Arkansas Children’s Hospital is the only pediatric medical center in Arkansas and one of the largest in the United States. The hospital wanted to upgrade its patient bedside media system, but the in-room systems it considered were costly and inflexible. Instead, the hospital designed its own system based on Windows® XP Media Center Edition 2005 and Xbox 360™. The new system not only provides entertainment and Internet connectivity, but it also delivers educational material to patients and families and lets staff access electronic medical records at the bedside. Now, patients and families are better connected to their lives outside the hospital, are more informed about their care, and enjoy better entertainment options. Plus, staff satisfaction is higher. Additionally, the hospital spent nearly U.S.$1 million less to implement this system than it would have spent on other systems.
At Arkansas Children’s Hospital in Little Rock, Arkansas—a premier pediatric teaching hospital with a worldwide reputation for medical breakthroughs—bringing the cutting edge of communication, education, and entertainment technologies to children and their families is a top priority. The hospital has seen firsthand how easy access to educational materials, e-mail, chat, movies, music, and video games can contribute to the well-being of both patients and their families.
For families who haven’t experienced it, it’s difficult to understand how isolating an event a prolonged hospital stay can be for a child. Because Arkansas Children’s Hospital is the only children’s hospital in the state of Arkansas, patients often travel several hours for hospitalization—leaving friends, families, and schools behind. “For these young people, being removed from everyday contact with peers and families is a great challenge,” says Penny Ward, RN, Adolescent Unit Nursing Director at Arkansas Children’s Hospital. “The phone can help only so much. Adolescents are completely ‘hooked up’—to the Internet, to gaming, to their schools. We need to meet those needs because a two-week stay is an eternity for an adolescent.”
||Our goal is to extend the hospital’s IT infrastructure out to the patient bedside. The capabilities are limitless, and the long-term benefit is the tremendous improvement CarePoint can make in patient care.
Chief Information Technology Officer, Arkansas Children’s Hospital
Patient rooms were equipped with a television, a bedside monitor, and a nurse call system; several gaming systems and computers were shared among the rooms. When a patient or family member requested a gaming system or a computer, a nurse had to find one that wasn’t in use, check it out to the patient, and roll it into the room on a cart. Because of the limited supply, patients often had to wait hours for the equipment and were allowed only one hour of use at a time.
The Adolescent Unit at the Arkansas Children’s Hospital includes the cystic fibrosis wing. Patients with cystic fibrosis are isolated from other patients because of the potential for fatal cross-infection. Consequently, one of the biggest difficulties with the shared gaming and computer systems was compliance with infection control. Each piece of electronic equipment—including monitors, keyboards, and handheld controllers—had to be disinfected each time it was moved from one patient’s room to another. “This is not just a quick wipe,” says Ward. “In our unit, where cross-infection of one resistant organism from one patient to another can be fatal, the equipment must be thoroughly cleaned.”
Providing Internet access for families—who needed it to stay connected to their jobs or to research information about their child’s condition—was also difficult. Often, parents had to leave the child’s room to obtain an Internet connection. “Parents don’t want to leave the child’s bedside to explore more information about the child’s diagnosis and care, and what they can do to help,” says Gloriane Kabat, CCLS, Director of the Child Life and Education Department at Arkansas Children’s Hospital. Additionally, there was a great need for children—and often family members—to use the Internet to keep up with schoolwork.
“A TV bolted to the ceiling was the extent of the entertainment choices in the hospital,” says Chris Smith, MD, Associate Medical Director at Arkansas Children’s Hospital. “We wanted to provide patients and families with better choices, as well as make the Internet more accessible during their hospitalization. We weren’t happy with what we had. We knew there was something better out there.”
