In November 2008, during a review meeting with Portsmouth Hospital NHS Trust's mobile operator Telefonica O₂, Sargent and Barkshire noticed the account manager taking notes using an unusual looking pen. The Trust had already deployed the BlackBerry® solution to a small group of users for mobile communications but had not seen this electronic note-taking solution.

The mobile operator then arranged a meeting with PaperIQ, an elite member of the BlackBerry® Alliance Program, which delivers the digital pen and paper solution. Sargent discovered that BlackBerry® smartphones, coupled with the digital pen & paper, could facilitate secure, remote note-taking using paper forms.

"Because we were getting resistance on the laptop-based solution, we arranged a presentation to the team-leads at the Trust. Immediately, the head of maternity liked what she saw," says Sargent. Maternity's midwives provide ante-natal care at home tracking everything they do in a booklet of forms. After filling out the forms, the booklet is left with the mother. The midwife then returns to the hospital and fills out the same forms again on the computer. Sargent continues, "By using the BlackBerry® solution with PaperIQ, we could eliminate the double entry of information as digital notes are taken at the episode of care with the mother and then immediately and securely transferred to the patient record system. This means that no patient-identifiable information is carried with the midwife whilst they are in the community which protects against information getting mislaid, lost or stolen."

Portsmouth Hospitals NHS Trust then conducted a proof of concept with the maternity department. It coupled PaperIQ digital pens and forms with various mobile phones but settled on BlackBerry® smartphones.

As he explains, "We needed something simple for users that wouldn't need rebooting or require user intervention, and that encrypted data from end to end. The main reasons we originally chose the BlackBerry® solution were stability, security and ease of use as the BlackBerry can be centrally managed and remotely administered."

James Barkshire training a group of Midwives

With the PaperIQ solution the design layout of the maternity forms are slightly modified for use with digital pens. The forms are then printed with a microscopic pattern of dots and the digital pen has an infrared camera that scans the dots and records the coordinates of the pen strokes made by the Midwife. When the Midwife wants to send data from the pen, they simply tick a box on the form, the pen encrypts and sends the data to the BlackBerry® smartphone via Bluetooth. Once the device receives the data, it encrypts and sends it to the BlackBerry® Enterprise Server installed in the Trusts's data centre, where it is then sent to the maternity records system. Transmission is automatic and requires no user intervention.

The midwife is notified, through their BlackBerry® smartphone, to indicate the status and validity of the form submission. This allows the Trust to ensure quality of the data from the community, reducing mistakes, missed information and the need for unnecessary revisits.

The next step was to run a field trial. "We chose six people who weren't very comfortable with technology," says Barkshire. "They were trained for 30 minutes on the BlackBerry® smartphones and 90 minutes on the digital pen then sent into the field for six weeks and after the trial period we practically had to pry the BlackBerry® smartphones out of their hands they liked it so much. That was quite a big win for us."

BlackBerry® smartphones and PaperIQ digital pens have been deployed to 130 midwives