Cool Technology of the Week

Structured electronic clinical documentation is the next frontier in EHR implementation.  It's particularly challenging in Emergency Medicine which is a fast paced, sometimes chaotic environment.   Documentation can be time consuming and is the most frequently interrupted task.  How can we balance the need for structured data capture with ED workflow?

There is no single right answer - we've used iPads with web applications, voice recognition, and disease specific templates.

We now have a new tool in our quiver, the Digital Pen from Anoto as implemented by Forerun Systems for ED charting.    Forerun is a technology spin out of BIDMC and I have no financial relationship to it.

The digital pen is NOT a handheld scanner, capturing graphics or PDFs.   It's a means to capture discrete patient data to support clinical documentation, quality reporting, and regulatory requirements.  It captures data at the bedside with a granularity that dictation cannot.

Here's how it works.

Forms are printed with a special background matrix that identifies the unique form, patient, clinician, and data elements.  Think of it as a page of  2D barcodes.   Forms can be printed as needed at various points in the ED workflow either manually or automatically.

The pen "knows" exactly which patient form is being used and what fields are being entered.   You can write on multiple forms in parallel without confusing it.    Checking a box generates structured data indicating that a sign or symptom is present.   Writing through a word generates structured data indicating that a sign or symptom is absent.   When free text is entered, both the original text and an optical character recognition interpretation are available.

As the pen is inserted in a USB dock, the structured data is uploaded into the EHR.

Here's an example

The form as entered by the user

The discrete data displayed in a web application (including handwriting recognition in red for editing).

The final output with all discrete data converted to structured documentation for clinical use.

Although we hope to use iPads for clinical documentation throughout the institution, there are workflows in which digital pens are faster, easier, and less intrusive to the caregiver/patient interaction.

A pen for patient specific structured electronic clinical documentation.   That's cool!