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Digital Pen and Paper Technology: a Tool for Data Capture and Patient Management

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Digital Pen and Paper Technology: a Tool for Data Capture and Patient Management Clinical PRACTICE DEVELOPMENT Digital pen and paper technology: a tool for data capture and patient management As pressure for scarce health service resources rises, tissue viability services are coming under increasing pressure to justify both their service provision and treatment decisions, as well as demonstrate quality outcomes. In this paper we demonstrate how digital pen and paper technology can be used to capture and computerise patient data, while maintaining a convenient paper record without removing healthcare professionals from the immediate care environment. Kathryn Vowden, Peter Vowden care organisations. This makes data healthcare professionals, with attention KEY WORDS exchange and ongoing analysis difficult. being focused on the computer screen Digital pen and paper (DPP) and keyboard rather than the patient. The technology authors were keen to avoid this when Capture of ongoing care Audit integrating computerised records into the data and incidence data is wound healing unit. Wound care form design challenging. This problem Information technology (IT) is not helped by the variety From the user’s perspective, digital of care settings and data pen and paper technology allows the healthcare professional to continue management systems working within a familiar environment xperience with the Bradford wound involved in the delivery of using pen and paper. To use the care audit (Vowden and Vowden, wound care. This makes technology requires no additional E2009a, b, c, d) highlighted the data exchange and ongoing computer skills and only asks that the difficulties, such as eliminating data and analysis difficult. user writes legibly. The technology transcription errors, and time involved consists of two components; paper in converting paper-based records to pre-printed with a unique patented dot a digital format for analysis. Capture of For a number of years the authors pattern (Anoto Group AB, Lund), that ongoing care data and incidence data is have used a standard wound assessment is overprinted with the data entry form equally challenging. This problem is not tool and have manually entered selected and a digital pen, consisting of a normal helped by the variety of care settings patient data into an Access-based ballpoint pen, an integrated digital camera, and data management systems involved database (Microsoft). A fortuitous an image processor, memory for data in the delivery of wound care, as both meeting with Longhand Data Ltd (York, storage and a mobile communication documentation and computer systems www.longhanddata.com/) introduced device and docking port which also acts differ markedly both within and between the unit to digital pen and paper (DPP) as a charger for the pen (Figure 1). Each technology and provided the opportunity pen has its own unique code that allows to develop a series of digital forms data to be related to that specific pen. based on the unit’s proven wound When writing, the pen takes a series of assessment tool. The authors experience snapshots, more than 50 pictures being developing this system was presented at captured per second. The captured Wounds UK conference in Harrogate images are automatically date and time in November of 2009 and provided the stamped and contain positional data Kathryn Vowden is Nurse Consultant, Bradford Teaching experience and information base from derived from the unique underlying Hospital NHS Foundation Trust and University of Bradford; which the National Wound Assessment dot pattern, that also links the data to a Peter Vowden is Consultant Vascular Surgeon, Bradford form reported by Fletcher (2010) was specific form. The pen can also capture Teaching Hospitals NHS Foundation Trust and Visiting developed. Information technology can nib pressure data that further assists in Professor of Wound Healing Research, University of Bradford act as a barrier between patient and text recognition. A managed database, 74 Wounds uk, 2010, Vol 6, No 2 Clinical PRACTICE DEVELOPMENT utilising this digital pen and paper and free text entries, and a supporting met all IT data security and encryption technology and based on the National coding sheet for fields relating to criteria, and that it was compatible with Wound Assessment Form is now treatment actions and dressings was the National Spine and Connecting For commercially available from e-fficient. developed. Versions of the forms were Health NHS (this aims to introduce trialed by the wound healing unit staff modern computer systems into the The pen-captured data is encrypted on a number of different acute and NHS nationally to integrate patient care. and downloaded either locally or chronic wound types until an acceptable, The NHS Care Records Service [NHS to a central server for processing, and user-friendly data entry tool was CRS] comprises national [the ‘Spine’] and interpretation and verification. The obtained that was acceptable to the leg local databases; http://onlinetog.org/cgi/ data downloaded from the pen is first ulcer and wound care nurses working content/full/10/1/27). assembled as a picture that combines within the vascular and wound healing data downloaded from the pen and the unit. Work continues to further refine this Results appropriate form. In this case, the final for specific chronic wound types, such as Over a six-month period starting in image was provided in pdf format. Text pressure ulcers, diabetic foot wounds and January 2009, the authors’ unit have recognition software converts written venous leg ulcers. recorded wound care activity on data to a computer readable format, over 500 referred patients using this in this case an xml file. This data was Currently, two specific forms have been DPP technology. The data has allowed validated and corrected where necessary, developed, one for general wound care individual patient activity to be reviewed by comparing the text contained in the and the other for patients with leg ulcers, and tools to allow analysis of outcome image file to the data held in the xml file each of these forms share a common using a TELER-based system of indicators (Figure 2). Once validated, the data can core data set. The leg ulcer form, for (Browne et al, 2005) are now being be exported to either a spreadsheet or example, contains additional data sets developed. This should allow more database for analysis. relating to Doppler assessment and accurate assessment of outcome over compression therapy. Data was collected time and will capture patient opinion Method for both inpatients and outpatients at as well as clinical data. Interim analysis The structure of the existing paper-based initial referral and for some patients as part of the data entry validation forms were analysed and converted to at their follow-up visits. One of our process is currently being undertaken. a series of digital fields consisting of tick main concerns in developing the DPP This process is being used to identify boxes, lists, specified alpha-numeric fields technology was to ensure that the system areas within the form which require modification, and to improve letter and number legibility for individual healthcare Ink cartridge and Bluetooth professionals. force sensor USB contacts Battery transceiver The first 436 wound care assessment records have been reviewed for transcription accuracy and validated against the hospital patient administration Camera Image Memory system (PAS), and are being used to processor inform staff training and form design. Examples of areas where accuracy needs to be improved include writing of certain letters, ‘E’ being the most commonly noted error (Figure 2), with the patient’s Right Up name field being the most likely area where this error occurred. This was easily rectified during data review. Numeric data was very accurate, approaching 99% accuracy. Free text fields were most difficult to review and use for analysis but the handwriting, despite being variable, was reasonably accurately translated into typed script. Left Down Discussion The NHS faces a huge challenge 0.3 mm computerising patient records across care settings. Patients with a wound Figure 1. Diagrammatic representation of the pen and paper technology. cross many professional and healthcare 76 Wounds uk, 2010, Vol 6, No 2 boundaries, receiving care from a variety of healthcare professionals working in separate disciplines at disparate locations within different provider organisations, and, like many care groups with chronic diseases, often have extensive care records. In many ways, the frequent care episodes patients with wounds Higher performance require exacerbate this problem. These difficulties have all contributed to the less intervention well-recognised deficit in accurate data collection on treatment outcomes for improved quality of life patients with wounds. The documentation system that the authors have developed jointly with Longhand allows a patient- held paper record with live data capture, without removing the healthcare profession from the clinical environment. Important lessons have been learnt, both in the form of design and data entry. The next stage is to trial this system more widely outside of the authors’ trust and to extend the system to other areas of care. Conclusion This pilot has demonstrated an effective method of data capture that is, in the authors’ opinion, applicable to all care settings and which has the potential to be compatible with existing data systems. It is simple to use, requires no computer skills, and frees clinical staff from a computer, allowing them to continue with a familiar paper-based record system. TM TM What have the authors’ unit learnt 3M Tegaderm Foam Adhesive from their early experience developing High Performance Foam Adhesive Dressing and using this data capture system? The first, and perhaps most important factor, is that it is easy to use, maintains the advantages of a paper record, yet overcomes the task of transcribing data from paper to computer. Coming In addition, the system has been found to work well. Analysis of the first 436 forms available for validation showed that a slower, consistent and accurate soon .
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