Healthcare // Electronic Health Records
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8/25/2011
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EHR Vendors Give Keyboard-Hating Docs Pen Alternative

Digital pen technology becomes an option from more EHR vendors. Will it help doctors cross the bridge away from legacy process?

17 Leading EHR Vendors
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Digital pen technology--an alternative to keyboard-based data entry--is starting to make serious inroads in healthcare, according to Anoto, the Swedish company that manufactures the leading digital pen in the U.S. Most significantly, electronic health record (EHR) vendors are beginning to offer Anoto-licensed digital-pen applications as part of their hospital, ED, and ambulatory-care products.

Anoto partner Shareable Ink said it has integrated its application with the EHRs of Allscripts, Cerner, Epic, McKesson, and Meditech. Allscripts confirmed that it is offering Shareable Ink with its Enterprise EHR for large group practices and is in the process of implementing it with its Professional EHR for medium-sized groups.

In addition, NextGen, which recently acquired Satori Labs, another Anoto licensee, has incorporated the NextPen digital pen derived from Satori into its EHR for clinical documentation. Previously, NextGen clients could use NextPen only with electronic clipboards to capture patient-entered data.

Anoto's digital pen uses a tiny camera to take pictures up to 70 times a minute as the user writes on specially designed paper forms. Then, by employing a docking station or built-in Bluetooth capability, the system converts the images to electronic data that is uploaded to an Anoto-compatible application.

Shareable Ink utilizes the digital pen to scan notations--either checks in check boxes, slashes or circles around words--on paper templates. It also can convert handwriting into typed text. The information can be sent into discrete fields in the EHR that match those on the paper forms, or it can be imported as a document into the document management module of the EHR.

Stephen Hau, president and CEO of Shareable Ink, said that his company's clients use both modes of data entry, although they are leaning more toward discrete data. Not only is discrete information required to show Meaningful Use of EHRs, but it will also be needed as quality-based reimbursement evolves, he pointed out.

Allscripts has a proprietary interface that allows Shareable Ink to "push and pull" data back and forth between the EHR and the digital pen application, Hau said. As a result, the Allscripts practice management system can send demographic information that prepopulates the printed forms used by Shareable Ink.

Shareable Ink can use the captured data to calculate billing codes and alert doctors about missing information both in Allscripts and other vendors' EHRs, Hau noted.

There seem to be two reasons for the increasingly popularity of digital pen technology. First, when it's used with electronic clipboards, the digital pen enables practices to import patient-entered data about medical histories and current complaints directly into their EHRs, reducing the need for costly manual data entry. Second, it can help physicians bridge the gap between their handwritten notes and the structured data required in EHRs.

In hospitals, Hau said, most physician notes are still being captured on paper. It's difficult to get doctors to switch to template-driven EHR documentation because it slows them down. "The digital pen is kind of a bridge where we can piggyback the legacy processes, and we also generate discrete data," Hau told . "So it's a nice way to get to where they need to be without a lot of change in workflow."

Nevertheless, digital pen technology is not a substitute for the traditional EHR, noted Roy Feague, director of technology for NextGen. Ultimately, a clinician still needs to use some kind of computer to access the data. Moreover, he pointed out, some specialties and settings are more suitable to the digital pen than others.

For example, he said, NextPen seems to be catching on fastest with specialists who do a lot of drawing, such as ophthalmologists and dermatologists. The digital pen can easily capture those drawings in color and export them to the EHR. In addition, physical therapists like NextPen because it's an easy way for them to do routine documentation of training exercises when they're not near a computer, Feague said.

In Feague's view, the digital pen would be less useful for primary care doctors because they'd have to use so many paper templates to document the many kinds of cases that they see every day. The digital pen makes more sense, he said, for specialists who do a limited number of things over and over again.

Emergency-department physicians also see a great variety of cases. But they're working in such a fast-paced environment that it's difficult for them to use keyboards and drop-down boxes to document patient care. Not surprisingly, T-System, a company that sells both paper documentation templates and EHRs to EDs, offers Shareable Ink's system as an adjunct to its EHR. NextGen also is considering using NextPen with its ED EHR.

Feague said that digital pen technology is less well-suited for electronic prescribing or lab ordering than for documentation, partly because decision support tools would not be available at the time of ordering. But NextGen is working on a way to apply the NextPen to computerized physician order entry, he said, adding that it could be available within a year.

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