Digital ink makes an impression

US company Bottomline Technologies recently purchased the assets of mobile documentation software firm Logical Progression and is now bringing its Logical Ink technology to the healthcare sector in Australia.

Logical Ink is a mobile documentation solution that uses digital ink and a pen-based interface to enable tablet-based data capture and form completion for healthcare organisations.

It allows validation of data in real time at the point of care, accessibility to patient records, mobility, security, and the creation of intelligent, interactive forms, with no duplicate data entry or scanning required.

The product was developed by Logical Progression's founder Chris Joyce, who has now joined Bottomline, and who saw a gap in the market for a mobile product that crossed the divide between paper-based forms and a full desktop-based EMR.

“As you're talking to physicians and looking at workflows, you realise that the form is really the interface to the hospital, but there was paper everywhere,” Mr Joyce said.

“What people were looking for was a way to more easily transition to an electronic medical record. They didn't want to make a big leap to a desktop because they were still, in their workflow and their bedside environment, attached to a paper- based process.

“Our software solution lets you build mobile applications from a paper document. Because it‘s pen-based, it’s a very natural interface for the clinician. It presents very much like the existing paper forms – you can complete form fields and write in margins, annotate diagrams and can sign documents with your biometric signature.”

“We complement the EMR by integrating through standards like HL7. We are not replacing the primary record system, but we’re sitting alongside those hospital systems and giving both clinicians and other supporting staff a document portal that is pretty much like the paper clipboard they had before, only under glass.”

Mr Joyce said one of the main catalysts for the uptake of these systems is the ability of Windows-based tablet PCs to support handwriting recognition. The Windows operating system now comes with this inbuilt capability, which has evolved from its early years and no longer needs to be 'trained' for individual users.

Kevin Burdette, an Australian-based workforce mobility specialist, who joined Bottomline Technologies in January of this year and will be promoting the product to the Australian and New Zealand markets, said another reason this sort of product will now become more widespread is the reduction in the cost of tablet PCs.

“Unlocking the capability of tablet PCs in healthcare has been slow to take off,” Mr Burdette said.

“There were a number of barriers such as hardware and cost. What has happened in the last little while to change that is that the cost of Windows-based tablet PCs has come down considerably and the variety has grown.

“But basically a tablet PC is a laptop without a keyboard, so without a platform on that tablet PC to unlock its power, it remains just a laptop without a keyboard. Logical Ink unlocks this power through the use of the handwriting recognition capability, and brings back and enhances the natural interface between the user, the PC and the patient.

“In the healthcare space, there is almost nothing that does it, using the natural human way. Physicians do love their iPads and tablets, but while they can use a stylus, there is no recognition of handwriting.

“I think this is a significant step forward in how technology and mobility is used in the healthcare space.”

Mr Joyce said the beauty of handwriting recognition is that the form will recognise a hand-written numeric value or a text value and will convert it on the spot, so users can immediately correct it if it makes a mistake. It also almost completely does away with the need for training, as the user experience is so similar to what they’re used to with a pen and clipboard.

He said the kinds of documents it can work with are almost unlimited. “Our application offers a designer which allows you to import Word or PDF documents, but there is nothing that is limiting you from creating any type of pen-based form, in any layout that suits your particular needs.

“We started our work initially in patient registration and informed consent forms, and it has progressed from there to things like the questionnaire that radiology technicians use to get a health history before an MRI.”

The company has also introduced clinical documents such as doctors' and nurses' progress notes, prompted in part by US legislation such as the Health Information Technology for Economic and Clinical Health (HITECH) Act, which gives incentives to healthcare providers to use EMRs more widely and encourages ”meaningful use” to achieve significant improvements in care.

The product interfaces with the hospital's EMR through common standards such as HL7 and CCOW (Clinical Context Object Workgroup), which allows disparate applications to present information at the desktop or portal level in a unified way.

“An HL7 feed from the clinical repository helps us keep our patient database up to date with demographics, vitals, and health history,” Mr Joyce said. “We are just leveraging existing standards. Most hospitals will buy an EMR system and then they come to us to fill in the gaps.”

Mr Burdette said that due to the nature of the medium, it has the ability to break down barriers between the clinician and the patient.

“When we talk about forms, almost ubiquitously a picture will develop in your mind of a structured form with boxes. But with this, you can break that mould and structure it any way you like and make it significantly more context-aware.

“By that I mean it becomes very relevant to the situation and the information you want to capture. It works with you as you move through the form, ensuring all the relevant fields are captured completely and correctly, which you can't do with a piece of paper. You end up with a very fluid, very relevant capture mechanism that improves the experience for both the clinician and the patient.”

He said there were a number of other innovations that the company was looking to bring to Australia over time using this platform.

“We'll also be looking at its applications outside of the hospital environment, for example in community and aged care in the home,” he said.

Posted in Australian eHealth

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