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Anoto Digital Pen and Paper to the Rescue – Saving Medic Ambulance Services’ Paramedics and EMT’s Time

Photo of Michael Frenn
EMS agency administrator for Solano County  

August 30, 2011 - By Margaret Beigle, Contributing Editor

Michael Frenn is the EMS agency administrator for Solano County and is president-elect of the Emergency Medical Services Administrators Associations of California was tasked with the goal of dramatically reducing the time that it’s county’s 90 plus  paramedics, EMTs and fire fighters spend on the routine administration associated with document creation, the processing of their Patient Care Forms, manual data entry and improving the accuracy of the data during the data entry process. 
Solano Country EMS agency together with its emergency service provider, Medic Ambulance Services, chose the unique patented Digital Pen and Paper invented by Anoto for creating electronic patient records for its approximately 20,000 calls it responds to in a year’s time because of its accuracy, ease of use, and affordability. “Medic Ambulance Services is by far our largest paramedic service provider with the largest number of patient transports for the county, operating some 12 – 16 units and responding to about 20,000 calls a year. The next largest volume of calls our community service team responds to would be from our fire stations that responds to approx. 6,000 – 7,000 calls a year. We needed a data collection tool that would be 95% - 100% accurate especially with our paramedics transporting such a large volume of patients. We started with the Digital Pen and Paper technology in some field trials, which turned out to be very successful,” said Michael Frenn, EMS Agency Adminstrator for Solano County, California.  The Digital Pen and Paper is not only being used by Medic Ambulance Services but also by a few of the county’s fire stations as well. “It a proven solution that we now have been using for 2 years,” added Michael.
Prior to the implementation of the Digital Pen and Paper, Paramedics would fill out a patient care form and provide a hard copy to the hospital and also to the SolanoCounty’s EMS station. A clerk at the station would than take that hard copy patient care form and would manually enter the patient’s data into a patient care records database developed by Toomay Technologies. “There were significant delays from the time when a Paramedic would document a patient’s condition to the time when the patient’s data would be entered into our database. Additionally we found that there were numerous discrepancies with the accuracy of that data during the data entry process which was partly because a non medical person would be trying interpret the information on the form and partly just due to human error in manually entering the data,” said Michael.    
Since the implementation of the digital pen and paper, the paramedics, fire fighters and EMS department can automatically have both the hard copy and electronic version of that hard copy close to instantly. The hospital still gets a hard copy but Michael Frenn’s vision for the future would be to have the digital pen data uploaded at the hospital and integrated with the hospitals’ records. This would mean that an electronic record would be created instantly at the hospital as well. Back at the station, the digital pen would be docked to a USB port on the computer and the patient’s data uploaded to their patient care database.   Michael brought together Tim Toomay of Toomay Technologies and Arthur James of IS2BE, to collaborate in integrating the digital pen and paper with electronic patient care records database.   “It was a real collaboration and the coming together of ideas and vision. Tim of Toomay Technologies and Arthur of IS2BE did a great job in working together to integrate the two applications to operate together,” said Michael.  The Digital Pen and Paper System was configured by IS2BE and customized to be integrated with Toomay’s database.
“Using the Digital Pen and Paper Solution made perfect sense to us from two perspectives. The most important perspective is that the patient’s care information is being transcribed directly from the paramedic as opposed to someone else who without the digital pen and paper would be manual entering the data and trying to interpret the paramedic’s notes. The use of the Digital Pen and Paper eliminated the need to manually enter the data but even more importantly it eliminated the chance of getting incorrect interpretations of that data,” stated Michael.  The station has always emphasized the importance of data integrity and accuracy, conducting periodic audits on the pen and paper efficiency and effectiveness. “I liked how the digital pen and paper technology allowed us to create quickly an electronic record that could be easily emailed to our compliance and data integrity group. It saves us time,” continued Michael.    The compliance and data integrity group cross references random records with the actual health assessments the paramedics made onsite.   The Patient Care Forms are printed on the patented Anoto paper which serves as the hard copy and works in conjunction with the digital pen in creating an automatic electronic record.
“The second perspective is that it is also very quick, saving us time because the paramedic can complete the form so that I have a hard copy of the form and immediately an identical electronic record of that same form as soon as the information is uploaded from the digital pen. There is a quality assurance factor here that is important to note. The timeframe from when a call occurs to the time the data is transmitted electronically is significantly shorter,” add Michael.
The EMS agency tracks statistical information for all calls which is defined as yes/no answers or providing numerical information such as how many IVs were given, or a yes/no answer to whether the patient was unconscious or not, whether they experienced chest pains, etc. Statistical data is considered concrete answers.   The digital pen documents this digital data that helps them track not only how many calls they respond to but what exactly occurs during the transportation to the hospital process. A form is used to collect patient records. Paramedics checks boxes on the Patient Care Form to capture all statistical type patient data that is used for quality assurance and assessment. The Patient Care Form includes various types of fields such as check boxes, free text and boxed fields. There is also analog or non digital data that Paramedics document tend to be their notations describing additional details and specifics to the incident. “The digital pen is extremely good at replicating what a paramedic writes as a narrative on a patient and can store it as part of the electronic record which can be referred to later but is not included as part of our statistical data nor interpreted as such,” said Michael.  
The EMS Agency for SolanoCounty has concluded that the Digital Pen and Paper technology integrated to their Toomay Technologies healthcare database provides an attractive solution for all emergency service organizations that have to contend with balancing service delivery, the technology that supports these initiatives with the resource constrained budgets emergency service organizations have to work with. Michael Frenn, a thought leader in his industry, hopes to realize his vision in having a completed autonomous patient care environment where the emergency fire and ambulatory systems are seamlessly integrated with their hospitals’ EHR systems. 
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