Rethinking the Paper Trail

Armin Moradi

2020-05-26

Thank you
Old Paper Trail
From OMG! to GMO.
Live Demo
Future
Discussion, Feedback, QA
Thank you

Thank you

Dr. T. Peluola
Dr. N. Patel
Dr. K. Reddi
Christina Skibinsky

Old Paper Trail

Overview

January 2020
30 Form G
10 Form M
17 Form O

Issues

Unhelpful naming for cataloguing

Issues

Illegible handwriting

Issues

Scanner failure

Issues

Errors and scratches

Issues

Missing fields

Issues

Repetition
date x7
name x5
location x3
patient residence x2

Issues

Old forms are a hazard

Issues Summary

Workflow

Advantages

Well-known
Easy to deal with
If it ain't broke, don't fix it

From OMG! to GMO.

But it IS broke!

So the question then is, how do we fix this? As I mentioned earlier, all these tasks fit a machine more than they do humans. So We've tried to enlist the help of the most common computation machinery we have access to, and that's the all-too-familiar personal computer.

I believe almost everyone here has had an opportunity to work with digital EMRs and knows how terrible they all are. Even the best ones I've heard of are clunky, unintuitive, and a hassle to use. That's mostly due to how they try to replace the paper trail, and not work with it.

For this pilot project, we've opted to instead work with the humans than against them. After all, I like to be efficient, I like my wrists when they're not in pain or fatigued, and I'm as far as I know at least 50% human. Excluding microbes.

Out with the old, In with the old

Accessible
Fast
Easy

The old is not going away, it's just pumped full of steroids!

So we set out to create a simple page – I won't call it a platform, I won't call it an app, and I certainly won't call it a lifestyle – just a simple page that replicates what we already have to the letter, but augments the functionalities a paper provides in an intuitive way.

The great thing about this page is that it integrates all three forms (G, M, and O), and only adds, but does not subtract what's already there. It's possible to simply print the page blank and you'll get a clean Form GMO stack of paper to fill it out as you've already done, or you can type away to your heart content and only print it for your signature. And everything inbetween, of course. The signature is required, so eventually there will be our beloved paper trail.

The page is accessible as in it can work with any reasonably modern free browser running on even old hardware. I tried it on a 400MHz computer with 256MB RAM and it functioned well. It's amenable to all the accessibility technologies that the paper can't provide such as screen readers, magnification, text to speech, and other assistive devices for our colleagues who may require those devices. It's fast, does not use extra scripts, does not track, and generally doesn't really do anything beyond what you see, and you'll see what it does shortly. And it's easy to use or not use: it gives you the choice to either use it or not, and if you decide to use it, it gets out of the way.

New Workflow

The paper trail is the king!
Long live the king!

The workflow is not much different than the old workflow. As you'll see shortly in a possibly-broken live demo, the form is the same, the fields, the look, even the logo is exactly where you'd find it on the paper forms.

At its most basic form, all one needs to do is to print the page. That's it. Double click, print, done. And things will be just as they have been before. Except, now some of the fields are already filled in, and that's the date field. The computer knows the date, says hey, I already know this, I'll fill it in for you, don't worry about it.

On the other side of the spectrum, the form becomes a little less-than-sentient and actually helps. The page recognizes the fields that should have the same content, such as patient name, address, next of kin information, and remembers the physician who was entered last and continues to fill that until a new person is entered.

So, the first time you enter a patient's name, or the date – although that's automatically entered, but you can still change it – all the other fields that are supposed to be the same get updated in real time. Or, again, you can fill them in yourself, but you don't have to. Instead of spending 15 minutes writing repetitive information, you can spend 20 seconds filling this form and spend the rest with the patient, which I believe would be a better use of time.

Another great thing about digitizing Form GMO is that the layout doesn't have to stay the way you see it on paper. So what I've done is add a small section with all the relevant information that's required at the very top, and that information is read and copied to relevant parts of the actual form. But when printed, the top section disappears, and the printed media looks exactly as the Ministry of Health intended.

Disadvantages

None

Disadvantages

I may be biased

Live Demo

Future

Where do we go?

This was just a pilot project, but there is a lot of potential here. Beyond rescuing my wrists from the tyranny of the pen, I wanted to also generate a little discussion on how digital forms don't have to be PDF, they don't have follow the same rules that paper follows, and they don't have to be cumbersome to use, like SCM's form which, after 5 years I still don't know how to use, and I haven't seen anyone actually use them either.

Digital forms can help, they can increase efficiency and they can be opt-in as opposed to all-or-nothing. It doesn't have to be an all digital vs all paper fight, it can be the best of both worlds, we can have people choose how much keyboard and how much paper they're comfortable with and let them work the way they see fit.

This form is now available, but I'm working on having it approved for use in ER. As soon as it's approved, I'll let our fantastic nursing staff know and I expected that knowledge is going to be propagated to whoever is on call. I've already received positive feedback on the forms, I've used it a few times, although had to recycle the papers and it's quite pleasant.

Rethinking the Paper Trail

Armin Moradi

2020-05-26

Table of Contents

Thank you

Old Paper Trail

Overview

Issues

Issues

Issues

Issues

Issues

Issues

Issues

Issues Summary

Advantages

From OMG! to GMO.

Out with the old, In with the old

New Workflow

Disadvantages

Disadvantages

Live Demo

Future

Discussion, Feedback, QA

Thank you