1. Implementing the use of recent digital pen & paper technology within the New Mexico Department of Health – Scientific Laboratory Division (NMDOH-SLD)
Phillip Adams - Chemistry Bureau, Scientific Laboratory Division, Albuquerque, New Mexico 87106
Taking these points in turn – having a quicker and more efficient turnaround in lab results should indirectly improve health monitoring, plus any additional diagnosis and investigation. This technology could support a number of legal requirements regarding how samples are collected (chain of custody, results turnaround). Finally, this technology would be useful for those environmental health programs that conduct research studies involving lab analyses, such as biomonitoring.
Introduction
The Chemistry Bureau at the New Mexico state public health laboratory conducts analytical testing on regulated and non-regulated contaminants in various environmental matrices – air, soil, and water. In a recent meeting with one of our clients, the lab was asked to develop a new analytical request form on one side of a sheet of paper. This was done, and as a further improvement over the old version, the form was developed in Adobe Designer so that it could be interactive - with drop-down menu selection boxes, text entry boxes, etc. This means the form can now be completed, in part, with typewritten text, before the actual sampling event.
One possible further step for analytical request form improvement would be to utilize recent digital pen and paper technology1. This would allow some or all of the fields on the form to be completed in the field by hand, allow the handwritten text to be converted to typewritten text, and this digital text uploaded onto the appropriate fields in the screen version of the form on the computer/database back in the office. This means the handwritten data entered on the paper form does not need to be keyed in a second time on the screen. Since the pen automatically records the date and time when it is utilized, this function would serve as an additional check for the date and time of sample collection entered on the form.
The analytical request form for environmental sample testing in the SLD Chemistry Bureau was selected to test the proof-of-concept of this new technology. The digital pen and paper offers several advantages over the use of similar technologies such as tablet PCs, and since we are required to maintain a paper copy of the analytical request form with a chain-of-custody, being paperless is not an option.
Objective and outcomes
“Can we improve analytical request form completion and field notes?”
This project is a chance to apply an emerging technology to improve the day-to-day work of environmental sample collectors and data entry staff at the public health laboratory. However, potentially troublesome issues include the installation of new software, additional costs, additional training, and acceptance from the end-users. These variables are captured in the behavior over time graph in figure 1.
Resistance to change
Variable
Available resources
Figure 2: The ‘limits to success’ loop diagram with mental models, to elaborate upon the variables over time graph in figure 1.
The logic model is shown in figure 3, below.
Figure 4: “The linkage of essential services to core functions” from Carl Osaki, RA, MSPH, Northwest Center for Public Health Practice, Essential Services of Environmental Health.
Next steps
The development of the application is still on-going, but the technology has been demonstrated to work. The current lack of available finances mean this project has been put on temporary hold. In figure 3, fewer than half the activities and outputs have been completed.
Reference
1 See for a review of digital pen & paper technology.
Further information
Please contact the author at (505) , or ;
Improvements in efficiency
(start of implementation) Time (after implementation)
Figure 1: Behavior over time graph for the major variables affecting the implementation of digital pen & paper technology.
The graph illustrates how the resistance to change would develop, affecting the user acceptance, and how the efficiency would improve over time. Resources to maintain operating costs would be made available as the implementation becomes more widespread.
For a systems thinking analysis of the three variables presented in figure 1, the ‘limits to success’ archetype was considered to be a good match. The mental models have also been added to this, and colored according to an optimistic (blue) or pessimistic (gray) perspective – figure 2.
Figure 3: Logic model and outcomes for digital pen & paper technology.
This technology, if implemented, would enhance or fulfill four of the ten essential environmental health services shown in figure 4 – monitor health, diagnose & investigate, enforce laws, and research.