Paper as a User Interface

The last session in this afternoon's adventure is a discussion of how OCR was used to populate an EMR.

It's a good talk.

He reviews how a paper template can be used to provide decision support and improve the quality of data entry.

They developed the concpt of "adaptive turnaround documents."

Aftern the patient checks in, a form is generated (based on a patient questionnaire that the patient fills out – and patient demographics) that the nurse and then the physician will fill out.  So the clinical staff get a custom developed form that helps them focus on issues that the rules engine thinks are important. 


So the kid with asthma gets a different form from the adult with diabetes.


  1. Patient checks in
  2. Patient gets the survey
  3. Nurse gets the patient (with the form)
  4. Nurse gets the form and scans it into the "Digital Sender" (HP4101mfp) and the device e-mails the scanned image to the OCR server.
  5. System reads the form and determines it slevel of confidence about each item.
  6. The system then creates a form based on the inputs from the patient survey

They did a fairily thorough of QA and observation of how the system worked from a workflow standpoint.  Research findings:

  1. 224 forms completed in a 6 day study period
  2. 98% or so were completed
  3. 98% were accurately scanned
  4. It took 25 seconds to generate the form
  5. 43% of the forms required some correction
    1. The software prompted the nurse for corrections and/or confirmation – the average was about 1 .4 fields per form. 
    2. This took about 10 seconds per form.

Soooo ..

Here's the punch line .. they can now alert the doc to clincial problems.   The doc is prompted:  "John has a BMI of 12 – you may want to consider malnutrition."

Interesting.  He's got other thoughts about faxing forms to teachers for ADHD evaluation, etc.  Cool.  Medical Informatics with paper.


2 thoughts on “Paper as a User Interface

  1. I teach high school computer science.

    Instead of paper, and the OCR process, anyone working on this think about figuring out a way to have the patients/parents and teachers to do this electronically. And find a way to make it painless?

    FYI: Those ADHD evaluation forms generally make me want to run screaming from the room. The last one I did was two pages of check marks. All I need is another piece of paper I have to deal with. Especially since THAT kid usually gives me lots of paper to deal with … phone messages, potential failure notices, discipline referrals, attendance signin sheets …

  2. I like that. The idea of a simple method of focusing information is wonderful. Its what I expect from EMRs, and I like being reminded you don’t need EMRs to get it.

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