April 2011

QIPP Digital and Technology Vision work stream – Phase 2Quick Wins – Digital Pens

Contents Scope & Vision Benefits Summary Intended Process Stakeholders Engaged Implementation

• Costs• Timeline

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Scope & Vision

Digital Pens for Maternity - Vision

Current Situation• “Mothers Book” often the only complete record of the pregnancy, created as hard copy

and held by the mother. • Maternity systems are often populated by re-keying data using a subset of information

created whilst simultaneously completing the Mothers Book, a process which is prone to error

Use of Digital Pens will provide the following local benefits• The digital pens allow an electronic record to be created at the point of capture. • Improved data quality and record completeness• Productivity gains due to de-duplication of record keeping activities• Ease of deployment due to familiarity with pens• Better information on staff productivity

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Digital Pens for Maternity – Scope and Vision

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To effect a step change in quality (completeness and accuracy) of maternity data currently captured on paper forms during consultations, by simultaneously and without additional effort making an electronic copy of the information written. Familiarity of pens and paper eases deployment whilst still capturing information electronically

Digital Pens are normal ball-point pens with a built in camera which recognises a unique pattern of dots printed on the paper forms, and those unique patterns encode a digital replica of the written information The pens are connected via Bluetooth to a smart phone, from which the captured information is uploaded to the Digital Pen application (server based). The application interprets the encoded dots and pen movements, and using Optical Character Recognition re-creates a digital facsimile of the written form. There is the option to use predefined lexicons to specific fields on the form to further improve data quality.

Information is captured electronically at the point of consultation, using existing business processes. This eliminates the requirement for duplicate note taking and re-keying of data into computer systems, with the associated time, quality and completeness benefits.

1. Standardisation of minimum set of information on Paper Forms2. Interoperability Toolkit Standards to support flow of this minimum set of information between

capture devices and clinical systems. .3. Implementation of CUI and ISB guidance for data entry and display

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Benefits Summary

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Summary of Projected Benefits

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Option Benefits Description (benefits quoted are incremental for each Option)

1. Standalone pens Data captured once at the point of care Data available to all clinicians involved in the pregnancy No change to the consultation More time available to provide face to face patient care – e.g. meet targets for 1st appointment

booking for Maternity services Digital data can be accessed from any PC (browser enabled); no need for a specific (location) PC

to be used Implement agreed protocols and datasets to support better, safer care Minimal end user training thereby enabling rapid deployment Improved handover between care professionals e.g. Midwife to Health Visitor Better management information to support resource planning and finance e.g. Commissioning

datasets

2. Standalone pens with enhanced application functionality

Eliminate reliance on non clinical staff for transcribing Elimination of human error in transcribing All data captured digitally; no subjective summarising

3. Application integrated with maternity systems

Eliminate the admin time spent transcribing paper records or digital facsimiles into the medical systems

Patient data can be populated from other systems A complete end to end view of the patients pregnancy shared by all clinicians involved in the

pregnancy Quality of Care benefit by all clinicians having holistic view of pregnancy

Summary of Financial Benefits and Commentary

£1,235 per year benefit per deployed pen Based on key input data:

• 650,000 pregnancies per year• 260,000 first time pregnancies per year• 1st appointment duration 90 minutes• Subsequent appointment duration 15 minutes• Total meetings in the year per pregnancy 10• Total meetings in the year per 1st time pregnancy 13

Main benefits realised from:• Rekeying saving by midwife and admin staff• Time saving efficiency of appointments

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Intended Process

INTEGRATED into maternity systems

Patient and midwife experience – DILO of a patient’s dataAt the Consultation the form is completed1.Inked paper record (Mother’s)2.Digital record (clinician’s)

On completion, midwife ticks ACTION box

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On checking the ACTION box of the form, the pen TRANSMITS data by bluetooth (record of pen strokes encoded in the pen movement relative to the form) to the smartphone.

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CONFIRMATION of data receipt is sent from the smartphone to the pen. The pen then DELETEs stored data.

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The midwife then TRANSMITS information from the smartphone to the server when time or signal availability allows.

As an alternative, the midwife can UPLOAD data automatically via a desktop component and docking station to the server. Note the docking station is used for CHARGING the pens.

