Saving Mouse Clicks and Keystrokes
Written by William E. Sorrells
The value of roaming sessions in an AHLTA environment.
by William E. Sorrells, Captain,
USAF, MSC, FACHE, CPHIMS
Recently I had a medical appointment in our family practice clinic. As I sat there on the exam table, I closely watched the medical technician perform her work. She worked like an Indy pit crew. No wasted motion, no wasted effort. She quickly and efficiently took my vitals, asked me numerous questions using a standard AHLTA template, and captured all relevant information concerning my ailment…all in four minutes. Some would say it’s not possible to do all the above in four minutes considering the time it takes just to log on/off a computer and log into/out of AHLTA in a typical military treatment facility. But at the 3rd Medical Group at Elmendorf AFB, Alaska, things are definitely different.
In August of 2007, the 3rd Medical Group, along with sponsorship and assistance from the Office of the Command Surgeon-Pacific Air Forces and Accelera Solutions, deployed Citrix hardware and software to provide a “roaming sessions” environment for several key medical applications. The roaming session feature allows users to keep the same active sessions when they move from one client device to another client device. This allows a session to follow its user regardless of the actual physical location of the client device. In other words, the session roams with the user. This feature allows users to keep one single session running all day long, even when they move from one PC to another. For example, instead of logging into AHLTA for every scheduled appointment, a provider logs in once and accesses their single session many times throughout the day. The idea was to give providers, nurses and medical technicians more time with the patient by reducing the time spent logging into medical applications. Less than a year later, the benefits of a roaming session environment continue to add tremendous value.
Going back to my appointment, I asked the medical technician how long she had been here and what she thought of the Citrix roaming sessions in the family practice setting. She smiled and said she arrived a few months earlier and couldn’t believe the rest of the Air Force wasn’t using this technology. Important to her was the ability to have the relevant medical information available when she needs it and where she needs it without having to go through a gauntlet of logging on and off a computer (and AHLTA), and without having to wait for AHLTA to load.
Before implementing the roaming session solution, it was taking an average of 2.5 minutes to get ready for the patient encounter (due to network and application log-in). In many cases, this delay forced medical technicians to take notes on paper, hoping to document them later in AHLTA. Often times the provider was ready to proceed with the appointment, but the medical technician had not finished their work due to log in/out delays. This created a frustrating situation for the care team. With roaming session now implemented, it takes 30 seconds to access the network, with AHLTA immediately available, right where the provider or technician left off. Two minutes make not sound like much, but when you have 18 providers seeing 20 patients per day, that is 2,880 hours per year the clinicians aren’t waiting for medical applications to load.
When the provider came into the exam room for my appointment, I made it a point to watch her work even closer. In this case, it was a contract provider hired to augment our existing staff. After a brief salutation, she went to work immediately. In went her CAC. She punched in her pin, and within 30 seconds my encounter was up automatically in AHLTA with the latest information input by the medical technician only minutes earlier. The provider asked me a few questions while looking over the previous history of my ailment and gave me a course of action including a new prescription. She typed a few keystrokes, and before I left she was finished with the encounter. I asked her later what she thought of roaming sessions, considering she wasn’t hired until after we implemented the Citrix solution. “Vital” she said. In a health care setting where electronic medical records are used, she indicated this was the best use of IT she had seen, particularly in a fast-paced family practice clinic.
Overall the medical roaming sessions project has been a significant success for the 3rd Medical Group. Not only can clinicians access the same AHLTA session throughout the day, but also CHCS, PIMR/ AFCITA and the PACS digital viewing application. For some, the time savings has helped achieve improved productivity by allowing more appointments per day. For others, it has created more quality time with the patient by having a more efficient encounter.
Likewise, roaming session environments nicely prepare an MTF for future wireless computing. There’s no doubt that wireless technologies have improved tremendously in the last few years. But losing a network connection in a wireless environment is still commonplace. The chief problem with using a client-based application in a wireless environment is that if in the middle of documenting an encounter the session is lost, so is most of the information for that encounter. Not so with Citrix. If a wireless session is lost, the roaming session is still active and waiting for the user to reacquire it. The beauty here is the encounter is picked-up exactly where it was left off. Ask a clinician in a busy family practice clinic how important that would be.
Regardless, the use of roaming sessions has made life much easier for everyone, even the IT staff. Before Citrix, the IT staff was often manually loading AHLTA and other clinical application updates to individual PCs when mass application “pushes” were not successful. Considering there are over a hundreds of these devices, the time and effort was considerable. Now with Citrix, the effort is considerably less because the application is only updated once on the Citrix server and not on individual computers in the exam rooms. Does it reduce the fulltime equivalent for the IT staff? Not necessarily, but it does give them a similar time savings to spend on priorities requiring their attention to better support their customers.
Are roaming sessions the “magic pill”? No, but it’s an example of how an idea was envisioned by some crafty IT folks who were listening to their customers with the goal in mind of making health care delivery easier and better for our patients. There is no doubt that the value of healthcare IT is enabling saved lives, early detection, self-management and best practices since healthcare delivery is more information based than ever. Saving mouse clicks and keystrokes by listening to our caregivers and finding solutions to meet their needs is one of our jobs as leaders. Two minutes: No, it doesn’t sound like much at first. But if you do the math, it adds up fast. ♦