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Paper, Paper Everywhere but Not a Drop of Ink Commentary 

Paper, Paper Everywhere but Not a Drop of Ink

A recent article on medium.com titled “UCSF Nurses Want Someone To Build These Products” By Fiahna Cabana, Desiree Matloob, and Priyanka Agarwal includes the following:

‘Frontline nurses attend to almost all of a patient’s basic needs. In doing so, they often juggle up to 25 pieces of paper with critical information. Ideally, nurses could use charting software that would help manage and streamline all this information.’

While hospital EHR software has gone a long ways toward eliminating paper, there are still a lot of paper forms populating the average hospital environment. A survey during an implementation of an EHR system in a small California hospital showed that the busiest area in the hospital was the medical records room in which many documents were added to patient charts using high speed scanners.

While EHR systems have done away with CPOE and many other functions, these instances would indicate that there is still a ways to go if we are going to truly be paperless. One of the big problems is that every hospital has its own set of paper forms, some of which are difficult to develop in software and there is a constant need to add new ones or reformat existing ones. This makes building computer screens to replicate them a never-ending job for programmers.

At least one EHR company, EHRI Inc. has developed a technology that takes a big step toward solving this problem in what they describe as Electronic Clinical Documents (ECDs). The underlying concept for ECDs is that any clinical document can be made into a computer process without programming and share information with any part of the clinical database. This includes reading information from the database into the document and placing any kind of order from within the document. It also includes capturing drawings, patient signatures, and pretty much any kind of data. Furthermore, the data captured in an Electronic Clinical Document can be reported on as discrete elements even if the document structure changes over time.

This is not like filling in a PDF file, but more like building a custom software app for a mobile device that has its own internal logic without having to write any software code. The underlying technology for this is an XML interpreter written by Kiko Taganashi, one of the EHRI programmers and has many unique capabilities not the least of which is the data storage itself. When a clinical document is complete (a partially complete one can be stored on the mobile device), the data is stored as part of the XML structure so that any document will appear in its original form.

While the user sees a very simple-to-navigate format, the underlying technology is quite complex and took a number of years to perfect. Today, it is serving the needs of a wide variety of documents including order sets, nursing assessments, exams, evaluations, patient consent forms, and many others.

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