The Digital Pen and Paper

Patient-perceived usefulness of an emergency medical card and a continuity-of-care report in enhancing the quality of care

OBJECTIVE

To evaluate the patients' opinion on the usefulness of the electronic medical card (EMC) and continuity-of-care report in enhancing quality of care, and to assess the effects of the patient-entered data on the quality of data in the electronic medical record (EMR).

DESIGN

A structured survey assessed patients' opinion on the usefulness of the EMC and continuity-of-care report. The accuracy of EMR data involved comparing the patient-entered data in the continuity-of-care report with the healthcare-provider-entered data in the EMR. The analysis assessed whether the EMR information was consistent with the patient-entered data. A data completeness evaluation compared data entries in the EMR collected before and after the use of continuity-of-care record application.

RESULTS

One hundred and thirty-three patients used the application, of which 76% who had actually used the EMC and continuity-of-care report to seek medical care and/or update EMR information were surveyed. Age was associated with the reported usefulness of the documents. Few users (16%) printed the continuity-of-care reports to take to their healthcare providers for data updates and fewer (9%) to correct errors in the EMR. Overall, 68% of patients found the documents to be useful.

CONCLUSIONS

Patients reported that the EMC and continuity-of-care report were useful in enhancing quality of care. They were able to identify missing or erroneous data in the EMR data, making them an important source of quality control for their information in the healthcare-provider-maintained EMR.

Revealing triage behaviour patterns in ER using a new technology for handwritten data acquisition

INTRODUCTION

Data acquisition is still one of the important challenges to be met in clinical settings. This is even more critic in settings with high cognitive workloads, such as emergency room (ER). Observations in these settings are difficult to realize without biases and there is little means to trace fine acquisition activities done in natural environments, using pen and papers. This study is based on the usage of a digital pen and paper (DPP) technology for the acquisition of triage information by nurses in ER. The DPP technology has been used to ease acquisition using a natural mechanism; it also minimizes the external influence of observation during acquisition activities. The aim of this study is to determine whether data recorded by the DPP technology allows explaining how ER triage nurses use the triage forms in real working conditions.

METHODOLOGY

The chief physicians of the ER service wanted to have answers about three main concerns pertaining to the triage process: (1) the average time spent during the triage process; (2) the sequence in which the fields of the forms were filled and; (3) the contribution of objective measurements, such as vital signs, to the triage emergency level and decisions. In order to answer these questions, detailed log data recorded by the DPP during form filling as been analyzed and allowed to built several representations of the triage process. In addition, we completed this analysis with ethnographical-like observations.

RESULTS

For seven consecutive days, 1183 triage forms have been recorded in the ER for all patients admitted. Among them, 954 forms have been digitalized and 906 forms have been considered as valid and complete. Based on this set of data, the median duration of the triage process is 143 s. There are no converging habits in filling the forms and the sequence of filling fields present a high variability. The emphasis of the objective measurements in the decisional process is rather low, as vital signs are recorded in less than 17% of the cases.

CONCLUSION

The DPP technology is an original approach to study data acquisition processes in unbiased conditions. The technical raw data recorded by the DPP allows building the time series of all activities on the paper, therefore letting to constructing several representations of the process. However, the technology is not able to provide information about the context of use, for example interruptions of the form filling processes due to calls or other activities. Therefore, it is necessary to complete these analyses with qualitative approaches such as observational studies and interviews. Noticeably, as a result of this study, the head physicians of ER have redesigned the triage form to enforce the use of objective measurements and ease the data acquisition process.

Acceptance and cognitive load in a clinical setting of a novel device allowing natural real-time data acquisition

INTRODUCTION

This paper reports the findings of an evaluation study in the field of human-computer interaction about the use of a new data acquisition device, the digital pen. It focuses on specific aspects of the interaction between the users and the technology: the cognitive burden induced by the design of the tool in real conditions of use and its impact on user acceptance.

METHODOLOGY

Human cognition is embedded in a complex sociocultural world. Therefore, we opted for ethnographically informed investigations reinforced by a satisfaction survey. The work context chosen for these investigations was the emergency room triage process.

RESULTS

The technology meets a high acceptance (median 3 on a [-5,5] scale) shaded by unexpected additional cognitive burdens. These burdens originate in several technological and ergonomic flaws that have been discovered during the observations. These results have been used to improve the technology.

CONCLUSION

We demonstrate the importance of this kind of field study to uncover unexpected possible sources of failure of acceptance of a new technology. Such kind of study should be held prior to the introduction of a new technology to lower the common failure rate encountered in the field of medical informatics.