The importance of screen real estate in a clinical setting

90 day ROI on all-in-one touchscreen PC's for office nurse workstations.

The Heartland Clinic of Platte City (10 minutes north of Kansas City International Airport) has been using Cerner's PowerChart for over 2 years in a nearly paperless environment. We initially started with notebook and tablet PC's with the nurses and the physicians carrying their machines into the patient exam rooms.  That quickly went by the way-side as we discovered patients wanted to see what we were doing and we needed to review lab results, digital images and other patient information with the patient.  The small screen devices just could not meet this need nor did we have a good place to set the devices without interrupting the visit.

Inexpensive PC's with wireless NIC cards (the rooms were not wired) replaced the mobile devices and very soon after that we installed 21" swivel monitors that hit the sweet spot with the patients, nurses and physicians.

Total cost for these inexpensive devices was less than $1,000 and we've been using them to complete the majority of our encounter notes in the exam room at the point of care as well as leveraging them to look up and deliver patient educational material from a variety of online resources.

We all saw productivity enhancements (less clicks, screen manipulation, etc.) with the larger screens.  If they were inexpensive we feel that 27 or 30" swivel monitors might be even better.

Similarly I, along with others, have found attaching a separate monitor to our laptops have improved the functionality and productivity by reducing the manipulation of windows on smaller screens and enabling the frequent side-by-side comparison of data.

  I've found that it's very beneficial to have one screen in landscape and the other screen in portrait mode. Many applications (like the New York Times Reader) are designed for landscape while others (USA Today and most web sites) are more functional in portrait mode.

The same thing is true with our electronic medical record.  Cerner's PowerChart is split into a section called the "Organizer" consisting of messages, tasks, patient lists, schedules, etc.  It works best in landscape mode as shown.  Opening a patient chart creates a new window that is independent of the organizer.  Using 2 screens it's quite obvious that most sections of the chart fit the portrait arrangement better than the landscape and in my office this is the way I set up the application when not seeing patients.

Lately I've been watching our nurses who are using the notebook computers given to them.  Day in and day out they have to juggle many parts of the patient's chart, the web (for accessing insurance information, locations of clinics and facilities to which we refer patients and other productivity applications). It seemed logical that they too would benefit by additional monitors. 

However, when we attempted this we discovered that there were enough quirks in how remote hosted applications (like our EMR) treated two screen arrangements and often they couldn't put the second screen on the right (the preferred arrangement for Windows applications).  Secondly there wasn't enough space to accommodate large second screens and all of the cords were a nuisance.

I was impressed with the iMac that I was using at home but there were cost constraints (as well as push back from our IT department) that prevented experimenting with iMac nursing workstations.  Instead we tried HP's new Touchsmart 600's and received permission to purchase one of them to test.

Within minutes of setting it up one of our better nurses who admits to being computer phobic was jumping all over the Aerosnap and other Windows 7 features including the touch screen functionality for web page and windows arrangements. Her response triggered us to purchase several more refurbished units for under $900.

This device, like the iMac, has a wireless mouse, keyboard and NIC card and due to it's vertical positioning actually increased the usable space around the machine on the nursing island while at the same time nearly tripling the effective screen real estate.

We started calculating the time saved by counting how many times during a routine phone interaction the nurse had to open close or manipulate a window to answer various questions.  The other party at times would want specific visit, lab, insurance and past patient data that necessitated jumping around to different sections of the chart.


In addition the nurses usually had to  bounce back and forth between patient's charts and their message center in the organizer section of the application.

On average a minimum of 5 window changes were required to complete that interaction.  Each of these changes added 5-10  seconds to close or bring to the front the desired window and then locate the data.

The very large screen devices with the Aerosnap feature enabled the nurses to have most of the needed windows open on the screen with minimal manipulation and the number of screen changes plummeted to a little over 1, a savings of 25 - 30 seconds per phone interaction.

Each nurse said that in the course of a day they fielded close to 50 phone interactions (this despite having nearly 80% of our patients using our web portal and saving nearly 8 hours of phone conversations a week per nurse).  This means in the 1st day of setting these devices up we were saving each nurse an average of 25-30 minutes a day in wasted PC manipulation.  Based on our average wage our calculated ROI on these devices is well under 90 days.


In short, you just can't have enough screen real estate and productivity gains is proportional to the amount of that real estate.