Digitising the undigitisable, one page at a time

Digitising the undigitisable, one page at a time

Summary: How the Internet of Things can help solve complex - and critical - business problems just by rethinking pen and paper


Over the past couple of decades we've digitised nearly every business process possible.

I should know: I've played a part in building the tools to do so in some really quite unusual projects back in my coding days (including delivering cement chemical analyses to engineers building highways before they mixed concrete, rather than after as was too often the case). But there were some that were just too difficult to digitise, for many reasons: cost, danger, the environment in which they took place.

One of the more complex processes — and one of the most critical — is capturing patient information in an ambulance. It might be as easy as bringing someone in for a check-up after a fall, or as complex as dealing with casualties from a major road traffic accident. The paramedics in the ambulance need to capture as much information as possible, ready to hand over to hospital staff with the patient.

That means using pen and paper; it's fast, reliable, and ensures that the information captured is accurate as possible. It can be used while the ambulance is rushing to the ER, jotting notes while trying to save lives.

The medical records form that needs to be completed before the ambulance reaches the ER.

The forms used are large — much larger than a typical tablet screen, and contain a mix of text fields, image fields, and tick boxes. That makes them hard to digitise; for one thing, modern tablets' capacitive screens don't have the resolution needed for sketches.

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So how to make this part of a modern electronic medical process, where the patient information doesn't need to be transcribed in the ER, and where the original forms don't need to be picked up by couriers at the end of each shift?

The answer turns out to be quite simple: use a digital pen to capture strokes and feed them into a digital copy of the form. Last week I sat down with a team from Anoto to look at the work they've been doing with one of the UK ambulance services.

Anoto's digital pen is designed for this type of scenarios, using a pattern of almost invisible dots printed on the paper to capture strokes and position accurately via a sensor built into the pen. A wireless link to a mobile device can upload the captured data when triggered by a special pattern on the page.

I knew that the forms were big, but the size and complexity of the document that needs to be filled out astounded me: it's approximately A3, full of detailed information that needs to be completed accurately. Using an Anoto pen, a paramedic would fill out the form, and when complete, tick a box.

That would trigger the pen to send its store of data via a smartphone to a server which would use text recognition to translate the handwritten text to fields in an electronic form — which could then be delivered to the hospital or ER, ready for use.

Tick the red box, and the form contents are sent to a server, and into a hospital records system ready for use.

The result is an interesting hybrid of the analog and the digital, which takes an existing (and highly complex) process and digitises it without having to change the way the front-end works. That means there's no need to take skilled paramedics out of the frontline, where they're desperately needed, for training.

It also means there's no need to invest in expensive hardware that may not be able to handle the conditions in the back of a speeding ambulance. All that's needed is a relatively low-cost, and extremely reliable digital pen, along with a standard smartphone to connect it to the form-processing servers over existing 3 and 4G networks and the public Internet.

It's even possible to embed special functions into a page: what was once a piece of paper is actually a user interface to a wide selection of applications and services, all accessed without exposing expensive and fragile hardware.

While the digital paper forms may be a little more expensive than the original versions, thanks to the dot pattern needed by the pens, they're still relatively cheap — and let you run the old paper processes alongside the new purely digital system. And of course, if you want to go completely digital Anoto recently announced support for its pen technology on Panasonic's 4K 20-inch tablet — which has more than enough pixels to display the pen pattern underneath text and images.

Further reading

Topics: Tablets, Emerging Tech

Simon Bisson

About Simon Bisson

Simon Bisson is a freelance technology journalist. He specialises in architecture and enterprise IT. He ran one of the UK's first national ISPs and moved to writing around the time of the collapse of the first dotcom boom. He still writes code.

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  • Who'd have thought

    the NHS would treat us like children...


    Seriously though, this is a major leap forward in bringing pervasive computing to reality. Its one thing to leverage smart pen/paper to teach kids how to read and write, an obvious application. Its come a long way from the book reader I bought my daughter many years ago. I've been hoping there'd be an application for it in the 'real world' because it is nearly idiot-proof having been designed with children in mind.

    The technology is so simple - its just an IR scanner that functions as an optical mouse, but is also capable of picking up a pattern of dots so small they look like magazine-quality newsprint to our eyes. With a little careful design, an entire picture of what appears to be regular print (or even blank paper!) can be produced that the scanner can distinguish any part of from another by the pattern used to create it.

    I contacted LeapFrog when I realised how it worked several years ago, and asked them if it would ever be possible to print your own material for the pen - it would be simple to scan a page (OCR the text out, or just digitise the picture) and once on the computer tag areas with sound samples - and then print it on any domestic inkjet.
    LeapFrog responded with the shortsighted premise that this would be possible, probably easy, but it would very quickly reduce their profits from selling the books that worked with the pen, so they'd never release their design software. That was a few years ago now...

    Seems I'm not the only one who saw what they were doing is not merely a children's toy, or even a brilliant teaching aid, but the next generation in real-world computing technology.
  • Not so fast

    My company considered investment in this technology and once you get to understand the consequences of being limited to specific printer, purchasing cost of pens and digital sheets, hosting and what not - the reward is simply not worth the outcome. The case studies show people completing forms in a moving vehicle - easy?

    The next issue is getting the hardware to communicate - try any Apple device and see what happens! Or Windows 8 or latest mobile phones.

    Try total digital applications. That is worth investing in,
    • Good luck on supporting those in the field.

      LeapFrog is a wonderful application for students. Anoto has Business Partners that solve those solutions in ways most of the world is unaware of.

      Always remember that no one ever talks about the hidden cost of keeping a tablet in working order and the cost. Just ask Gartner the cost:)
  • naturalForms

    Is that why all "partners" are migrating to naturalForms or other forms of Digital Solutions? Would love to get confirmation that digital pens is feasible. LeapFrog is wonderful for Kids! LiveScribe possibly the best for students and exec's. The rest is limping along. Why all the layoffs if the solution is expanding - see press for details?

    Most partners are replacing their former pens based solutions with digital solutions. As "clients" we pay the price.

    The point is simply make sure before you fall for the hype. The concept is very good. The practice is killed by weak support & development, excessive cost of pens, pattern and infrastructure to make these pens work in any business application.

    Why would anybody fill our a form in an ambulance and then hook up with a mobile phone to connect and send data. Who is doing the work - the emergency medical staff? Who is taking care for the patient? In our "3rd world country" we phone in the patient details, save a life and then worry about saving costs and few cents of admin work.

    How did the pattern enabled printed form get in the ambulance? With what machine was it printed? What happens to the data when the moving ambulance cause printed ink to overlap with other fields? What if the persons phone is not authorized to pair with the pen? Runs an OS that is not supported by Anoto Software.

    Just something on cost of ownership. If you stop using the pen it is a $400 piece of useless garbage. A tablet, iPad or Phone can still be used in used for alternative purposes or recycled to reclaim some value.

    Our company bought a number pens which we decided is costing more than the value it is adding. Best offer form "partners" - $50 each and then the Anoto Licence needs to be renewed - again and again and again.

    Did Gartner do a cost comparison? I think not? :)