Evaluation of digital pen and paper (DPP) technology within an acute

public hospital

Nikki Littlewood

ISYS90060

Imagine a nurses station in a hospital ward

(except less smiles, more mess and patient files everywhere except where they’re meant to be kept)

The missing patient file is a problem

• Of course, it isn’t really missing.

• It’s either being used by one of the many health professionals assisting with the care of the patient.

• Or it hasn’t been returned to its rightful place.

• Or it’s with the patient at x-ray, theatre or anywhere else that the patient is and their notes are required.

Which wastes time and energy and results in...

Is there a solution to the ongoing search for a patient file?

Yes.

• Electronic medical records (EMR) are already available, however the nature of work on wards has not yet allowed real-time information transfer using this system.

• Digital pen and paper (DPP) technology is one solution to bridge this gap http://farm3.staticflickr.com/2473/35

32795871_2d81ce74ed_s.jpg

What are its features?• A regular ballpoint pen

• With an integrated digital camera

• Using specially printed paper with nearly invisible uniquely sequenced dots to accurately duplicate exact location of writing on paper

• Incorporated memory for up to 50 sheets of A4 paper

• The pen wirelessly connects to a smartphone or tablet via bluetooth. Or alternatively can be docked via USB to PChttp://www.inphoactive.com/capture-

data/digital-pen/#!prettyPhoto

How does it work?

Anoto Functionality © Anoto Group ABhttp://projects.oucs.ox.ac.uk/vre/ibvre/index.xml?ID=digitalpaper

• If the surface being written on is printed with the anoto dot sequence then the pen has the ability to read it.

• This can include LCD screens, whiteboards and transparent glass.

• Pre-existing forms can be modified using a forms package software.

• A small tick box exists in the bottom corner of each piece of digitalised paper that when ticked will automatically allow data to be transferred when docked or immediately via bluetooth

http://www.emeraldinsight.com/content_images/fig/0490340604007.png

Additional information

• The data stored on the pen is encrypted.

• The pen can record the time, date and name of the person who has used the pen.

• The digital paper can continued to be used as a paper copy of the document.

What are the benefits to use in a hospital ward?

• There will be a paper copy available as usual

• There will be a real-time electronic copy available too which has been updated via DPP technology.

• More than one person will be able to view the file at one time

• Less time will be spent looking for the patient file which will lead to increased productivity

• Health professionals will be happier because they won’t be frustrated from being unable to locate notes.

Usability of DPP amongst nurses

• Usability of DPP was assessed by 21 nurses in a labour ward, who volunteered to trial using the DPP and regular pen for 4 weeks each over an 8 week period to complete the labour admission database form.

• They found that despite a positive attitude from nurses towards DPP that post study preference was for conventional pen.

• Reasons given were a conventional pen was less bulky and simply reaching for what was closest at the time.

Yen and Gorman (2005)

Integration of DPP into an existing clinical information system (CIS)

• A further study in Switzerland assessed the feasibility of integrating and using DPP in a pre-existing CIS within primary, secondary and tertiary healthcare systems.

• Concluded that the quality of the DPP was as good as using a professional scanner and that the mobility of DPP was an advantage over scanning.

• Satisfaction surveys demonstrated DPP to be well -accepted amongst users.

• DPP was able to be successfully integrated with pre-existing CIS using JAVA and web-services.

• The requirement of colour laser-printers to produce the forms was inconvenient.

Despont-Gros et al. (2005)

Feasibility of DPP technology to record vital signs in acute care

• A six week prospective study was conducted on surgical and inpatient medical units using DPP to document vital sign data and accuracy of data was compared with the original working paper-copy. Random generator selected 25% vital sign values to review.

• Data collected by DPP was found to be 92% accurate in comparison to paper-copy.

• Error in accuracy was related to inaccurate recognition of handwriting or missing data.

• User satisfaction survey demonstrated greater satisfaction in vital sign data recording post DPP but this was not statistically significant.

• Concluded that DPP is a promising transition from paper-based systems to EMR

Dykes et al. (2006)

Advantages and Disadvantages

• Enables real-time transfer of data whilst allowing traditional paper-copy to be maintained

• Generally well-accepted amongst users

• Easy to implement alongside pre-existing CIS

• Digital copies consistent with scanned versions

• Cost-effective in long-term

• Colour laser printer required which is more costly than black and white

• Early versions of pen are bulky

• Increased training may be necessary to encourage use

• Expensive in short-term

Recommendations

• Further studies into the use of DPP are required.

• Limitation of Yen and Gorman (2005) feasibility study on labour ward was that it only involved one task which did not encourage full-active use of DPP to provide more accurate evaluation.

• Further studies on quality of handwriting and capture of vital sign data would be helpful in deciding use in acute care settings as majority of information is not captured in forms.

• Further usability studies should be conducted for DPP. The requirement for printed surfaces has not changed but the digital pen has been redesigned by a number of different companies.

Conclusion

• DPP technology is a cost-effective and user-friendly transition of healthcare systems from paper-based patient files to EMR.

DPP “From handwriting to computer...in real-time”

Anoto Group AB (2013)

References

• Yen, Po-Yin., & Gorman, Paul. (2005). Usability testing of digital pen and paper system in nursing documentation. AMIA ... Annual Symposium Proceedings / AMIA Symposium. AMIA Symposium, 844-848.

• Despont-Gros, Christelle., Bœuf, Christophe., Geissbuhler, Antoine., & Lovis, Christian. (2005). The digital pen and paper technology: implementation and use in an existing clinical information system. Studies in Health Technology and Informatics, 116, 328-333.

• Dykes, Patricia C., Benoit, Angela., Chang, Frank., Gallagher, Joan., Li, Qi., Spurr, Cindy., . . . Prater, Marita. (2006). The feasibility of digital pen and paper technology for vital sign data capture in acute care settings. AMIA ... Annual Symposium Proceedings / AMIA Symposium. AMIA Symposium, 229-233.

• Anoto Group AB. (2013). from http://www.anoto.com/lng/en/pageTag/page:home/