The Hospital Room PC, Reimagined

A new PC being tested in hospital rooms isn't like any PC you know. Sure, it delivers streaming video and gaming, but it can also provide patient monitoring and reporting.

Virtual desktops may be on a trajectory to erase the traditional work PC in hospitals, but at the International CES show last week, Intermountain proved that PCs have a new, somewhat surprising starring role in healthcare.

Last September, I wrote about how Memorial Healthcare in Owosso, Michigan had decided to replace traditional PCs with so-called "zero client" hardware that provided maximum mobility for clinicians and minimum maintenance headaches for IT staff. That trend continues, although some readers noted that antiquated software licensing policies at Microsoft and the PC-based EHR companies are slowing the move to zero-client PCs.

But at last week's International Consumer Electronics Show in Las Vegas, Intermountain Healthcare made the point that the hospital room of the future very much depends on adding a somewhat reimagined PC at the heart of that room, and the software running on that PC won't be a zero client.

That's because the PC would effectively be a set-top box.

Intermountain is pilot-testing a modular PC with up to 350 ICU and ER beds, says Fred Holston, Intermountain's chief information technology officer. He showed off the technology at CES with technology partner Xi3, a company conveniently based in Salt Lake City, like Intermountain.

Xi3's PC probably doesn't look like any PC you have or had. It's a softball-sized, cube-shaped diskless wonder that also captures the fancy of computer gamers looking for an alternative to computer gaming consoles such as Microsoft's Xbox or Sony's PlayStation boxes.

In its first Intermountain incarnation, the Xi3 is becoming the chief enabler of room-to-room telemedicine services I described in the October 2013 issue of HealthLeaders magazine. From any Web browser, an Intermountain physician can establish a videoconference to the patient's room, as well as other room controls and information being generated by sensors in the room, Holston says.

At CES, however, Intermountain demonstrated the Xi3's set-top box capability to enhance the patient experience, providing patients with a rich computing experience of their own, ranging from Internet-based videoconferences with friends and loved ones to the kind of immersive movie watching and video gaming experiences that CES is known for.

Intermountain's Transformation Lab, which Holston runs, is still defining what kind of controller the patient will be using, but the term BYOD could take on new meaning. Holston tells me the healthcare system may give patients the option to bring their own consumer devices, such as tablets or phones, to access the in-room video and Internet services.

If such a scenario comes to pass, for security and simplicity purposes, Intermountain would restrict the patient's device to a specified set of commands and interfaces. Holston doesn't want to have nurses distracted by having to teach patients how to use the system. Or, patients without their own devices might receive a tablet from Intermountain for use while in the room.

Intermountain is starting with ICU and ER scenarios because patients in those rooms are less likely to be using any device during their stay, but I can easily imagine the BYOD phenomenon breaking out once the pilot reaches main hospital beds.

Patient education will get a boost too, since the same infrastructure that delivers movies or games can also deliver interactive content about everything from procedures to patient discharge instructions.

Then there's the continuous monitoring aspect. Like other systems, Intermountain is demonstrating VisiMobile wrist-worn tech from Sotera Wireless that delivers a stream of continuous patient vital sign data to the electronic medical record. I was interested to learn that Sotera just received FDA approval to add the first-of-its-kind cuffless, continuous blood pressure monitoring to its mix of generated data.

That might give patients something beyond value to healing–a good night's sleep.

"in a normal monitoring floor, nurses come around every two hours to wake you up, and then they take vitals with all these things they haul in here, and they run back to a machine and type it all in and document it," Holston says.

"So what if I took all that away? I let you sleep all night. I continuously get the data. I auto-document every 15–20 minutes, into the EMR and do all the alarming from that, and then all of a sudden I've got this beat-to-beat data set that I can learn things about patients and certain things that we discover they have—diseases, situations, whatever, and I discover new things I never knew before, because I've got new data."

All of this new data, however, puts demands on the in-room PC, as do the requirements of streaming live video or delivering a fast-action video game. Hence the Xi3 running Windows 7 initially, because a zero-client PC can't keep up with these processing demands, Holston says.

"You need something closer than the data center, and for us that's a server in the patient room," he says. The responsiveness of the Xi3 hardware will also let the patient control the environment of the room, including light, power, and air.

Although it's also quite possible to run Linux on this kind of hardware, Windows gets the nod because of Intermountain's comfort level with the Microsoft operating system, and because the Transformation Lab is writing the software running on the Xi3 hardware that makes all this work.

Lastly, if Xi3 or something similar takes off in the home – something I think is possible due to the hardware's modular design, simplicity and small physical and energy footprint – Intermountain could be well positioned to be able to take the next step and implement its hospital bed of the future outside of the hospital's walls, in homes or longterm care facilities.

If you want to see just how far information technology can move in transforming healthcare, this latest incarnation of the personal computer is worth watching.