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The midwife than can ACCESS the data through a web browser

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The midwife can make CHANGES to the stored data, and the patient can have her paper records updated at the next consultation

Features of the Solution

Inked record of data Indicated / Enforced data

capture format• Tick boxes• Block characters• Free text• Diagrams

Structured data capture• Dataset• Care protocol• Commissioning / ERP

data

Transmit function Pen battery level check

coded onto form Staff alarm

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Inking Transmission success

/ error indication Low battery indicator Transmit function Pen / staff

identification Charging and data

transmission via docking station

Form Browser

Smartphone

User validation of handwriting interpretation

User correction / addition of data

User notification for missing / required data

User management of stored files

Management of users – pen allocation, assigning users to groups, setting permissions

Digital Pen

Transmission and acknowledgement of receipt of data

Mobile working Staff alarm

Form creation Form layout Data entry type (radio, block or free text) Data entry format Implementation of lexicons for use on

specified data fields Repository of all available forms Form printing / management of pattern

library Receipt of pen data + acknowledgment Storage of inked marks as facsimile Audit trail of times and users’ inked

marks (who wrote what and when) Interpretation of inked marks

Optical Character Recognition Action areas e.g. Battery Check,Transmit

& Staff Alarm Charcater boxes Free text

Application of data structure and metadata (XML, HL7, SNOMED)

Transmission of data Error handling User checking/ validation/ edit of data Account/ user administration

ServerApplication

What does this mean for…

Mother still gets to keep a written record ; no change

Mother is reassured that even if her hard copy “mother’s file” record goes missing, the information will not be lost; an improvement

With integration the paper form will be pre-populated with information from other systems e.g. GP, SCR etc.

Midwife“I can spend more time caring and

less time doing admin” Patient interaction is unchanged No need to re create information or re-key

data into a maternity system. Electronic copies and interpreted data are

validated at the end of the shift – this is much quicker than re-keying the data

No need to queue for a specific PC in the Hospital or GP practice as data validation is via browser

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Patient“I still have my paper record, and everyone involved in my pregnancy has access to the information as well”

The PathwayFocussed on quality of the service, through timely access to accurate information shared with patient, midwife and

clinicians Data captured once at the point of care Data available to all clinicians involved in the pregnancy Eliminate the admin time spent transcribing paper records into the medical systems Elimination of the human error in transcribing Eliminate reliance on non clinical staff for transcribing All data captured digitally; no subjective summarising No change to the consultation More time available to provide face to face patient care – e.g. meet targets for 1st appointment booking for Maternity Digital data can be accessed from any PC (browser enabled); no need for a specific (location) PC to be used Minimal end user training thereby enabling rapid deployment Improved handover between care professionals e.g. Midwife to Health Visitor

Implementation

Implementation Approach

Technology assessment:

• The technology exists

• The vendor market is mature

• This is a commodity product

• No development/delivery is required from the centre

Implementation Approach

• This will be a local implementation approach

o Local procurement of the commodity product

o Local business changes in usage of the commodity product

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Deployment Options and Functionality

Option 1 – standalone pen deployment, minimal application functionality Storage of a digital facsimile of the paper document Creation of a hard copy to leave with the mother Ability to share the record and when necessary create a duplicate Optionally, supplier hosting would minimise the need for local infrastructure provision

Option 2 – standalone pen deployment, with enhanced application functionality Data validation of digital data Use of lexicons to improve data quality Optical Character Recognition Form Repository

Option 3 – pen deployment, enhanced application functionality, integrated maternity systems Integration with existing maternity systems ITK Components CUI and ISB Standards Best Practices and care protocols

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Deliverables (national) required for standardised deployment(beyond QIPP DTV Phase 2)

Deliverable For Option No. Description RationaleOutline Safety Case 1, 2, 3 Outline Approach to assessing Clinical,

Technical and IG Hazards. To support deployment by providing a partially populated hazard assessment template

Minimum Information Standard

1, 2, 3 An approved operational information standard to include data items, data format, clinical content to support safe capture and exchange of information

To support safe and consistent exchange of information between systems

Draft ITK Standard 3 A set of standards and frameworks for connecting Digital Pen systems to existing systems. Potential focus on Maternity initially

To support systems integration and seamless data flows between Digital Pen systems and existing systems

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