Going Mobile: Replacing COWs

OR Today Magazine | Cover Story | Going Mobile

The move to replace computers on wheels with tablets in the OR

by Don Sadler

Since Apple introduced the first iPad in 2010, tablet computers have become increasingly common. Many people have gone so far as replacing their laptop or desktop computers with tablets.

But is this practical in the operating room environment? Will tablets ever replace the computers on wheels (or COWs) that most surgeons and perioperative nurses rely on to track patient admissions and records as well as nursing and physician documentation?

OR Today Magazine | Cover Story | Going Mobile

Still In Its Infancy

The move to replace COWs with tablets in the OR is still in its infancy, notes Andrew Litt, M.D., Chief Medical Officer with Dell Healthcare and Life Sciences.

“Tablets are just now starting to make their way into the operating room, so we’re early in the adoption process,” says Litt.

Ken Jarvis, Director, Health & Life Sciences Industries, Americas Region at Hewlett-Packard, agrees.

“We’re not seeing a huge move toward tablets in the operating room yet,” Jarvis says. “Many hospitals have been preoccupied over the past year with the migration to Windows 7, and Windows 8 is coming up next.”

In addition, many hospital IT departments are still dealing with electronic medical record (EMR) implementation, Litt adds.

“This has been the big issue on their technology plate,” he says about EMRs.

Ensuring data security is another obstacle to the widespread adoption of tablets in the OR.

“This is especially true with surgeons bringing their own devices into the OR, which can introduce malware and other security breeches into the hospital’s IT system,” says Litt.

With the heavy focus at most hospitals on infection prevention, sterilizing tablets and keeping them sterile in the OR environment is another concern.

“Sterile casings need to be developed for tablets so they can be used in the sterile field and kept sterile,” Litt says.

And there is the challenge of a different workflow for data entry, Jarvis adds.

“There is a small minority of early adopters using tablets who can pinch and zoom to enter data, but most nurses still want to enter data on a full keyboard and see it on a 24-inch monitor,” he says.

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Potential Benefits of Tablets

Despite some limitations and drawbacks, Jarvis and Litt see incredible potential when it comes to using tablets in the OR.

“More hospitals are starting to look at where they can introduce mobile technology to improve patient engagement and streamline the workflow,” says Jarvis.

“I think the biggest advantage of tablets in the OR is the fact that they bring data closer to the patient,” says Litt. “COWs helped in this regard, but tablets take it several steps further. And many patients today, who use smartphones and tablets in their everyday lives, expect this kind of mobile technology from their healthcare facilities.”

Also, many ORs have space limitations.

“There’s more and more technology that needs to fit into the OR, but many ORs

just aren’t built for all of it,” Litt says. “Tablets offer an opportunity to make ORs much more efficient.”

In an interview with TabTimes, Dr. Felasfa M. Wodajo, MD, an assistant professor of orthopedic surgery at the Virginia Commonwealth University School of Medicine’s Inova Campus and Georgetown University Hospital, described several different ways he uses an iPad in the operating room.

“For me, the most important use in the operating room is for reviewing imaging studies,” he stated in the interview. “Traditionally you look at a CD-ROM at a PC workstation, and once you are scrubbed you can’t easily go back and change the images. With the iPad you can continually change which slices you look at wherever you are.”

Wodajo also transfers photos he has taken with a digital camera during surgery to his iPad so he can share them with the patient’s family and friends in the waiting room. He believes that surgeons are just scratching the surface of the potential of using tablets in the OR. In particular, he is interested in the possibility of using the iPad’s built-in sensors, like the accelerometer and gyroscope, to create new assistive surgical tools.

In an interview with The SmartVan, Daniel Schwartz, the medical director at QxMD, a software company that creates mobile apps for medical professionals, described another practical use of tablets in the OR: for documenting the surgical safety checklist.

“We have actually implemented the checklist into a full-featured tool so that people can actually run through the checklist and track it electronically as they are in the operating room,” Schwartz stated in the interview. “This is a really practical example about how we hope people will use these tools at the point of care to improve patient outcomes. The whole idea of having it on a tablet device is that the number of these tools is increasing exponentially.”

“The surgical checklist is the perfect place to bring an IT, rather than a manual, approach to standardized procedures,” adds Litt. “This is an opportunity for tablets in the OR that hasn’t been widely explored yet.”

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Cultural and Workflow Changes

The move away from COWs to tablets in the OR is about much more than just devices or software — it’s about cultural and workflow changes, says Litt.

“It will require a different way of thinking on the part of all OR personnel,” he explains.

Jarvis suggests that hospitals develop an overall mobility strategy that details how mobile devices like tablets will be used to optimize the OR environment.

“This involves determining how tablets will be used to improve productivity, efficiency and patient engagement. Hospitals need to decide where, when, why and how they will use mobile technology,” he says.

Christine Kennedy RN, BSN, MA,CNOR, the Nursing Informatics Coordinator with Lawrence and Memorial Hospital in New London, Conn., suggests that a good first step for OR personnel considering transitioning from COWs to tablets is to ask their IT or IS department to request that a vendor bring some tablets in to try them out.

“This will answer a lot of questions right out of the gate, and you won’t have to play a guessing game,” says Kennedy. “In addition, IT and IS will be familiar with all the factors that will come into play in choosing a device, like ergonomics, the weight of the device, how it will be carried around, how it will be cleaned, etc.”

Two tablets that are currently being used in the OR environment are the HP EliteBook Revolve and the Dell Venue 11 Pro tablets. According to Jarvis, the HP EliteBook Revolve allows surgeons and OR nurses to access, collect and verify information immediately.

“This helps improve the accuracy of patient records and the overall patient experience,” Jarvis says.

Meanwhile, the Dell Venue 11 Pro’s enhanced security features — including multi-factor biometric access authentication, like smartcard and fingerprint readers — meet stringent HIPPA compliance standards.

“This gives OR staff the peace of mind to easily enforce and adhere to some of the most rigorous security regulations,” says Litt.

In an interview with OR Manager, Dr. Keley John Booth, MD, predicted that tablets and smartphones will start to replace COWs and even WOWs (or wireless computers on wheels).

“Tablet devices are going to allow us to do everything a WOW can do on a lightweight platform,” he said in the interview. “We are going to see leaps to the point where mobile technology becomes a mainstay.”


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