Digital Pens for Maternity - Streamlining Data Capture and Record Keeping

1. QIPP Digital and Technology Vision work stream – Phase 2Quick Wins – Digital Pens April 2011

2. Contents • Scope & Vision • Benefits Summary • Intended Process • Stakeholders Engaged • Implementation • Costs • Timeline

3. Scope & Vision

4. 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

5. Digital Pens for Maternity – Scope and Vision 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 Vision 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. What is it? 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. Leap in the offer Standardisation of minimum set of information on Paper Forms Interoperability Toolkit Standards to support flow of this minimum set of information between capture devices and clinical systems. . Implementation of CUI and ISB guidance for data entry and display National Delivery

6. Benefits Summary

7. Summary of Projected Benefits

8. 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

9. Intended Process

10. Patient and midwife experience – DILO of a patient’s data 1 4 5 • At the Consultation the form is completed • Inked paper record (Mother’s) • Digital record (clinician’s) CONFIRMATION of data receipt is sent from the smartphone to the pen. The pen then DELETEs stored data. The midwife then TRANSMITS information from the smartphone to the server when time or signal availability allows. 3, 4 8 INTEGRATED into maternity systems 5 3 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. 2 On completion, midwife ticks ACTION box 5b 6 6 7 The midwife than can ACCESS the data through a web browser 5b 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. 7 The midwife can make CHANGES to the stored data, and the patient can have her paper records updated at the next consultation

11. Features of the Solution Digital Pen Browser Server Application Form • 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 • 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 • Inking • Transmission success / error indication • Low battery indicator • Transmit function • Pen / staff identification • Charging and data transmission via docking station • 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 Smartphone • Transmission and acknowledgement of receipt of data • Mobile working • Staff alarm

12. What does this mean for… 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 Patient “I still have my paper record, and everyone involved in my pregnancy has access to the information as well” The Pathway Focussed on quality of the service, through timely access to accurate information shared with patient, midwife and clinicians • 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. • 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

13. Implementation

14. 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 • Local procurement of the commodity product • Local business changes in usage of the commodity product

15. 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

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