Academic journal article Australian Health Review

Digital Pen and Paper Technology Is an Effective Way of Capturing Variance Data When Using Arthroplasty Clinical Pathways

Academic journal article Australian Health Review

Digital Pen and Paper Technology Is an Effective Way of Capturing Variance Data When Using Arthroplasty Clinical Pathways

Article excerpt


The aim of this study was to test the effectiveness of digital pen and paper technology (DP&PT) to capture clinical pathway variance data in real time and at the point of care for patients on an arthroplasty pathway.

This study was conducted across multiple departments providing orthopaedic services in a public health care facility. Treating clinicians were required to record variance data on a predefined coded template, and these data were uploaded to a database for analysis and reporting. The information could be represented in a web-based user interface for immediate review.

User acceptance, length of stay (LOS), accuracy of data, and reliability of the DP&PT hardware were measured. User acceptance was high; LOS reduced; and the data and hardware were, respectively, found to be accurate and robust.

This technology provides a dependable, real-time solution to transform handwritten clinical data into a digital format. The data available will help inform clinicians of areas for clinical practice improvement, and provide ongoing monitoring of care processes for patients on a clinical pathway. Future studies should aim to assess if using this method to capture variance data is a more efficient and effective means of informing clinical decision making than retrospective review pro cesses.

Aust Health Rev 2009: 33(3): 453-460

THIS PAPER PROVIDES a case study of an investigation testing digital pen and paper technology (DP&PT) and its effectiveness in capturing realtime variance data for patients on an arthroplasty clinical pathway in a hospital setting.

Clinical pathway (CP) variance is defined as any deviation from the expected outcome for the diagnosis-related group for which the pathway applies. This variance capture is important, as analysis of variance from the stated path is a sophisticated means of providing quality control in health care delivery, and therefore patient care.1 The reasons behind a variance occurring can be multifactorial. Therefore, to have an effective clinical pathway program, variance analysis must be included as a quality activity to measure the effectiveness of the pathway and the care processes delivered to a patient.

Yet health care organisations rarely collect variance data. In one study, only 4% of health care agencies with CPs implemented also had a process for analysing variance.2 More recently, a local survey evaluated the uptake of clinical pathways and variance management in all Queensland public hospitals, revealing that of those hospitals using CPs, only 5% were able to complete variance analysis. The barriers to completing variance analysis in these hospitals were found to be multifaceted, including lack of human resources (commonly, Local Project Officer returned to normal duties), lack of clinical relevance in the code set (see Box 1), cumbersome manual processes for capturing data, or lack of an electronic information system.

DP&PT is relatively new to health care, and evidence of its uptake is limited. However, application of this technology appears to deliver an efficient and effective means of capturing data in the clinical setting. DP&PT has been increasingly used in clinical settings as there is little change management or technical education required.3 In several European health care facilities, improvements in real-time data capture in clinical environments using DP&PT have been observed, for example in emergency departments and cancer screening. These organisations have identified benefits for the quality of patient care and for the organisation. These are:

* Readily accessible critical patient information

* Improved data accuracy

* Highly accurate data entry resulting in the elimination of misdiagnosis

* High level of clinician acceptance as the process is intuitive and natural, therefore easy to use

* Eliminated need for clerical data entry assistance

* Improved billing processes. …

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