In 2005, the hospital’s Education Council—composed of representatives from the hospital’s Child Life and Education, Community Outreach Programs, and Volunteer Services departments, as well as members of the hospital’s medical staff and patients’ families—formed a committee to evaluate the available in-room media systems. Most of these systems, similar to those found in hotel rooms, were TV-based; provided only limited gaming and limited tools for parents or nursing staff to use to enforce curfews or regulate content; and would not integrate with the external patient and family Web portal that the hospital planned to develop. Furthermore, these systems required per-bed, per-day licensing fees that would increase as the hospital added new systems. “We explored a number of possibilities,” Smith says. “But when we looked at the amount of money we would have to invest in those systems, compared to what we would get from them, it was obvious we had to go a different direction.”
|Figure 1. Patient viewing an educational video|
The committee teamed with the hospital’s IT department, headed by David Higginson, Chief Information Technology Officer at Arkansas Children’s Hospital, to explore the possibility of developing its own bedside system. That’s when the ideas started flowing. The team decided on a bedside gaming and Internet access system made up of the Windows® XP Media Center Edition 2005 operating system, which provides an all-in-one, PC-based entertainment system, and the Xbox 360™ video game and entertainment system.
Patient Education a Top Priority
But the team also brainstormed about other features and services that they wanted the system to provide. As a result of the brain-storming, making use of the new bedside system to improve patient and family education emerged as a top priority. At the hospital, patients and families often viewed educational videos on topics such as diabetes care training. The hospital had a limited number of copies of each video, and like the gaming systems and computers, the videos had to be checked out to patients for viewing and a TV and videocassette player had to be rolled into the patient’s room on a cart. “We referred to the new system as communication, education, and entertainment,” says Smith. “In addition to entertainment, we wanted parents and kids to be able to communicate outside their rooms with this system, and we wanted to use it to deliver patient education.”
||When we compared the costs, we saw that using Microsoft technologies would be less expensive than any of the other systems and would provide us with the best options for improving patient care.
||Chris Smith, MD
Associate Medical Director, Arkansas Children’s Hospital
Smith also saw the new system as an opportunity to give doctors bedside access to patient information stored in the hospital’s third-party healthcare information system, Meditech.
The team decided that with Microsoft® technologies, they could develop an integrated entertainment, communication, and education system—one that would also interoperate with the hospital’s healthcare information system. “We wanted to be able to connect doctors and patients to the electronic ‘consciousness’ of the hospital, at the bedside,” says Higginson. The new system not only would enable the hospital to deliver a wider breadth of digital content, but also would be highly scalable. Adding new features and new systems would require only the costs of development or the purchase of new hardware components—no new licensing fees.
CarePoint—Enabling Communication, Education, Entertainment
In early 2006, the team received funding to conduct a one-year pilot of a custom-developed bedside entertainment and education system. With input from a family advisory board and Ward’s nursing staff, the team worked together to design the system. Higginson’s IT staff completed development of the first phase of the new system, named CarePoint, in November 2006 and installed it in 14 rooms in Ward’s unit.
The CarePoint system includes:
- A Shuttle G2 computer running Windows XP Media Center Edition 2005
- A 15-inch touch-screen monitor
- An Xbox 360 System with Media Center Extender technology
- A 32-inch liquid crystal display (LCD) screen
The computer is installed out of sight in the wall behind the headboard of the hospital bed and is connected to the touch-screen monitor, which is attached to a swing arm mounted to the headboard. The computer is also connected, over the hospital’s IT network, to the Xbox 360 system, which is mounted below and connected to a 32-inch LCD screen. The patient can access TV, music, photos, movies, and other content through the Xbox 360 System and view them on the LCD screen on the wall in front of the hospital bed.
Compliance with infection control was critically important in the design of the CarePoint system because each bedside system needs to be sterilized before a new patient is moved into a room. Therefore, Higginson’s staff selected components with minimal cracks and crevices so that they are easy to wipe clean. Specifically, the IT staff replaced traditional keyboards with silicon, “keyless” keyboards and developed their own control system, which uses the 15-inch touch screen instead of a standard handheld, button-driven, remote-control device.
The IT staff created this control system using the Microsoft Visual Studio® 2005 Team Edition for Software Developers development system and a third-party infrared (IR) remote-control technology from IR Blaster. When the user presses a button on the touch screen, a command is sent to the computer, which then sends an IR signal to a device that sits on top of the 32-inch LCD screen, which in turn sends the signal to the Xbox 360 System. The touch screen enables the user to access TV programs, movies on demand, games, and music; open a Web browser; start a chat session; or send e-mail.
