizes work-flow, processes medical test data and communicates with laboratory equipments such as an analyzer for specimen test execution, storing patients’ test data and therefore manages the overall laboratory operations. An LIS is composed of computer hardware, a configurable operating system, database manager and specific programme applications that meet the laboratory requirements. Many advanced technologies such as mobile technologies, web-based technology/services, Radio Frequency Identification (RFID) are enabling the high level of functionality demanded from modern LIS solutions. The procedure which is employed through bar coding, RFID solutions and mobile hand held computers allow the logical flow of the work carried out at the bedside. The system which interface to the LIS automatically integrates the data collected and so reduces the burden of rework, cut shorts personnel time and the cost for data entry, collects additional information, minimizes errors and thus improves the patient care.

Opportunities in the Middle of Difficulties
LIS market in Europe is detained under tight competition. A large majority of over 95% of the hospitals have installed LIS in Europe. Stipulation for a change towards mobile computing cannot be overlooked for the product success in terms of technology, product portfolio, market visibility and service differentiation in this saturated market. Although constraints of budget, competition and conservative mind set of lab administrators and physicians to adopt technically advanced laboratory solution prevails, advancements resume occurring in this industry. Healthcare organizations across Europe have their budgets pre-planned for specific activities. The major component in most hospitals budgets concentrates on the clinical side. Low budgets and spending priorities are major hindrance factors for the European mobile computing in laboratory market. There is an increase in the need for connectivity and data sharing due to the quality control measures and changing healthcare needs along with the public pressure. This gives a hope for the acceptance of mobile computing in the laboratories to a larger extend. A large number of hospitals in Europe are expected to change their obsolete laboratory systems over a couple of years. Considering mobile computing to be an advancement that is catching up in a flash, the revenue generation for this market largely depends on laboratory related consulting, licensing, maintenance and customer service during the LIS upgrades. Today the adoption of EMR is a growing trend in Europe. An EMR ideally aids in sending fast orders to laboratories by eliminating phone calls and paper-based orders. Once the laboratory tests are performed, the patient data quickly gets updated to the EMR. Apart from increasing the productivity, mobile computing technology aids in the quick processing of bills that leads to fast reimbursements. The LIS-EMR combination reduces maintenance costs, because data processing is automated and the need for middleware is eliminated.

Market Trends: Moving Ahead from the Predicament of Small Customer Base

Consolidation of hospitals is a general trend that has been happening in European healthcare. This reduces the customer base for the vendors of mobile computing market. The European market is overwhelmed with middleware utility in hospitals. In order to gain a larger customer base, the small-scale middleware manufacturing firms are acquired by larger companies. Vendors of hospital information system (HIS) are teaming up with the mobile computing vendors to deliver portable solutions for their wireless technology. With a change in the laboratory information delivery system sure to happen over the years, proviso for the integration facility of the new solutions with the existing ones increases. Though the PC / mobile computing applications have laid its mark in the medical laboratory environment, in most cases these applications are still not integrated in the overall business process. In such situations, the focus should not be restricted to the technical aspect; but should also be laid on its unmitigated applications. Apart from the reason of difficulties faced by the physicians and lab workers due to complexities of system interface with multiple options, another reason for laboratory workers’ disinterest in adopting mobile technology in laboratory is the extensive training required. Instead of spending extensive hours on training, laboratory operators prefer a user interface that is self explanatory and without multiple options. With a simple user interface, the operators could reduce the number of training hours.   User interface is the most important driver for any software application in healthcare. Success for mobile computing devices for the laboratories might be limited to a few vendors as its functions involves real-time interface with the existing order and result systems. A well designed application that meets the user needs on a larger scale and that which merges easily into the business process grasps the interest of the healthcare institutions more easily. Partnership with well-known traditional vendors and adding integrating tools to the solution would be a strategy towards success for the new vendors.

