Protecting patient data and simplifying the daily workload while making use of IT opportunities – for medbo, these ideas are no contradiction but a reality.
There is good reason for the Medical Facilities of the Upper Palatinate District’s (medbo) Intensive Care Unit of the Neurological Rehabilitation Center to be comprehensively equipped with IT: Jürgen Schedlbauer, head of medbo’s Information and Communication Technology department, explains, “All patient beds are equipped with a computer, which is not only used for accessing electronic patient records (EPR) but also for tracking any data recorded by the respective monitoring devices.” For the purpose of saving space and maintaining the highest level of hygiene, medbo does not resort to the use of mobile trolleys. Schedlbauer says, “We frequently treat contagious patients. Unlike normal care units, in the ICU it is just not very practical to work with mobile trolleys. The risk of spreading pathogens is too high, especially for immunocompromised patients.”
One computer for each bed – a viable solution for the ICU
In consultation with the medbo hygiene specialists, the decision was therefore made to find a technically more complex solution. The advantage: continuous access to the patient’s electronic record directly at their bed. “We are fully digitalized,” Jürgen Schedlbauer says. “This makes daily work significantly easier, particularly for the staff working in the ICU.” Previously, complex data had to be transferred to a paper chart on a regular basis; today, monitoring devices regularly save vital sign trends and further crucial information in the electronic patient record. “Before patients can be transferred to the normal care unit, patients’ average length of stay in the ICU is approximately two months,” elaborates the IT lead. “This leads to vast data volumes.
“That is, however, still not all: such data volumes additionally need to be used to generate billing codes. i.s.h.med® simply generates such billing codes automatically in the background with medical documentation. All that is left to do for our physicians is to check such codes and sign the documentation, which reduces the administrative workload significantly. We have calculated that the documentation of vital signs progression and the generation of billing codes alone would require at least two nurses per year. Thanks to the newly introduced automated processes, nurses can now focus on the patient instead of worrying about administrative tasks.”
Quick changes of user and high standards of hygiene – a challenge for authentication concerns
Such an enhanced level of digitization with computers installed in the units is at the same time, however, quite challenging. “Patients in the ICU require the most intense care. They are not only looked after by nurses and physicians, but also by other professional groups, such as physiotherapists,” Jürgen Schedlbauer summarizes. Hence, computers had to be set up in such a way that users could be changed in a time-efficient and secure manner while also adhering to high standards of hygiene. “Generally, using a keyboard to log in by entering a username and password is not a major issue,” the IT expert admits. “Considering the rapid user changes, however, we were committed to providing a simpler way of proceeding for intensive care units.”
Against this backdrop, the implementation of a solution offered by Cerner’s partner Imprivata was decided upon. This solution allows for single sign-on by simply using access badges, which employees already have at hand. Jürgen Schedlbauer explains the approach: “Similar to other companies, our access badge is a smart card, which may be used for different purposes, such as paying meals in the cafeteria or accessing employee parking. In this light, it was an easy decision to also use the badge when logging into the computer.” The ICU is a small area, which may be monitored easily: access is restricted, and strangers attract immediate attention. Therefore, decision-makers opted for the implementation of single sign-on in agreement with the data protection officer. “Unlocking the computer is as easy as placing the badge in front of the reader. Two-factor authentication is not practical for the day-to-day operations of an ICU. Not only do hygienic factors play a role here, but also the fact that sometimes things have to be done very quickly.”
It may seem trivial at first, but these small details reduce the staff’s workload significantly. When a staff member logs into the computer at the patient bed, they automatically access the patient's electronic record. This is possible because the respective computers are linked to the patient bed. At the same time, data recorded by the monitors is transferred to the care unit room to allow for centralized monitoring.
Adjusted proceedings depending on the area of application
Not only do the ICU staff appreciate the simple log-in with Imprivata, the Neurological Rehabilitation Center’s remaining six care units are also using this solution. These units, however, require all 3,003 employees to enter their password prior to logging into the station computer or mobile trolley. “Firstly, the processes there aren’t quite as urgent and time-critical as in the ICU, and secondly, there are more frequent visitors. Even though the probability of an access badge falling into the wrong hands and someone trying to log into a computer without authorization is very low, we don't want to take any chances. Therefore, we have consulted our data protection officer as well as our security officer with respect to all workflows.” Even if a laptop was stolen, data protection would still be ensured. “All patient-related data is centrally stored on a server,” Schedlbauer says. “Additionally, all our data carriers are encrypted. Ultimately, the fully digital system that we have implemented here is safer than keeping files on paper, and yet much more convenient. This is also thanks to the Imprivata solution.”
Balancing data security and practicability while making use of innovative solutions
While paper records may not be encrypted, digital data can be protected against unauthorized unpredicted access. “Enabling authorized staff to access the electronic chart in a time-efficient and simple manner despite security requirements fosters acceptance in terms of digitization and facilitates the daily work,” Jürgen Schedlbauer points out. Imprivata’s authentication solution facilitates the challenge of balancing the duel high demands of security and easy access in daily routines; this is one of the reasons why decision makers at medbo envision the implementation of the system for other areas where staff are still required to enter their password. Perceiving digitization not solely as a means of simplifying processes involving data, Schedlbauer believes that such an implementation was only a logical step. “Our commitment to promoting comprehensive digitization will offer substantial opportunities. I am not only talking about spectacular projects. In fact, small details can sometimes make all the difference. In cooperation with Cerner, we have, for example, developed and implemented an application that enables staff working in the neurological rehabilitation unit to document admission and discharge of patients during rounds by simply using a tablet. Staff have come to love this application because there is no need for the bulky mobile trolley.”
These success stories encourage the IT expert to consider implementing further applications, also in terms of areas outside the hospital. “Currently, a project on the early detection of attention deficits in children and minors is being planned. The earlier these disorders are detected, the more patients can benefit from treatments. Being a specialist clinic for neurological and psychiatric illnesses, it is generally of crucial importance for us to consider factors going beyond our hospital to offer patients the best possible treatment,” Schedlbauer concludes. Using IT solutions to the best possible extent for the patient’s benefit and taking into account opportunities for innovation is a point of honor for Jürgen Schedlbauer and his colleagues.