The digital content of the system, including movies, music, and educational videos, is stored in a Microsoft SQL Server™ 2005–based database. In the time it takes for a patient to enter the room after check-in, the system retrieves patient information—such as age and sex—and automatically downloads appropriate content to the room. “It’s a highly individualized experience,” says Higginson.
|Figure 2. Patient navigating educational content on CarePoint|
Nurses have full control over each bedside system. From a computer at the nurse’s station, system components can be turned on or off—most commonly for the purpose of imposing a gaming curfew. “If kids are up all night playing video games, they aren’t up at 9 A.M. doing their therapy,” says Kabat.
For doctors, once they swipe their identification badge through a card reader to verify their credentials, the CarePoint system provides bedside access to patient records stored in Meditech, such as lab results and x ray or digital radiology images. CarePoint also displays these lab results and images on the 15-inch touch screen for the patient’s viewing. Higginson’s staff used Visual Studio 2005 Team Foundation Server to connect the CarePoint system to Meditech.
Higginson’s team is finishing development of the next phase of CarePoint, a Web portal developed using Microsoft ASP.NET. The portal will allow family members and friends to interact with the patient from outside the hospital. “We wanted to reach out to those people who are not in the room—the other parent at work, or an aunt several states away—with what’s going on in the hospital,” says Higginson. Through the portal, users will be able to share pictures and music files or conduct chat sessions. “And it includes parental controls!” adds Higginson. The portal will also allow patients and their families to watch educational videos and sign up for the hospital’s education curriculum from home.
In May 2007, the hospital approved the team’s request to install the CarePoint bedside entertainment system hospital-wide. Higginson plans to have installed 250 of the systems by September 2007, including all inpatient rooms and several long-stay clinics such as hematology and oncology.
“Our goal is to extend the hospital’s IT infrastructure out to the patient bedside. The capabilities are limitless, and the long-term benefit is the tremendous improvement CarePoint can make in patient care,” says Higginson.
With the CarePoint system, Arkansas Children’s Hospital is able to more easily and effectively deliver educational materials and provide a more positive experience for patients. It has also improved staff satisfaction—all at a lower cost and with more flexibility than could have been achieved with other systems.
Enhanced Patient and Family Education
CarePoint helps Arkansas Children’s Hospital better promote patient education both during and after the patient’s hospital stay. For example, during the pilot, patients with diabetes were able to view a series of educational videos on demand instead of waiting to check out the hospital’s copy of the video from the nurses’ station. Because CarePoint tracks patient viewing of educational videos, the hospital can see who is viewing the videos and how many times they are viewed. Tracking conducted during the pilot demonstrated a significant rise in patient viewings, and the hospital is currently converting its entire library of training materials to digital format so that they can be made accessible through CarePoint. Higginson also plans to add follow-up viewer comprehension testing—in the form of a Web-based questionnaire—to the videos so that hospital staff can evaluate the effectiveness of these educational experiences.
Comprehension testing is just one aspect of a broader patient education curriculum in which each patient will eventually participate. The external CarePoint portal will also give patients and their caregivers access to educational materials pertaining to their diagnoses and care, without leaving home. “The external portal will be a huge extension to our education plan,” says Ward. “There is great support for patients while they are hospitalized, but they can take only written material home. Access to education from home will be very valuable because needed information can be shared with others, such as the babysitter or next-door neighbor, so that they have the same knowledge base with which to take care of these kids.”
Better Entertainment and Support for Patients
Digital TV, movies, music, gaming, and Internet options accessible through CarePoint help keep patients entertained during long hospital stays. “CarePoint has really changed how kids view their hospitalization—a huge change for the positive,” says Ward.
||CarePoint has really changed how kids view their hospitalization—a huge change for the positive.
||Penny Ward, RN
Adolescent Unit Nursing Director, Arkansas Children’s Hospital
One patient says, “It [CarePoint] made it so much more enjoyable. Let’s face it; the hospital is not as fun as a five-star hotel! It made the hospital seem less boring.”
