Digital pens serve as some physicians' bridge to EMR

Alexander Stemer, MD, president and CEO of Medical Specialists Centers of Indiana, said that even as the practice converted to an electronic medical record system, it "wanted to preserve the quality of physician-patient relationships by not subbing face time with screen time."

He said most physicians, especially those who have been practicing for many years, have developed a style that involves sitting with patients and writing clinical notes on a clipboard. The practice was looking for ways to balance the physicians' needs with meeting Centers for Medicare & Medicaid Services guidelines as well as meaningful use requirements to make the data quantifiable.

The multispecialty group, which has 13 locations in Northwest Indiana, decided on a bridge that had the potential of becoming permanent: a digital pen integrated with its EMR system.

Several EMR vendors recently launched their own versions of the digital pen aimed at reducing the frustration involved with getting rid of the standard clipboard. A few of the products were announced at the annual Healthcare Information and Management Systems Society's conference in March. Since then, several more partnerships have been announced with Anoto, the Swedish creator and patent holder of the digital pen technology used by most EMR vendors.

Implementing an EMR is a complex undertaking with many barriers, said Harry Greenspun, MD, senior adviser of health care transformation and technology at Deloitte's Center for Health Solutions. "Anything that can be done to lower those barriers is, in my view, a good thing."

The technology works by placing a camera in a pen that captures what is written on special paper designed with a dot pattern. The content on the paper can be converted into a variety of digital data. It could become a computer file that would show a picture of what was written. Or the handwritten text could be converted to typed text and pushed into an EMR.

Purchased alone, a digital pen can cost $100 to $200. But when used with an EMR, the price will depend on the overall system and the digital pen applications used.

Medical Specialists Centers of Indiana is using the pen to streamline clinical documentation. The practice worked with Shareable Ink, a Nashville, Tenn.-based EMR vendor using Anoto's technology, to reprint its documentation forms on the special dot paper so physicians still could use their clipboards during clinical visits.

Once the visit is complete, the pen is placed in a docking station connected to the computer. The data contained on the forms are uploaded into the EMR and can be culled for analysis and reporting, a component of meaningful use criteria.

Dr. Stemer said even though physicians don't have the best reputation for good penmanship, the pens still capture the data quite well, because most of the information consists of checked boxes and circled answers. Doctors also approve the accuracy of the data before it is entered into the EMR. He said he has a 99% accuracy rate with his own notes, but acknowledged that his rate is higher than many of his colleagues.

Anoto said accuracy rates vary depending on the partners' individual applications. Steve Hau, CEO of Shareable Ink, said its application has an accuracy rate of nearly 100% for checked boxes and 94% for free text. But the pen "learns" nuances of users' handwriting over time, improving accuracy levels the longer it is used.

Primary Care Physicians, a multispecialty practice in New York, has added digital pens -- but for patients, not physicians.

Allen Boxbaum, chief administrative officer of the group, said the practice decided that the best course when converting to a new EMR would be to rely on patients to populate the data fields that contain their histories. The standard patient history form, with questions and check boxes, is put onto the digital pen paper. After patients complete the forms, the digital pens they use are docked and the data are uploaded into the EMR.

The practice plans to expand how the pens are used. Boxbaum said patients may use them to fill out self-reported symptom-review forms. "And we don't see this stopping," he said. There also are plans to move the health information exchange consent forms to the digital pen so they won't have to be manually scanned in the patient's record.

Dr. Greenspun said digital pen technology could be seen as an unnecessary layer of the EMR. But for others, it may be the only thing that makes an EMR usable.

"It's about giving the right tools to the right providers for the right purpose," he said.