User Findings Log

October 22, 2017 Findings

Questions asked:

1. What was your position in the hospital?
2. When do you write things down on an average day in your position?
3. Approximately how many people will read a given document you wrote?
4. Have you seen or experienced any incidences due to poor handwriting in the hospital?

User 7: Justin, a researcher at the Department of Health in Washington DC

1. Justin was recently tasked to travel to Africa to study the recent outbreak of ebola.
2. His hesitation is understandable, but he wants to try and be as prepared as possible for when he goes out there.
3. After exhausting an online search of research on ebola and it's progression, he decides to look at historical archives for more information. He wishes there was a way that he was able to go through decades and even centuries of written text to glean any bits of information about ebola.
4. If he had this technology, he would be able to potentially track similar clinical presentations, and pick up a more thorough understanding about the disease, and what he could expect during his research.

October 1, 2017 Findings

For our initial round of user findings, we are concerned with the use and importance of handwriting in modern hospital contexts. We asked our users the following questions:

1. What was your position in the hospital?
2. When do you write things down on an average day in your position?
3. Approximately how many people will read a given document you wrote?
4. Have you seen or experienced any incidences due to poor handwriting in the hospital?

User 1: Madison, a researcher at a lab at a New York hospital

1. Maddy was a research intern in the hematology/oncology department, where she worked primarily in breast cancer research.
2. Due to NIH laws, all experiments conducted within a government-funded laboratory are required to be recorded in a lab notebook. Therefore, records of the majority of her work were handwritten on a daily basis.
3. Maddy's direct superior was typically the only one who read her records on a weekly basis, but when it comes time for that lab to publish potentially 2-3 more people authoring the paper could be required to refer to them.
4. She had to clarify a lot of handwritten instructions and protocols that her superiors had in their lab notebooks because it is critical that the numbers written for certain experiments are the measurements that she was using (for example, using the right about of a certain chemical for an experiment could make or break the results of it, and potentially set the lab back a days worth of work if not done correctly). Had Maddy not made those clarifications she could easily see those mistakes being made.

User 2: Ziyang, an Attending Physician at the University of Pennsylvania Hospital

1. Ziyang is an Attending Physician at the Department of Cardiology of the University of Pennsylvania Hospital. He had five years of experience at this position.
2. I usually handwrite personal notes before morning rounding to organize the information and instructions that I want to brief my students later. For most occasions, I and most of my colleagues use the software called "Dragon" to orally dictate the information. Oral dictation software is super common among physicians now.
3. Around 5 people, mostly medical students, residents and interns in my team.
4. Very occasionally, since important info are mostly entered into the EHR directly at UPenn nowadays.

User 3: Joshua, an Internal Medicine Resident at the University of Washington Boise Internal Medicine

1. Joshua is an Internal Medicine Resident at the University of Washington Boise Internal Medicine. It's his first year at this position.
2. I take handwritten notes when interacting with my patients face-to-face. I feel looking at the screen creates distances between my patient and I.
3. Usually just myself, because most of the information on the handwritten notes need to be entered into the IT system shortly after.
4. Haven't experienced any so far. Most of the transferring or sharing of information are done electronically and in electronic form.

User 4: Tetz, a Staff Physician at the University of Tokyo Hospital in Tokyo, Japan

1. Tetz is a Staff Physician at the Department of Cardiology of the University of Tokyo Hospital in Japan; he had ten years of experiences at this position.
2. I use handwriting whenever I need to record information. I think handwriting is still the most accurate and versatile way of recording information. However, I do need an assistant who organizes and transcribes my handwritten notes into digital form.
3. Myself, my assistant, and two to three of my students.
4. That rarely happens. Medical students in Japan are trained to write in a very specific way, both in style and in content, so physicians usually have no problem understanding each other's handwriting. Moreover, handwriting is usually only shared within a small circle of people (for example, within an office or lab), so we are all familiar with each other's handwriting.

User 5: Wei, a Staff Physician at the National University Hospital in Singapore

1. Wei is a Staff Physician at the Pediatrics Department of the National University Hospital in Singapore. She has three years of experience working at this position.
2. I already hardly use handwriting professionally anymore. My hospital is the pioneering hospital in Singapore to adopt a new integrated EHR system that is literally making my working process paperless. However, in my department, nurses still use pen and paper to take notes occasionally because it's sometimes not convenient to carry a screen while handling very small children. Also some parents are wary of electronic devices near their babies, in those instances, we should use pen and paper instead.
3. In the rare event of use handwriting, a nurse would enter my handwritten notes into the electronic system immediately.
4. This question is almost not applicable to my hospital now. And the nurses working with me know my handwriting very well.

User 6: Nigel, an Anesthesia Medical Officer at the Singapore General Hospital in Singapore

1. Nigel is an Anesthesia Medical Officer at the Singapore General Hospital in Singapore, he has been in this position for three years.
2. On the anesthesia chart- preoperative assessment, instructions for inpatient cases, intra-operative vitals/ events/medications charting, post operative recovery room vitals/events/ medications charting
3. Maybe 4-5? Depends on how many operations patient have in the future- will check old charts for the airway grading/ devices used, intra-op and post op events. But recovery room doctor/ nurse and ward nurse/ doctor will read
4. Referrals from private Hospitals/ general practitioners if written in hand and cannot decipher. Otherwise the anesthesia chart is actually the only handwritten chart in hospital besides blood tubes. And we might phase it out soon to go electronic.