From CS160 User Interfaces Fa06

Contents 1 Names 2 Brainstorm 3 Idea Selection 4 Next Rx 4.1 Target User Description 4.2 Project Description 4.3 Problem Context 4.4 Why the Anoto System is a Good Technology for the Problem 4.5 Solution Sketch

Names

• Rayhan Lal
• Michael Mai
• Utsav Shah
• Jason Shangkuan

Brainstorm

• Conversion to paper/pen world

• Personal Use

1. Take notes in class/work

2. To do list

3. Shopping list

4. Recording lyrics from radio

5. Expense tracking

6. Writing recipes

7. Dream Recording

8. Children’s creative drawing record

9. Resume notes

10. On airplane, when your laptop battery is dead/also FAA requires laptops to be checked in on certain international flights

11. Trading and selling stocks

• School/Tests

12. Time markers for time sensitive tests/quizzes

13. Answer Sheet, instead of bubbling

14. Professors and researchers working on proofs and mathematical formulas

15. Rapid mass exchange of personal information between people for projects

16. Chemistry labs - drawing molecules for lab reports

17. Learning/writing new languages

18. Proofreading

• Online Applications

19. Send emails in original languages

20. Blogs

21. Instant messaging

22. On demand

• Work

23. Central storage for written documents

24. Company checks for financial track and data reliability

25. Mass idea sharing at corporate meetings (Brainstorming)

26. Disappearing ink - reusable paper

27. Stealing ideas

28. Find out what employees are doing through personal pen IDs and data

• Industries

• Musicians

29. Writing sheet music

30. Writing/Designing lyrics

• Lawyers

31. Recording legal documents

• Architects

32. Draft drawings

33. Blueprints

• Clothing designers

34. Digital prints on clothes

35. Design and outline of new clothing line as well as critique

36. Measurements

• Sports

37. New plays

38. Trades/Roster Changes

• News/Data Gathering

39. Field work (Location, Time, event)

• Scripts/Movie

40. Script writers - write movie script with Anoto pen and send it to all the parties involved electronically

41. Dialogue writing for movies

• Restaurants

42. Inventory

43. Ordering

44. Expenses

45. Evaluation

46. Special orders

47. Reviews

48. Tip tracking

49. Menu tracking

50. Timecards

• Medical

51. Prescription tracking

52. Pharmacy filling

53. Intradepartmental recommendation

54. ER sign in

55. Patient tracking

56. Charting/Records

57. Slightly revise charts

• Form Designs

58. Security

• Forgery Eliminated (unique pen ID)
• Less Incorrect orders

59. Optometry

• Lens power

60. Medical Charts

• EKG
• Sensors data
• MRI annotation
• Plastic Surgery
• Communication
• Last visits/problems

Idea Selection

The Anoto pen system has countless potential uses, especially in the areas of: medicine, business, food service, academics and personal organization. All rely on the convergence of traditional pen and paper with the digital world. Despite having many different applications, the general solution remains the same: to combine what is written and harness that information by performing computations on it. A very useful way to access, modify, search and process this data is with a database. In choosing our topic, we wanted to create an application that merges hand-written notes and the power of a database. In addition, we wanted to apply it to an industry or area with the greatest need and one that has a positive influence on society. Many studies have shown that the health care industry is significantly lacking and is behind in integrating technology into its services. As a result, we decided to focus on an application in the medical/ healthcare industry. In addition, we wanted to focus on a day-to-day issue faced by physicians. Hospitals and doctors constantly deal with issues related to forms and documentation. The use of prescription pads and tracking patient history seems like a good fit and a practical approach that combines the digital and physical mediums. This project is a solid foundation for other projects because the project alone opens up possibilities to incorporating changes and integrating other medical forms.

Next Rx

Target User Description

The healthcare industry is dedicated to the preservation of mental and physical well-being. It is quite unfortunate that this noble effort has not been able to utilize the digital technology currently available. This is especially ironic in light of the fact that radiologists, for example, deal with some very sophisticated digital imaging technology. The problem is nurses, doctors and the like – who deal with patients on a day-to-day basis – are accustomed to working with pen-and-paper for record keeping. Additionally, looking for patterns or trends in public health necessitate someone examining all these notes (if they did not ask hospitals to track this data ahead of time). Though this group is very well-educated, it consists of people, not information processing machines. Their job is to care for patients not to get buried by paper work. In emergent situations, where a patient is unable to explain their condition, immediate access to patient history is critical. Patients also suffer unnecessary delays sometimes forced to transport directives themselves from department to department.

Project Description

As a first step towards integrating forms and charts we would like to create digital prescription pads. The typical prescription pad has fields for: patient identification, doctor identification, medication, dosage, use and quantity. If doctors are comfortable using our system for this function, then designing similar forms for patient charts should also be feasible. Reducing the incidence of medical errors and increasing the robustness of safety practices are continuing issues for the medical industry. One common error among doctors that is easily avoided is prescription writing. A theoretical based study done by Richard Marken “A Model-based Approach to Prioritizing Medical Safety Practices” on prescription writing errors stated that the error rate for prescribing the wrong drug and incorrect dosage were 39% and 57%, respectively.

