The Science Journal of the American Association for Respiratory Care

2004 OPEN FORUM Abstracts

COST SAVINGS ASSOCIATED WITH CONVERSION FROM PORTABLE COMPUTERS TO DESKTOP COMPUTERS FOR ELECTRONIC CHARTING

Susan Rinaldo-Gallo, RRT, MEd, Janice J. Thalman, RRT, MHS, FAARC, Duke University Health System (DUHS), Durham, North Carolina

Background: Electronic patient care charting can be accomplished using a variety of devices such as: tablets, personal digital assistants (PDAs), laptop computers, or desktop computers. User acceptance of the charting device is crucial to success of the system. In October 2002, the RC Department converted from a RC Information System (RCIS), which had been used since 1995, to a different RCIS. At this time the method of electronic charting used by the Respiratory Care Practitioners (RCPs) changed from portable charting devices (Symbol 3000) on a wireless network to stationary desktop computers.

Method:
A variety of portable charting devices were demonstrated and evaluated by the staff. The following problems were identified: battery issues, difficulty viewing display screens, too large or too heavy to carry, not robust enough to hold the entire hospital census, and download and synchronizing delays. Management identified the cost and maintenance of mobile computers as a disadvantage. As a result, the decision was made to use desktop computers.

Results: Cost was significantly less. When using portable computers each RCP has a computer to chart in wherever they travel within the hospital. At DUHS this would require 23 mobile computers (maximum staff) plus 2 for back up. Each computer cost approximately $3,000. PDAs cost much less, but were unable to hold the entire hospital census and downloading or manual entry of new patient information would be necessary. Eight desktop computers were purchased for $2,000 each. One desktop computer was located on each floor of the hospital. The cost saving was $59,000. The initial training for the system was reduced by 50% since it was not necessary to learn a new computing device. We estimate that the training was reduced from 4 hours per staff member to 2 hours. With a staff of 80, that represents a reduction of 160 hours for our staff of 80 RCPs. This resulted in a saving of $3,360 (average rate of pay =$21.00 per hour). System maintenance time was reduced by five hours per week. There were no broken mobile devices, battery issues, data transmission problems and fewer trouble calls. These were previously the responsibility of a computer clerk. This resulted in a clerical staff saving of $3,900 per year. We experienced an increase in accuracy using desktop computers.This was due to quick and easy access to every patient in the hospital and immediate availability of newly admitted patients. As a result, patient billing records required fewer corrections and patient care revenue increased by approximately 25%. This also decreased the clerical time previously required to audit and correct patient billing records, which resulted in an additional clerical savings of 3 hours per week saving of $2,340 per year. Staff satisfaction also increased because the computers were quicker and more accurate and downloading or synchronizing was no longer necessary. An added benefit was the multiple uses of the desktop computers.The staff has easy access to hospital applications such as e- mail, policies, annual competencies, and the electronic medical record. When surveyed, 85% of the staff indicated they were more satisfied using the desktop computers.

Increases in the following: Reductions in the following:
Accuracy of data Training time
Billing and productivity capture Clerical time and cost
Staff satisfaction Capital expenditure
Access to multiple applications Supplies (i.e. Batteries)


Figure 1. Advantages realized by using desktop computers

Conclusion:
Converting from portable computers to desktop computers for electronic documentation resulted in significant cost savings, improved accuracy and billing and an increase employee satisfaction. The estimated cost saving for the first year was $130,960. In addition, we experienced a 25% increase in billing, which resulted in increased revenue.

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