An Evaluation of the Clinical and Financial Value of Work Station Single Sign-on in 19 Hospitals.

Background: A large health system implemented computer workstation single sign-on (SSO) in 19 community hospitals. In SSO technology, manual keyboard login is replaced with an identification badge reader that clinicians swipe for expedited access to the electronic health record (EHR) and clinical applications while roaming the hospital. Objective: To assess the clinical workflow and financial value of SSO implementation in reducing clinician time logging in to the EHR and clinical applications. Methods: Mean login time duration before and following SSO implementation was measured over 128 logins during two seven-day periods across eight hospitals selected randomly from 19 facilities where the technology was live. Mean first-of-shift login duration and mean reconnect login duration during the rest of shift were compared prior to and post-SSO implementation. Dollar values of keyboard time saved were calculated for physicians, nurses, and ancillary clinicians. Total facility-wide and enterprise-wide clinician time liberated from keyboard use are reported in hours and in dollar value per week and per year. Results: Following SSO implementation, first-of-shift login was reduced by 5.3 seconds (15.3 percent), and reconnect login duration in the remainder of the shift was reduced by 20.4 seconds (69.9 percent). The total weekly time savings realized by SSO was 943.4 hours (the equivalent of 78.6 12-hour shifts) across 19 hospitals, a mean of 49.7 hours (4.1 shifts) per facility. Annually, 49,056.8 hours (4,088.1 shifts) of mixed clinician time were liberated from keyboard use for the enterprise, a mean of 2,584.4 hours (215.4 shifts) per facility per year. The annual dollar value of clinician time liberated from keyboard use to care for patients was $3,201,001 for 19 facilities, or $168,474 per hospital. Future savings due to desktop virtualization and use of a thin client device, in lieu of replacing more costly desktop computers, increases the annual financial value conveyed by SSO to $3,330,601. Conclusions: In the 19 hospitals evaluated, SSO improved clinician efficiency and delivered substantial financial value. The use of SSO is an effective method for liberating clinician time from keyboard use to focus on providing patient care, and can facilitate EHR use.

Secure Clinical Texting: Patient Risk in High-Acuity Care.

The Joint Commission recently reversed its prior authorization of the use of secure clinical texting to issue patient care orders, now again prohibiting texting of orders. However, the potential sole or exclusive use of clinical texts to transmit other patient care information beyond care orders still poses a risk to patient safety in high acuity care because of text transmission delays resulting from carrier-dependent latency. Although texting in routine patient care may deliver high value to clinicians, the risk of latency and delayed receipt of clinically urgent or time-sensitive texted patient information in high-acuity care settings can harm patients. We completed a review of 19 secure clinical text vendor websites, finding that 16 of 19 (84 percent) market their products for use specifically in high-acuity and critical patient care. The secure clinical texting industry needs the policy guidance of The Joint Commission and health information technology professionals to minimize risk to patients, clinicians, and hospital systems as secure clinical texting becomes standard accepted practice.

Clinical impact and value of workstation single sign-on.

BACKGROUND: CHRISTUS Health began implementation of computer workstation single sign-on (SSO) in 2015. SSO technology utilizes a badge reader placed at each workstation where clinicians swipe or "tap" their identification badges. OBJECTIVE: To assess the impact of SSO implementation in reducing clinician time logging in to various clinical software programs, and in financial savings from migrating to a thin client that enabled replacement of traditional hard drive computer workstations. METHODS: Following implementation of SSO, a total of 65,202 logins were sampled systematically during a 7day period among 2256 active clinical end users for time saved in 6 facilities when compared to pre-implementation. Dollar values were assigned to the time saved by 3 groups of clinical end users: physicians, nurses and ancillary service providers. RESULTS: The reduction of total clinician login time over the 7day period showed a net gain of 168.3h per week of clinician time - 28.1h (2.3 shifts) per facility per week. Annualized, 1461.2h of mixed physician and nursing time is liberated per facility per annum (121.8 shifts of 12h per year). The annual dollar cost savings of this reduction of time expended logging in is $92,146 per hospital per annum and $1,658,745 per annum in the first phase implementation of 18 hospitals. Computer hardware equipment savings due to desktop virtualization increases annual savings to $2,333,745. Qualitative value contributions to clinician satisfaction, reduction in staff turnover, facilitation of adoption of EHR applications, and other benefits of SSO are discussed. CONCLUSIONS: SSO had a positive impact on clinician efficiency and productivity in the 6 hospitals evaluated, and is an effective and cost-effective method to liberate clinician time from repetitive and time consuming logins to clinical software applications.