The European healthcare industry in terms of IT is not the part of the front runners for mobile computing. In contrast to the speedy overall improvement of healthcare in various fields, PC/mobile computing in healthcare IT is often not regarded as a priority. The fragmented nature of the healthcare market contributes to one of the major reasons for this. Laboratories are witnessing decentralization. This format of organization within a healthcare organization, including laboratories stems the challenge for the IT department’s activities to bring together a centralized control over its wireless and mobile devices decision. Decentralization within an institution has an impact on the source of funding for mobile computing equipments and infrastructure devices. Another generic scene that is watched today in the mobile computing in laboratory environment is the changing role of the laboratory employees in tune to the dynamic healthcare environment. In medical terms, there is a transition from phlebotomists to generalized caregivers. The guidelines which these caregivers have to adhere are strict, especially in terms of handling the incorrectly labelled specimens. Although these guidelines demands discrete designs of the equipments considering the interface issues and workflow, they are not as complicated as the guidelines for internet applications are. It is very important for critical medical services to have a ubiquitous and unified wireless coverage. User interface, which is a driver for the mobile computing market can also become a matter of concern. Due to the lacking indoor wireless coverage in retail settings and offices, it is seen that pockets of coverage and gaps between isolated networks prevails in today’s medical scenario.  This issue can be tackled by setting antennas which can provide a better access to data and communication facility of the devices throughout the hospital.

Bear Downs and Push Ups
Intense competition in the laboratory information systems market is likely to reduce the mobile computing cost by the vendors.  If the vendors seek to raise the price or even maintain the same price, they are likely to lose their clients to competitors. In order to introduce the new technology of mobile computing to the customers, it is very important for the vendors to satisfy their existing customers. Maintaining a harmonious relationship with hospitals is a crucial factor.  Hospital authorities has to be let known that mobile computing modules in laboratories offer better interoperability with other ancillary systems in the hospital, increase laboratory productivity and quality control, downsize full time employees (FTEs), reduce or eliminate errors caused in billing or in ordering new tests and provide better tracking. In short, hospitals are able to process the laboratory work flow more proficiently. It is seen that an increased work flow is directly proportional the hospital’s ROI.  It is very important for the vendors to convince the hospitals to rule out middle ware utility. Although the middleware is seen as a small investment that offers quick solutions, it requires complex interfaces that sometimes do not interact with a hospital’s existing LIS. Not only will this increase the maintenance cost for hospitals, but also the middleware is not scalable when the work flow increases for hospitals.

Resolution to Succeed through Strategies
Better patient service means, better access to information for the physicians, lab employees, nurses and medical support staffs. The mobile/ wireless devices connected to the clinical information systems provide real-time event notification to the healthcare workers. This access is provided by the technology of extensive data resources available across the hospital networks. Over time, the advancing technologies accepted in each department of the hospital are often unrelated to one another. Thus getting the right information at the right time and place has proven to be difficult. In the view of looking at the mobile technology remuneration in healthcare, the impact these tools would have on its users is often underestimated. It is the erudite lesson from the past experiences that the healthcare workers would resist to any change when a new technology confers its benefits along with major disruptions in the current practice. The vendors are thus finding it difficult to convince the clients to adapt to the new technology. To maintain the loyalty that the client holds with each vendor, focus should be laid on accelerating the response time for any inquiry raised by the hospitals. Meetings should be held at regular intervals with hospital management and laboratory administrators to address any issue and concern related to the mobile technology and also provide advanced notice on any major upgrades. Vendors should also organize specialized programmes that will require participation and feedback from hospital faculty, when developing major upgrades to the mobile computing devices.  Device decision is often made with a lesser range of customer specific options. It would be ideal to expand this range and become more customer specific. New customers often stress on what they would get on the current and added advantages such as expandability and special features. Having an answer for every question about compatibility, meeting the future needs, unique features, integration with legacy system, methods to maintain data security, data ownership, file distribution and synchronization at the tip of the solution and devices would help the vendors mesmerize the PC/mobile computing in laboratory market.

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