Electronic Recordkeeping with the Stroke of a Pen

Originally Published MDDI January 2005

NEWSTRENDS

Erik Swain

Most devices involved in patient recordkeeping generate their data through scanning or keystroke entry. But is that the most appropriate and efficient way for all healthcare environments? Medical technology manufacturers and healthcare systems may need to consider other methods that fit better with established workflow.

In some settings, most notably emergency rooms, getting patient information via pen and paper is necessary. The problem is that transferring data from pen and paper into an electronic recordkeeping system can be highly inefficient. According to Hewlett-Packard (HP; Palo Alto, CA), each year in the U.S. healthcare system, more than 10 billion paper forms are generated. By a conservative estimate, it costs $1.28 to transfer one piece of paper into a database. Using those numbers, $12.8 billion per year is spent duplicating information originally generated by pen and paper.

Eliminating pen and paper is easier said than done, though. In the frenzied atmosphere of the emergency room, for example, information must be gathered quickly, and in a manner that is most convenient for a patient in trauma. Jotting it down on paper is often preferable to moving the patient to an electronic workstation for digital input of information.

With that in mind, HP has developed a digital pen-and-paper system that stores each keystroke in the pen, and then transfers that memory into a computer system to store and regenerate those forms electronically. The company says the system reduces the cost of transferring paper data to electronic data to 35 cents per page. That amount, the firm says, makes such data transfer one-fourth to one-fifth of the cost of manual duplication.

In addition, hospitals often take one to three months to transfer paper forms into electronic databases. The digital pen-and-paper system allows transfer to happen almost immediately.

"The healthcare information systems industry has not lent itself well to using paper as a means to generate information without a lot of money added to get it into a database," says Don Palmer, HP's director of forms automation systems. "That has led to undesirable effects. What we found is that people are used to pen and paper, and in certain environments, it is preferred." Other such environments include physician note-taking and notification that a hospital room is clean and ready for a patient, he noted.

To begin, a user prints out a form on HP's digital paper. Each form has a different pattern of dots. The user then fills out the form with the digital pen. An infrared sensor reads the absolute coordinates of each pen stroke, based on the pattern of dots on the paper. That information is stored in the pen. The pen is inserted into a cradle of the computer where the database is stored. The computer uploads each pen stroke and regenerates the appropriate form electronically.

HP introduced the system in a number of pilot programs at the end of 2003, and many are expected to go full-scale in early 2005. One hospital system, Cherokee Indian Hospital Authority (CIHA), reduced its paper-processing costs from $18 million to less than $6 million in a yearlong trial at its main facility in Cherokee, NC. At press time, it was planning to roll out the system at its 300 satellite facilities by the end of 2004.

"For more than 15 years, the CIHA system has been plagued with the problem of how to get data into the resource and patient management system effectively and efficiently," says Jim Eller, program analyst and developer at CIHA. "If information does not flow into the system in a timely manner, it can adversely affect our ability to deliver quality healthcare. [These] technology solutions will really improve our organization's ability to successfully manage our business and provide a caring, patient-centered environment for our community."

Could other providers of medical technology pick up on this concept? Michael Wiklund, a Concord, MA– based human factors consultant, says the idea is a good one in theory.

"I admire the fact that they're recognizing that forcing people to interact with a keyboard-based user interface is not compatible with a number of jobs, and that they're exploring alternatives to conventional ways of getting information into computers," he says. "In human factors, an underlying principle is to work to accommodate the system or product to the person. In that regard, this seems like an interesting strategy."

To ensure success, he notes, the system must be engineered properly, and the users must remember to download the information.

Copyright ©2005 Medical Device & Diagnostic Industry