Emergency responders at disaster sites have a difficult problem -- organizing patient data quickly, in a rapidly evolving, stressful environment. Adding an electronic health record (EHR) system to that scenario adds a layer of complexity.
Pocono Raceway’s executive director of medical operations Michael Wargo -- who also serves as emergency operations administrator for nearby Lehigh Valley (Pa.) Health Network, the raceway’s official medical sponsor -- has found a solution to that problem with digital pens that sync data to an EHR system. That’s a tall order, as Pocono, a NASCAR track, attracts six-figure crowds for Sunday Sprint Cup races and 200,000 over the course of a six-day event leading up to it. The system features T-System Inc. DigitalShare software, Shareable Ink Corp. paper forms and Anoto Inc. pens, which capture writing strokes, store them digitally and later can be read to the T-System EHR Web portal.
While the bulk of the forms use basic yes/no questions and answers -- signified by "0" and "/" to speed data entry and ensure accuracy in sync -- physicians, nurses, paramedics, EMTs, administrative staff, medical technicians and other personnel using the forms also write longhand for data points such as patient name and street address. Handwriting recognition software digitizes it upon sync -- making it live, editable text in the EHR system, as opposed to a non-searchable "flat" image, such as a fax.
Disaster planning requires hybrid digital, paper workflows
Paper wasn’t ideal for Pocono Raceway, Wargo said, as the emergency operations team wanted more than just scanned PDFs for its records system. At the same time, setting up laptops or PC workstations -- and the network infrastructure and Internet access to administer them -- was "too cumbersome" for a disaster site.
So Pocono Raceway settled upon this hybrid paper-electronic clinical workflow. It works well for field work at disaster scenes -- after all, patients often move around as they are treated -- and can interact with multiple practitioners. Having that paper record to move around with them is crucial. It's more portable than a laptop or even a tablet such as the iPad, which the team dismissed as beyond its means, anyway.
At the same time, Wargo added, having the electronic component of the patient record ensures information isn't lost. It also gives incident command center (ICC) leaders a read on how many patients are and where they’re located, as well as the nature of their health issues. That makes ICC leaders better able to allocate resources and, after the event is over, conduct analytics on the scope of the disaster's toll.
The combination of digital pen technology, paper form and EHR software "translates the data into useful information for us, after the event and during the event if we chose to," Wargo said. "For a mass casualty event where we're treating multiple patients -- and that can be anywhere from five patients to hundreds of patients -- [the] registration form captures demographics and facts about the incident that we can tally and cluster and do surveillance from. For instance, if it was a sporting event and we had people coming in with GI upset, we might be able to track on the registration form clusters of people maybe with food poisoning."
The combination of digital pen technology, paper forms and EHR software translates the data into useful information for us, after and even during an event.
Beyond that, medical treatment forms then cover the usual medical chart data, such as treatment, physician orders and nurse follow-up. Responders can also document consent to care in the forms if and when they are able to get it from the patient.
After the fact, analytics can help for future planning purposes, especially if it's a regularly occurring event such as the Pennsylvania 500, Pocono Raceway's annual NASCAR Sprint Cup race. Analytics can reveal how supplies hold up or if injury/illness trends point to a particular risk -- an area of the track where multiple spectators fell and got hurt, for example, which would require repairs or upgrades to grandstands.
Luckily, Lehigh and Pocono Raceway have not been forced to use the system in a mass-casualty event. For required disaster planning drills, Wargo and his colleagues have tested and refined their implementation of DigitalShare at actual race events, using it for the routine care they administer on site.
So far, so good.
"For a race event, because it's planned, I like to term it a 'controlled disaster,' because potentially it's a mass-casualty scenario -- it's controlled chaos," Wargo said. He said the data gathered and analyzed over several past race weeks has been very helpful in determining where to position responders and how many people, and what kinds of ailments, to expect to treat.
Next up on their data analytics plate is working with T-System to compare the efficiency of pure paper workflows on the race site versus the workflow using digital pen technology to prove the latter's return on investment.
Handwriting recognition, digital pen technology to push EHR adoption?
While the handwriting recognition software isn't perfectly accurate yet, Wargo said it's still pretty good. In the future, he thinks it could be an answer to a particularly vexing problem for health IT leaders working to get 100% compliance in EHR adoption -- reeling in outlier physicians who either can't, or won't, learn to type.
"So far we've had pretty good success with it. We haven't had any critical errors at this point; the minor changes that have been required have been pretty insignificant from our standpoint," Wargo said. Some nurses and doctors have further suggested that the health network get rid of their PCs and laptops back in the hospital and adopt digital pen technology instead. That's not possible from a business standpoint yet, because the computer-based systems can capture much more detailed patient data, he said.
But there's potential for the future of handwriting recognition software in general, Wargo believes, for health care.
"Quite a few physicians, as well as myself and others on the leadership team, we don't have impeccable handwriting. We're pretty sloppy, our minds are thinking faster than our hands can write -- that's typically why we have scribble-writing," he said. "The system has done a pretty impeccable job interpreting our handwriting…I think the technology's being used and acknowledged a lot more. Handwriting recognition and speech recognition -- that's the wave of the future."
Correction: The original version of this story misstated the relationship between T-System Inc. and Shareable Ink Corp. The story has since been updated.
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