Using a Laptop as a Fixed Station

One of the problems I face in my clinic is a lack of space. Although my exam rooms are quite spacious, they are not huge and would not accomodate a desk for a desktop PC. This requires some creativityso that computers are not intrusive, but are accessible when needed.

Actually, this was the primary reason I looked for a wireless solution. I set up the clinic with a wireless VPN (Virtual Private Network) to ensure a high level of security on the wirless network. As workstations, I have been using a DELL Laptop and a Gateway Tablet PC (Motion M1300) for clinical data entry. Unfortunatly, neither of these units have met my expectations. I have found it difficult to physically carry the laptop from room to room. I also have limited space to place the unit while doing the physical examinations. The Tablet PC has not met my expectations in terms of handwriting recognition, although the technology is improving rapidly.

I am aware of some physicians who have begun using Tablet PCs quite effectively using the Journal note taker or other software that meets their needs, but this has not been my experience.

Recently I decided to move back to fixed PCs in each exam room hard-wired to the network to ensure maximum speed and stability. When I looked at the potential solutions, the best option was a Pentium 4 laptop with a 15" screen which I could wall mount on a bracket which would allow me to tilt and rotate the laptop for most effective use. I have just ordered laptops through DELL Canada. (This worked out very well as I was able to get a 10% discount (by being a CMA member) and free shipping (due to a promotion). In the end the laptops have not cost any more than similarly configured desktop PCs with flat panel monitors.

My current challenge is working out how to effectively mount the laptops on the wall. There are a number of brackets available for keyboards or monitors which can be wall mounted, however I have been unable to find many reasonable solutions for laptop computers.

I am working on some current hybrid solutions to mount the laptops and as soon as the units are installed, I will post images to demonstrate what I have done and provide feedback on the how the units work.

If any visitors to CanadianEMR have had any experience in this regard, please post your comments by clicking on the 'Comments' link below.

Comments

[Alan Brookstone]

I have just been made aware of a laptop mount that is available from a US company called ICW. Many thanks to Tom Conners,
Business Manager, York-Med Systems Inc. for this information. Laptop Tray Mount

[Fred Freedman]

Alan
Why do you want to mount a laptop. Laptops have the advantage of a small formfactor (ie: you don't have to store a CPU) but by mounting them you loose the major advantage of portability (which you say you don't need now that you are wired).
For me the most significant problem would be not being able to adjust the screen for best viewing.
I would have preferred to have an LCD screen on my desk with a keyboard or mount the LCD with any of the available hardware that is out there now and still have a keyboard on my desk. That way you can independantly move screen and keyboard.
Let us know how it works out. By the way, Lee Valley Tools has some interesting hardware for computers.

[Alan Brookstone]

Thanks Fred, Lee Valley is a good suggestion, they have a number of mounting solutions that could be useful. Lee Valley Tools - Hardware Index

I have decided to fix the laptops rather than keep them mobile because I want them to be immediately accessible in each room with a dedicated printer. I went with the laptops because cost wise, there was little difference to a similarly configured desktop. In addition, I do not need to find a space to store the base unit. With a good bracket, I believe I will be able to easily move the laptop to a comfortable viewing position and the newer screens can be more easily viewed from a wide angle.

Appreciate your suggestion on Lee Valley. I am going to create a link sub-category of computer mounting solutions as I believe this will be useful to other users of EMR.

Alan

[Scot Mountain]

After having purchased a tablet PC (expensive) I found much the same as you Alan; the wireless experience left something to be desired with respect to speed, stability and portability. I was similarly constrained for space, so I bought some flat panel LCD monitors, and external keyboards and mouse, and hooked them via a USB hub to my tablet.

Now my tablet functions as a very inobtrusive desktop computer, tucked away standing on edge in a corner of my desk.

The flat panel monitors are great, as they are small enough to not take up much room on my desk, but light enough that I can easily rotate them to share information on them with my patients, and I really value the full sized keyboard for data input.

