Using adaptive turnaround documents to electronically acquire structured data in clinical settings

Abstract

We developed adaptive turnaround documents (ATDs) to address longstanding challenges inherent in acquiring structured data at the point of care. These computer-generated paper forms both request and receive patient tailored information specifically for electronic storage. In our pilot, we evaluated the usability, accuracy, and user acceptance of an ATD designed to enrich a pediatric preventative care decision support system. The system had an overall digit recognition rate of 98.6% (95% CI: 98.3 to 98.9) and a marksense accuracy of 99.2% (95% CI: 99.1 to 99.3). More importantly, the system reliably extracted all data from 56.6% (95% CI: 53.3 to 59.9) of our pilot forms without the need for a verification step. These results translate to a minimal workflow burden to end users. This suggests that ATDs can serve as an inexpensive, workflow-sensitive means of structured data acquisition in the clinical setting.

Figure 1

A completed ATD. This pre-screening form was developed to better inform our pediatric decision support system at the point of care. The top section is specific to nurses and support staff. Vital signs and other measurements are recorded in their associated field on the form. The bottom section is directed toward the particular patient. Up to twenty questions tailored to the patient’s medical history are answered by filling in the corresponding bubble located to the left of each question.

Figure 2

Two examples of handwritten entries incorrectly evaluated by the Teleforms package. Note in the bottom example, an attempt to write two digits into one box.

Figure 3

Two examples of incorrect OMR evaluations. In the example to the left, the software assumed that the left bubble was the intended answer. In the right example, the software did not register any response, as this particular parent circled all twenty bubbles.