Evolution of the Clinical Workstation
My wife and I just bought a new car this past weekend. It is a hybrid and I never thought I would say it, but this new technology is way cool! I love watching the energy UI on the little computer screen of the car as it shows me how the gas and electric engines share responsibility as I brake and accelerate. I feel like I am driving the car of the future each time I go out to do errands and this is before I even think of the car's Bluetooth technology.
This got me thinking about how technology will impact the clinical workstation of the future. What I mean by clinical workstation is the "point of access" where any clinician gets a guaranteed response time to all the applications they need to do their jobs effectively. As I visit and speak to hospitals I hear about two different kinds of clinical workstations. The one is a very well defined and locked down computer that has been fully loaded with all the applications that the clinicians use. It is a true "thick client" making extensive use of local computer processing power. Hospitals often create a local program or menu to give streamlined access to these different applications. The data that these applications use is stored on a common file share so that all clinical workstations can access the same, current patient data. The other type of clinical workstation is a standard computer that can simply access the network and run a web browser. All applications are served up as web pages with little or no local computer processing - the true "thin client". Very often these hospitals have also created a common web front end, an intranet website or clinical portal, to provide directed and easy access to the various web applications.
I have also noticed another trend. More and more hospitals are adding common components to their clinical workstations to enhance functionality and ensure privacy. We see screensavers that log the user out after a defined time and require reauthentication (often deployed at kiosk-style clinical workstations). We also see components that allow two or more independent applications to automatically show different data (e.g. labs and X-rays) for the same patient (common patient context) significantly reducing keystrokes and time for the clinician.
The need for clinical workstations is about to increase dramatically as RHIOs take hold over the next three to five years. Today's RHIOs are focusing on the centralized access to different data sources for the same patient. Ultimately, this data will need to be served up in an acceptable way to every clinician and this is going to require a new approach to clinical workstations that can easily access all the RHIO data though common record locator services. Some people are already referring to this as the "last mile" of the RHIO. I predict that the world of clinical workstations will change over the next few years. We are going to need a clinical workstation somewhere between the thick client and the thin client clinical workstations of today. We will need something more akin to the concept of a "smart client" clinical workstation. This station should come preloaded with many of the common clinical components that clinical applications need to use. Good examples of these common healthcare components are access to the RHIO record locator service, ability to share context and common clinical authentication. They could also provide components that support best UI practices like where to locate key information on the screen and UI components that make the views between applications consistent. One thing that the smart client clinical workstation can do is combine local computer processing and networked processing in an intelligent way to improve response times. That is what gets me thinking about clinical workstations when I drive my new hybrid car. Perhaps the way to think of the clinical workstation of the future is as the Hybrid Clinical Workstation. I look forward to your comments on this and other topics.
Dr Bill Crounse is back today. I trust he had a good vacation and I wish him and all of you a very Happy New Year and a prosperous 2006. I have really enjoyed being a guest blogger on the Healthcare Blog. Thank you for bearing with me and I would welcome the opportunity to blog with you again in the future.
Clifford Goldsmith, M.D., US Director, Provider Industry, Microsoft Healthcare and Life Sciences