For mounting solutions, I have purchased some equipment from a company in Ontario that is a reseller for an American company called Media Mounts. They have a pretty broad range, and are purpose built for computer mounting solutions.

You can check out the Canadian company, called "The Bracket Company" at http://www.brackets.ca/. I think they have a link to Media Mounts on their site.

Good luck with your search.

[peter richards]

I have laptops in all my offices mounted on brackets and hardwired for many of the same reasons as Alan. We bought used Dell laptops computers tht run Linux and run Oscar so as a browser based app, The network speed is excellent. The used laptops have been very robust and only the battery is non funvtional but that does not matter as we have them plugged into the wall. We used very heavy brackets that could swing away as I use the laptops for prescriptions only and don't want children playing with the units. The printer is outside. My brackets cost $800 which certainly is expensive. But they are very robust and move up and down well. They are counterbalanced. Lee Valley units are only good for under counter locations. - not right for us. We have recently signed a distribution agreement for similarly robust brackets for a fraction of the above cost. if any one is interested, we will supply the info to Alan Brookestone who can pass the information along to interested users. That's so that this site does not become commercially oriented.

How you use a computer and where you put the computer during an office interview is just as important ( well almost) as the program itslf and yet there is precious little research done on the effect it has on patient / physician interaction.

One thing that works very well is that we have our printer on its own print server (Hawking) so that we dont need it hooked up to a local computer and we can even print to the unit from outside the office if we need.

[Ray Simkus]

We have tried a number of arrangements of computers in our clinic. A recent effort with a tablet computer failed for the various reasons listed in other messages. My exam rooms are 8 by 10 feet. I have been using an Ergotron arm mounted on the wall to hold a flat panel screen, the computer box is behind the exam table and the keyboard is left loose on the end of the exam table. I have been using the Ergotron arm for 5 years. I looked at their web site and noticed that they have an arm that is desiged for notebook computers. Their equipment is pricey but it is industrial strength.

Ergotron: Laptop mounts and keyboard mounts

[Michael Rath]

I tried the laptop and tablet route and didn't like it. I use voice recognition as well - lugging the wires and mic around was especially clumsy.

My solution was buying inexpensive computers and LCD panels for each examination room. The LCD panel is quite inobtrusive. The computer is hidden underneath the counter. I use a wireless Gyration keyboard and mouse.The keyboard is about the size of a laptop keyboard can is free to move around without wires to contend with. In fact it can be used up to 25 feet from the computer. Similarly, the mouse is unencumbered. In fact, this mouse does not even need a flat surface. The gyroscope inside permits the mouse to be manipulated in thin air.
Gyration Company Information

[Alan Brookstone for Brian Nelligan]

This is an interesting comment from Brian Nelligan who has contributed to CanadianEMR in the past:

We have been looking for a solution for our PHC sites in the IHA. As some comments above have stated, tablets or laptops still have to be placed somewhere to do the physical examination. The idea of mounting a laptop or PC is a good one, just finding the right fix is the trick. There have been some companies mentioned and I will put another into the fray. They have someone in Calgary and I have yet to see the product but I am impressed with the pictures I see on the web. You can go to www.ergotron.com to view their products.

Another issue that was recently brought up in our group that concerns point-of-care is the idea that most PC/Laptops/Tablets in an exam room may get dirty and carry infectious materials from one patient to another. Maybe you all either wash your hands and wear gloves in the exam room, but what if a patient coughs or sneezes on the keyboard, how do you clean that? I am sure this will now become an issue for us in our PHC sites, just wondering if anyone out there has a solution they used.

Thanks

Brian Nelligan
Systems Analyst, PHC

[dseguin]

If you use a print server on your network, beware the new breed of GDI, host based printers. They will NOT work with your print server. They depend on a local PC for their processing power. Most frustrating if you have a new print server and a new laser printer and (typically) poor manufacturer hardware support.
Print servers - Can My Printer Be Networked?