Errors in writing prescriptions originate from many sources including: misdiagnosis of symptoms, patient history, and the surrounding environment. There are many databases that could aid or check diagnosis based on probabilistic models. If patient databases were available, a prescription could be checked based on possible differential diagnoses, drug allergies and known health issues. In a CBS news article “Because the Doctor Isn’t Always Right”, the article describes how only 6% of hospital deaths are autopsied, and of those, 40% were due to misdiagnosis. Another study by http://www.wrongdiagnosis.com/mistakes/types.htm states that 10% of misdiagnosis is due to medication errors. Most hospitals do not have patient databases and since electronic charts may not be implemented, one should at least ensure no individual is prescribed two drugs with known negative interactions. Doctors and pharmacies often operate under heavy workload; prescriptions should not be up to interpretation. Furthermore, patient communication is incredibly varied. A patient might not remember or report information that could be vital. Clearly, an automated system to verify prescriptions would be useful in mitigating these issues.

Problem Context

When doctors and pharmacists become overloaded with work, they become more susceptible to making mistakes. A very simple but common mistake is to write or fill a similar sounding drug name or misread/miswrite the dosage on a prescription. Examples of common name mistakes from http://www.usalaw.com/a-mp-similar-drug-names.html include:

• Ambien .....Amen
• Amiodarone......Amrinone
• Cardene SR......Cardizem SR
• Clonidine......Klonipin
• Feldene......Seldane
• Flutamide......Flumadine
• Imipenem......Omnipen
• Lodine......Codeine
• MS Contin......Oxycontin
• Oruvail......Clinoril
• Prilosec......Prozac
• Retrovir......Ritonavir.

Some pharmacies have implemented systems to check a patient's history. Although this is a good safety check, it definitely has inherent flaws. For example, the patient has to fill out a new history with each pharmacy that has this system since the database is not universal. If a mistake is found at the pharmacy then the patient has to go back to the doctor's office wasting excess time to correct the error. All such checks should take place at the hospital; it should not be up to someone in a pharmacy to inspect every record.

Why the Anoto System is a Good Technology for the Problem

The process starts with the paper; forms are designed on a computer. Using a form explorer tool, rectangular areas are designated for entry of particular data types. A name field would, for example, be designated as an area for character strings. Checkboxes would simply be Boolean areas where any mark would indicate true. With further development, certain areas could contain limited vocabularies (e.g. medications). The hospital already recruits printing companies to deliver their paper charts. There should be no problem adding on the dot pattern. Each form would either have a unique dot pattern or an area to enter which form one is dealing with. Since we will only be dealing with prescription pads, one dot pattern should suffice.

The pen system is ideal because a paper-copy is maintained (for patients) and only slightly more work is necessary to synchronize this information to the electronic system. Verifying handwriting recognition ensures both the doctor and the pharmacy will know what medication is being prescribed. Additionally, the pen affords a few modes of output including vibration and status lights. Vibration could signify a patient is recognized by the system and if a streaming system is available this can cause a terminal in the exam room to display the patient’s record. Additionally, stray marks into other fields can be deduced by timestamps and continuity from the main text written in a field. Security is ensured because each pen has a unique ID, one is immediately aware of the doctor who wrote the prescription. If the pen is lost or stolen, the doctor need only report it and all prescriptions that have the corresponding ID and a timestamp after the time it went missing can be investigated.

Using an open-source database management system, such as PostgreSQL, would allow unparalleled data management and manipulation. The user-interface will be very important for this part of the system, since we would not expect a general practitioner to be able to write SQL queries. The data can be transported via any communication network to a pharmacy.

Solution Sketch

A form explorer will allow for the design of paper documentation. It should support the creation of tables and insertion of graphics. (Alternatively, these designs could be imported from a PDF or word document). Then areas will be selected for their specific processing needs (image, text, binary). The pen’s ability to track where it is on the page will be utilized to identify which item it is recording and the association. The pad areas will record certain information common in today’s prescription pads: patient identification, doctor identification, medication, dosage, use and quantity. A check box for authorization following the signature will be added to authorize the prescription and notify the pen to send the prescription to a preferred pharmacy to be filled.

Once patient identification (medical record number, name, etc.) is entered, the pen will query the hospital’s patient database and check if the patient data exists and is up-to-date. If the patient name is not in the database, the pen will flash red twice, which will alert the doctor that a file needs to be created for the patient. If the name does exist the pen will buzz. The drug name area will be limited to pharmaceutical vocabulary. Additional checking can be done if and when electronic patient records are available.

The doctor will sign the prescription, which the pen will record for documentation, and the doctor can authorize by checking a check box. When the check box is filled, a timestamp is generated so that the prescription cannot be rewritten. The prescription is then sent to pharmacy to be filled. This method allows the pharmacist to prepare the prescription before the patient arrives, decreasing delays. The patient can bring the hard-copy of the prescription as verification.

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