The Limited Use of Digital Ink in the Private-sector Primary Care Physician's Office

Abstract

Two of the greatest obstacles to the implementation of the standardized electronic medical record are physician and staff acceptance and the development of a complete standardized medical vocabulary. Physicians have found the familiar desktop computer environment cumbersome in the examination room and the coding and hierarchic structure of existing vocabulary inadequate. The author recommends the use of digital ink, the graphic form of the pen computer, in telephone messaging and as a supplement in the examination room encounter note. A key concept in this paper is that the development of a standard electronic medical record cannot occur without the thorough evaluation of the office environment and physicians' concerns. This approach reveals a role for digital ink in telephone messaging and as a supplement to the encounter note. It is hoped that the utilization of digital ink will foster greater physician participation in the development of the electronic medical record.

A primary care physician perspective survey on the limited use of handwriting and pen computing in the electronic medical record

“…Speed, fluency and accuracy are necessary in telephone documentation. 2,32,36 Halam's study indicated that telephone contact accounts for 20% of a PCP's workload. 36 Richards indicated that these documentation attributes are necessary to prevent future misunderstandings, which may lead to litigation.…”

“…Concern about typing by physicians is commonly reported but physicians in private practice are equally concerned about inadequate staff typing abilities. 2 A 20% drop in gross collection percentage over the last 15 years in the US has reduced disposable income and has compelled many small practices to use part-time and poorly trained clerical help to record telephone messages. 44 The use of handwriting in the form of digital ink would facilitate staff training and allow for accurate message recording because of the fluency, speed and accuracy of the written language.…”

“…As has been demonstrated by many investigators, interference with normal workflow processes meets with considerable resistance. 2,14,16 Several studies have demonstrated that care in considering interface design can improve usability dramatically. Lussier demonstrated that by adding handwriting to the medical record via a pen computer with digital ink, user satisfaction and usability were increased.…”

“…1 The author previously reported on the use of handwriting (in the form of digital ink) and pen computers in the EMR. 2 The report considered its utility in telephone messaging and data entry of unstructured information in the consulting room. Key arguments for the use of handwriting and pen computers are that, in telephone messaging and in the entry of unstructured information in the consulting room, better user acceptance leads to a more complete and fluent entry.…”