Evaluation of dpp technology within a public hospital
Evaluation of digital pen and paper
(DPP) technology within an acute
Imagine a nurses station in a hospital ward
(except less smiles, more mess and patient files everywhere except where
they’re meant to be kept)
The missing patient file is a problem
• Of course, it isn’t really missing.
• It’s either being used by one of the many health
professionals assisting with the care of the patient.
• Or it hasn’t been returned to its rightful place.
• Or it’s with the patient at x-ray, theatre or anywhere
else that the patient is and their notes are required.
Is there a solution to the ongoing search
for a patient file?
• Electronic medical
records (EMR) are already
available, however the
nature of work on wards
has not yet allowed real-
time information transfer
using this system.
• Digital pen and paper
(DPP) technology is one
solution to bridge this gap http://farm3.staticflickr.com/2473/35
What are its features?
• A regular ballpoint pen
• With an integrated digital
• Using specially printed paper
with nearly invisible uniquely
sequenced dots to accurately
duplicate exact location of
writing on paper
• Incorporated memory for up to
50 sheets of A4 paper
• The pen wirelessly connects to a
smartphone or tablet via
bluetooth. Or alternatively can
be docked via USB to PChttp://www.inphoactive.com/capture-
• If the surface being written on is
printed with the anoto dot
sequence then the pen has the
ability to read it.
• This can include LCD screens,
whiteboards and transparent glass.
• Pre-existing forms can be modified
using a forms package software.
• A small tick box exists in the bottom
corner of each piece of digitalised
paper that when ticked will
automatically allow data to be
transferred when docked or
immediately via bluetooth
• The data stored on the pen is encrypted.
• The pen can record the time, date and name
of the person who has used the pen.
• The digital paper can continued to be used as
a paper copy of the document.
What are the benefits to use in a
• There will be a paper copy available as usual
• There will be a real-time electronic copy available too
which has been updated via DPP technology.
• More than one person will be able to view the file at
• Less time will be spent looking for the patient file
which will lead to increased productivity
• Health professionals will be happier because they
won’t be frustrated from being unable to locate
Usability of DPP amongst nurses
• Usability of DPP was assessed by 21 nurses in a
labour ward, who volunteered to trial using the
DPP and regular pen for 4 weeks each over an 8
week period to complete the labour admission
• They found that despite a positive attitude from
nurses towards DPP that post study preference
was for conventional pen.
• Reasons given were a conventional pen was less
bulky and simply reaching for what was closest at
Yen and Gorman (2005)
Integration of DPP into an existing
clinical information system (CIS)
• A further study in Switzerland assessed the feasibility
of integrating and using DPP in a pre-existing CIS within
primary, secondary and tertiary healthcare systems.
• Concluded that the quality of the DPP was as good as
using a professional scanner and that the mobility of
DPP was an advantage over scanning.
• Satisfaction surveys demonstrated DPP to be well -
accepted amongst users.
• DPP was able to be successfully integrated with pre-
existing CIS using JAVA and web-services.
• The requirement of colour laser-printers to produce
the forms was inconvenient.
Despont-Gros et al. (2005)
Feasibility of DPP technology to record vital
signs in acute care
• A six week prospective study was conducted on surgical and inpatient
medical units using DPP to document vital sign data and accuracy of data was
compared with the original working paper-copy. Random generator selected
25% vital sign values to review.
• Data collected by DPP was found to be 92% accurate in comparison to paper-
• Error in accuracy was related to inaccurate recognition of handwriting or
• User satisfaction survey demonstrated greater satisfaction in vital sign data
recording post DPP but this was not statistically significant.
• Concluded that DPP is a promising transition from paper-based systems to
Dykes et al. (2006)
Advantages and Disadvantages
• Enables real-time transfer
of data whilst allowing
traditional paper-copy to be
• Generally well-accepted
• Easy to implement
alongside pre-existing CIS
• Digital copies consistent
with scanned versions
• Cost-effective in long-term
• Colour laser printer
required which is more
costly than black and white
• Early versions of pen are
• Increased training may be
necessary to encourage use
• Expensive in short-term
• Further studies into the use of DPP are required.
• Limitation of Yen and Gorman (2005) feasibility study on
labour ward was that it only involved one task which did
not encourage full-active use of DPP to provide more
• Further studies on quality of handwriting and capture of
vital sign data would be helpful in deciding use in acute
care settings as majority of information is not captured in
• Further usability studies should be conducted for DPP. The
requirement for printed surfaces has not changed but the
digital pen has been redesigned by a number of different
• DPP technology is a cost-effective and user-
friendly transition of healthcare systems from
paper-based patient files to EMR.
DPP “From handwriting to computer...in real-
Anoto Group AB (2013)
• Yen, Po-Yin., & Gorman, Paul. (2005). Usability testing of digital pen and paper
system in nursing documentation. AMIA ... Annual Symposium Proceedings / AMIA
Symposium. AMIA Symposium, 844-848.
• Despont-Gros, Christelle., Bœuf, Christophe., Geissbuhler, Antoine., & Lovis,
Christian. (2005). The digital pen and paper technology: implementation and use
in an existing clinical information system. Studies in Health Technology and
Informatics, 116, 328-333.
• Dykes, Patricia C., Benoit, Angela., Chang, Frank., Gallagher, Joan., Li, Qi., Spurr,
Cindy., . . . Prater, Marita. (2006). The feasibility of digital pen and paper
technology for vital sign data capture in acute care settings. AMIA ... Annual
Symposium Proceedings / AMIA Symposium. AMIA Symposium, 229-233.
• Anoto Group AB. (2013). from