The technological revolution has caused the entire world to migrate to a digital environment and health care is no exception to this. Electronic Health Records (EHR) or Electronic Medical Records (EMR) are the digital repository for health data of patients. Nation wide efforts have been made by the federal government to promote the usage of EHRs as they have been found to improve quality of health service. Although EHR systems have been implemented almost everywhere, active use of EHR applications have not replaced paper documentation. Rather, they are often used to store transcribed data from paper documentation after each clinical procedure. This process is found to be prone to errors such as data omission, incomplete data documentation and is also time consuming. This research aims to help improve adoption of real-time EHRs usage while documenting data by improving the usability of an iPad based EHR application that is used during resuscitation process in the intensive care unit. Using Cognitive theories and HCI frameworks, this research identified areas of improvement and customizations in the application that were required to exclusively match the work flow of the resuscitation team at the Mayo Clinic. In addition to this, a Handwriting Recognition Engine (HRE) was integrated into the application to support a stylus based information input into EHR, which resembles our target users’ traditional pen and paper based documentation process. The EHR application was updated and then evaluated with end users at the Mayo clinic. The users found the application to be efficient, usable and they showed preference in using this application over the paper-based documentation.

As technology has advanced in recent years, tablet devices have started to make their way into all walks of life. Yet, many medical documentation processes still see the use of paper. Though the paper based documentation method has been shown to be effective for some purposes, the introduction of tablet devices has the potential to make the documentation processes a lot smoother. In this thesis, tablet based documentation systems are reviewed, and based on this, a new custom application is developed that medical staff can use with ease. This new application, developed for an iPad is one where users can fully customize their own forms for different uses in the intensive care unit for resuscitation scenarios. The thesis discusses the architecture behind this application along with designing different elements of the system. Through this thesis project, the application was evaluated to see if such a complex documentation process can be easily used and created on a tablet device. The medical staff surveyed, responded positively to the use of the application and agreed that the electronic documentation usage and creation is a powerful tool that could help improve resuscitation practice by making it more efficient.

The American Heart Association recommended in 1997 the data elements that should be collected from resuscitations in hospitals. (15) Currently, data documentation from resuscitation events in hospitals, termed ‘code blue’ events, utilizes a paper form, which is institution-specific. Problems with data capture and transcription exists, due to the challenges of dynamic documentation of patient, event and outcome variables as the code blue event unfolds.

This thesis is based on the hypothesis that an electronic version of code blue real-time data capture would lead to improved resuscitation data transcription, and enable clinicians to address deficiencies in quality of care. The primary goal of this thesis is to create an iOS based application, primarily designed for iPads, for code blue events at the Mayo Clinic Hospital. The secondary goal is to build an open-source software development framework for converting paper-based hospital protocols into digital format.

The tool created in this study enabled data documentation to be completed electronically rather than on paper for resuscitation outcomes. The tool was evaluated for usability with twenty nurses, the end-users, at Mayo Clinic in Phoenix, Arizona. The results showed the preference of users for the iPad application. Furthermore, a qualitative survey showed the clinicians perceived the electronic version to be more accurate and efficient than paper-based documentation, both of which are essential for an emergency code blue resuscitation procedure.