Note to hospitals: The pen is mightier than the data entry worker

Shareable Ink is hoping to popularize a camera-in-a-pen that wirelessly transfers text written on paper to a remote database to better track such data as glucose levels.

(Credit: Shareable Ink)

It all started when anesthesiologist Vernon Huang wanted to figure out a better way to streamline his billing. How could he bridge the gap between what's written on paper and what must be entered into an electronic database?

Huang, who's clocked in time as a senior manager for health care markets at Apple, designed the application for a digital pen whose tiny camera embedded right next to the ink cartridge captures every stroke of the written word on film and whose images are uploaded wirelessly and automatically to a remote database.

He knew such an invention has a range of applications well beyond billing, and founded Shareable Ink (headquartered in Newton, Mass., with a branch in San Mateo, Calif.). Medgadget caught up with Huang at TedMed and posted a shaky but informative demonstration:

There is, of course, competition. German company Ontaris is already using this kind of technology for DiabCareOnline, allowing people who need to track their glucose levels regularly but don't always have access to the online forms--or perhaps don't know how to use a computer at all--to simply fill out a form by hand whose numbers autopopulate for the physician's review.

Huang lists emergency care and anesthesiology as fields with obvious early, but clearly not exclusive, adopters. "Anesthesiology is our low-hanging fruit.... Once people see this technology they really start to brainstorm various ways to use it," he tells me by phone today.

I see this pen migrating all over, and well beyond, the medical field, especially because it is the pen, but not the paper, that is special.

[PiCASSiMO]

Interesting... I'm curious how the pen recognizes the exact location of the where it makes contact with the individual pages, aside from what was written on the page.

[vwhuang]

The paper has a microscopic, proprietary pattern, printed on the background. The pattern mathematically defines a vast enough "geography" to ensure that each page is unique. Any time the pen writes on the paper, the strokes are recorded.

[dinkeldorf]

So the secret sauce is defiing the online form, and it's prtined (on site) counterpart prior. <br /> <br />Do regulations treat this as a scanned record, and the signature as the authentication? <br /> <br />For this to work / clinical adoption, all forms for a practitioner would need an online and printed counterpart. It's an interesting bridge, but would it preclude or delay full adoption of EMR / EHR?

[vwhuang]

dinkeldorf: The system creates much more than a scanned record. Not only is a PDF image of the paper generated, but actual discrete data elements are entered into the EMR/EHR. In essence, the paper becomes the most natural data entry method into the EHR system of record. Encryption and two factor authentification ensure that the data are compliant with regulations.<br /><br />The system will not preclude or delay an EMR. On the contrary, it will speed adoption. "Meaninful Use" does not specify a data input modality. This can create a win-win scenario allowing the provider to meaningfully use an EMR without destroying the workflow.

[Gabey8]

For this to work, the person writing with the pen has to jot the correct info down, too.<br /><br />If they have a dyslexic moment and transpose some digits, for example, they have to be able to go back and fix the error (if they realize they made it). Otherwise, the error will go right into the computer along with the valid data.

[debasisg]

If the communication is encrypted the signature should be recognized as authentic. In my experience, every country has different forms of regulation/restrictions on privacy, authentication etc. In the US context, it should not pose a problem. One thing here is actually better than traditional computer box-keyboard-mouse-driven model is that it is a natural extension of normal human communication and hence the signature is a real signature, not a memorized word that somebody can steal. In fact, in my expectation, we will very soon see proliferation of these technologies across the hitherto dinosaur medical practical practice world in terms of computerization. Important thing to note here is that people always thought that medical world is no special in terms of computer box-model adoption. And that is why it is relatively behind in computer technology.

[dinkeldorf]

I'm unsure that a tablet in a practise setting wouldn't be more usefulI, and would see this benefitting more CRFs in clinical trials. The non repudiation is addressed right there.

[kfelix18]

vwhuang please explain further. Is this a special paper or what? and does every hospital have to buy these papers from your company?

[vwhuang]

It's standard paper printed on-site using a off the shelf laser printer. In fact, no software is installed on the end user site. Hospitals print forms out on site, on an as-needed basis. If a new regulatory standard or quality measure is imposed, there is no need to do a lot of heavy coding. A change to the master document means every form printed thereafter will be compliant with the new regulations.

[dinkeldorf]

vwhuang: thanks for the response. I get that it's brought in as data. I was curious as to which is the "master". The paper or the electronic? Do they then have to "sign" the electronic also? <br /> <br />Don't get me wrong, this is awesome.

[vwhuang]

Thanks! I think it's pretty awesome as well. <br /><br />You raise a good point about the equivalency of the paper and electronic record. The answer to that question depends on the state and state medical boards policies and adoption of the Uniform Electronic Transactions Act as well as individual hospital policy.

[barbar1]

what is the difference between this and the following product http://www.logipen.com/lp/logipen_lp.php

[setjeff15081947]

Considering the state of affairs surrounding most Medical-Practitioners?' handwriting, I see this Wonder of Technology leading to plenty of work for the law firms of "Subway and Bus Poster". <br />Give this guy something useful to occupy his time. May I suggest Sharpening-Pencils?

[michaelejahn]

While the Anoto pen pattern can be printed on regular paper - it is a pattern that is printed 'behind' the form that enables the pen to work - the pattern is not 'microscopic' - you can see it with the unaided eye if you are young (I need my cheaters!) - to most people, this simply looks like a light grey tint.<br /><br />I use the Anoto pen every day. There are quite a few developers and service providers.<br /><br />http://docs.google.com/View?id=dfwf37zj_670g2jzdth8<br /><br />[e-mail]