CarePoint also provides communication technologies that help patients feel less isolated by connecting them to a network of other patients with similar diagnoses. “With CarePoint, patients can chat with other patients in their unit, allowing a newly diagnosed patient to chat with others about their disease and, in essence, forming a mini-support group,” says Higginson.
In the hospital’s cystic fibrosis unit, where patients are separated due to the potential for fatal cross-infection, this kind of communication is particularly important. “To be able to allow patients to interact, but not face-to-face, has been a real challenge,” says Ward. “This system has helped us make significant progress in bridging the gap between isolated patients.”
Stronger Connection to the Outside World
With CarePoint, patients and family members can easily access the Internet from their room, helping them stay connected to their lives outside the hospital—including family, friends, work, and school. “With CarePoint, the patients and even the parents have been able to keep up with their schoolwork. One parent completed a college course online, from the hospital,” says Kabat.
Once it is completed, the external CarePoint Web portal will enable patients and family to interact with their friends outside the hospital through pictures, messages, video, and chat. The portal will also allow external users to order items from the hospital’s gift shop or make a donation to the Arkansas Children’s Hospital Foundation.
|Figure 3. CarePoint education and entertainment system|
Improved Staff Satisfaction
CarePoint helps patients be more self-sufficient in satisfying their entertainment needs, freeing staff to focus on the patient’s medical needs. “Now, patients don’t need a nurse to bring in new videotapes. They don’t need a nurse to bring in the laptop so they can send e-mail to their friends. Staff satisfaction has increased because nurses can now focus on the patient’s medical needs—which is what they want to do. In the midst of a national nursing shortage, job satisfaction is key,” says Ward.
In addition, nurses in Ward’s unit no longer spend hours each day cleaning equipment. Ward says, “We no longer transfer equipment from room to room many times a day. Cleaning each piece of equipment could take 10 minutes or more. It doesn’t take long before that begins to detract from nursing time.”
Doctors also enjoy the ability to pull up records at the bedside instead of having to get the records from their work area before going to the patient’s room. Ward explains, “Young patients are very visually oriented. When you’re talking to adolescents and can pull up a picture of their lungs right there, it has a very great impact.” She says that this immediacy has had a significant effect on doctors’ ability to communicate with patients and encourage them to be involved in their own care.
Lower Cost, More Flexibility
Before developing the CarePoint system, the Arkansas Children’s Hospital evaluated several third-party systems. After comparing the projected costs of the systems over a seven-year period, the hospital determined that it could develop, implement, and maintain CarePoint for less than U.S.$2 million—which included the salaries of two full-time IT staff members to administer the system. The other systems would have cost between $2.7 million and $3.34 million. “With the other systems, we would be restricted to the hardware they provided. With our custom-developed system, we can choose affordable hardware, independent of the software solution. This resulted in a huge savings,” says Higginson.
||Staff satisfaction has increased because nurses can now focus on the patient’s medical needs—which is what they want to do. In the midst of a national nursing shortage, job satisfaction is key.
||Penny Ward, RN
Adolescent Unit Nursing Director, Arkansas Children’s Hospital
Aside from lower initial development costs, CarePoint offers the hospital advantages for future customizations to the system and additional flexibility. With the other systems, adding new custom features, such as those that provide patient education, would mean incurring additional per-day and per-room licensing fees. Even then, the vendor could choose not to develop the requested features. The hospital would have essentially been limited to features and programming offered by the vendors of those systems. “CarePoint gives us a great deal of flexibility and control. Using Microsoft technologies, we can develop and add the features we want, without the added licensing fees,” says Higginson.
Smith agrees and says that CarePoint has met the organization’s unique needs “and also integrates with our Meditech system. When we compared the costs, we saw that using Microsoft technologies would be less expensive than any of the other systems and would provide us with the best options for improving patient care.”
Higginson adds, “It’s very rare that IT gets the opportunity to make a direct impact on the quality of life for our patients—and have so much fun doing it.”
Microsoft Solutions for the Healthcare Industry
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For more information about Microsoft solutions for the healthcare industry, go to:
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