Mental Health Provider Streamlines Incident Reporting with Tablet PCs

Customer Profile The Office of Mental Health (OMH) oversees New York State’s mental health system and directly operates 28 psychiatric centers, serving both inpatients and outpatients. Business Situation OMH wanted to improve clinical and administrative workflow processes by exploiting the benefits of mobile computing and wireless technology. Solution In a pilot project, the Tablet PC, running Microsoft® Windows® XP Tablet PC Edition, is streamlining the clinical risk management–incident process in psychiatric hospitals. Potential Benefits Streamlines the incident–reporting process Eliminates paper and the need to rekey data Enables anytime, anywhere access to OMH’s incident management and reporting system Enables electronic input of data as soon as it is collected Provides management with a current picture of incidents as they occur Software and Services Microsoft® Windows® XP Tablet PC Edition Microsoft Office XP Oracle 8i Microsoft Visual Studio® Microsoft Consulting Services Hardware Fujitsu Stylistic Series 4000 Tablet PC Cisco Aironet 350 Wireless LAN Adapter

The New York State Office of Mental Health is deploying Tablet PCs running Microsoft® Windows® XP Tablet PC Edition to clinical staff responsible for managing incident reporting and investigations. Instead of recording findings on paper to rekey later, clinicians and clinical risk managers can carry the Tablet PCs right into the examination room, or use them on the ward to gather information. Mobile access to OMH’s incident management and reporting system ensures that users efficiently and accurately collect incident findings and that incident information is saved as soon as it is collected.

Situation

New York State has a large, multifaceted mental health system that serves more than 500,000 individuals each year. The Office of Mental Health (OMH) operates 28 psychiatric centers across the state, serving both inpatients and outpatients. It also regulates, certifies, and oversees more than 2,500 programs that are operated by local governments and nonprofit agencies.

The Office of Mental Health has a complex and diverse computing infrastructure that must meet the information technology needs of dispersed hospitals, outpatient clinics, local patient providers, and a mobile workforce. OMH has a production wireless computing environment consisting of a mixture of 802.11 (primarily at the Central Office) and CDPD devices.

OMH is constantly reevaluating and piloting new technologies with the ultimate goal of improving patient care, and it strives to maintain a flexible infrastructure that easily accommodates new technologies. To that end, OMH had tested deploying personal digital assistants (PDAs) to field clinicians so they could download patient, clinical, and medical records. However, the agency quickly found that PDAs offered less functionality than it required.

When OMH heard about Tablet PCs running the Microsoft® Windows® XP Tablet PC Edition operating system, it decided to use the Tablet PC to evaluate the latest evolution of the notebook PC as a platform for mobile patient care applications. This time the agency would be working with Microsoft’s most advanced desktop operating system, plus additional features to enable pen–based computing in a lightweight "Slate Tablet PC" form factor that weighs less than three pounds. "The Tablet PC is not just a PDA replacement," says Mark Mitchell, Programmer, OMH. "It provides the full power and functionality of a regular business notebook PC that can be used on the ward, at the office, or at home."

The Office of Mental Health chose the clinical risk management–incident process for the RAP project. Historically, staff had followed a paper–based incident reporting process. Recently, OMH created a proprietary, Microsoft Visual Basic®–based application called the New York State Incident Management & Reporting SystemTM SM (NIMRSTM SM), to replace the paper–based process and to facilitate the reporting, tracking, and analysis of incidents that endanger the safety and well being of patients. However, the absence of a suitable mobile computing platform for the NIMRS application has meant that staff must still rely in part on paper recoding. "The Tablet PC project enables us to realize the paperless potential of NIMRS and opens possibilities for further development," says Jayne Van Bramer, Director of the Bureau of Quality Management.

Staff first record incidents on a paper form that is reviewed by several levels of staff before being entered into NIMRS. In conducting investigations of incidents, clinical risk managers rely on their handwritten notes, which are later typed into a document. "Typing data into a desktop computer while conducting an examination or interview would be intrusive to the process and is not practical. This plus the lack of wireless connectivity on the wards limited the mobility needed by staff to use NIMRS in the way it was intended–dynamically and in real time," says Cindy Sherwood–Judd, Mental Health Program Specialist.

Clinical risk managers, responsible for determining if a follow–up investigation is required, had also been using pen and paper during interviews and while taking statements from witnesses. Delays in getting the data into NIMRS meant that there were also delays in making that information available to other staff with appropriate security rights to access the data remotely.

Solution

The Office of Mental Health deployed the Fujitsu Stylistic Tablet PC to two user groups in a proof–of–concept project to assess the potential benefits of loading NIMRS onto a tool that nurses, clinicians, and clinical risk managers can carry and use anywhere on the OMH wards. The agency chose two wards in a juvenile facility and a ward for high–risk patients in an adult facility. "In order to take full advantage of the built–in wireless access and mobility of the Tablet PC, OMH set up these wards with 802.11b access points secured with Virtual Private Network encryption between the Tablet PCs and the wired, private network," says Mark Bilanski, Data Communications Specialist. "In addition, to boost the wireless connectivity range we installed Aironet 350 Wireless LAN Adapters."