A Feasibility Evaluation of a Digital Pen and Paper System for Accomplishing Electronic Anesthesia Record-keeping

Abstract

In 2001, the Institute of Medicine stated that one of the parameters needing to be addressed to improve health care was the creation of electronic health records for all patients. This goal has proven to be very challenging to health care providers. Many barriers exist that prevent the goal of computerizing health records such as high costs, usability problems, interface incompatibility, and fear of change. The purpose of this feasibility project was to evaluate the usefulness and acceptability of a digital pen and paper (DPP) system for anesthesia documentation. The specific DPP technology used in this evaluation was a product developed by Shareable Ink®. Seven certified registered nurse anesthetists (CRNAs) evaluated the DPP system through a cognitive walkthrough procedure. During the cognitive walkthrough, the participants talked aloud as they carried out a series of anesthesia documentation tasks. Just prior to the cognitive walkthrough, participants were given a questionnaire that measured their perceived computer knowledge, attitudes and skills. After the cognitive walkthrough, a second questionnaire was used to determine their satisfaction with the DPP and their opinions about its usefulness for use in multiple anesthesia work settings. In the second phase of the project, I interviewed other stakeholders in the hospital environment who would also be affected by implementation of a DPP system. This portion of the study was conducted at a community hospital without electronic record-keeping capability. Participation from several departments was sought via contact with hospital administration and department heads. Among those departments targeted for interviews were: Information Technology, Chief of Anesthesia, Anesthesia Billing, Medical Records and Nursing. Semi- structured interviews were conducted and the responses of the participants recorded both as field notes and via audio recording. This intent of this study was to test the feasibility of the digital pen and paper system for various types of anesthesia work environments by means of descriptive, survey and qualitative data analysis. Overall, the device was not only found to be usable by providers but also acceptable to stakeholders. Therefore, this device could be deemed a feasible solution toward implementing and adopting electronic documentation in some anesthesia work settings.