The creators of Scutsheet made the same observation as countless other medical students preparing for morning rounds, but came to a different conclusion. The observation was that it does not make sense to spend hours laboriously hand copying information from bedside flow sheets and ward computers to note cards only to copy them back into progress notes in bedside charts. Their conclusion, however, was that they are going to try to make a better way. So they created Scutsheet, an iPad app for tracking patients.

In their own words :

To recap, vitals, which were entered into the computer by nursing, are hand copied onto a progress note, then again into the sign out, and in some cases, a third time onto notecards and scutsheets.

By their own admission, Scutsheet does not entirely solve the problem. In particular, the patient data entered into Scutsheet is still entered manually and, as of now, cannot be shared with other doctors. However, for anticipating how tablet computers may actually be used at the bedside and for creating a visually beautiful app, we should congratulate the makers the Scutsheet.

The underlying concept of Scutsheet is to replace the notecards many students and residents still carry –  one card for each patient. Of course, we have to respect the well entrenched advantages of paper technology. Paper is lightweight, flexible, unbreakable and allows for very rapid data entry. Any attempt to replace paper has to offer at least commensurate advantages. In the case of Scutsheet, the developers added several key features:

• track multiple patients
• add events for each patient
• calculate important parameters, such as BSA, BUN/Cr ratio, albumin-adjusted anion gap and corrected calcium

While there are numerous fields for data entry, no fields are mandatory. There are tabs for viewing the entered data as a table or in visual format. I did not see that results could be graphed. While the automated calculations (anion gap, etc) are helpful, the app does not seem to routinely screen for erroneous entries or suggest normal ranges for tests.

The major shortcoming of this app in its current incarnation is its most obvious one – that it requires manual entry of all patient data. Furthermore, once data has been entered, the user is still required to copy it again into the patient’s progress note. Regarding the latter, the app could clearly use the entered information as a scaffold of a progress note, which could be printed and entered into a paper chart. The developers seem to acknowledge this on their website, implying that a few “killer features” are in the works, such as “print and email progress notes, to do list, transfer data to other devices”. Currently, no details are available. As these features would greatly increase the utility and value of Scutsheet, we would guess they will be forthcoming in future versions.

As for the inconvenience of manual entry of laboratory and other data, the only way to circumvent this is to directly interface Scutsheet to hospital information systems. Unfortunately, this access is jealously guarded by hospital IT, which is primarily concerned with keeping existing information systems up and running, with as few interruptions as possible. Where the safety of patients is at risk, this is quite rational. But it does tend to slow the rate of change, and thus innovation.

Scutsheet is a native iPad application available in the iTunes App store for $9.99. It seems to have been developed by at least one 4th year medical student. In their words “Unlike your EMR, Scutsheet wasn’t designed by IT.” While maligning hospital IT is not terribly productive (see above), better software for doctors will indeed require more direct involvement by us, the end users. We hope the developers of Scutsheet continue evolving it. Legions of future students and residents (and their patients) will appreciate it.

Disclaimer: the author (Felasfa Wodajo) is co-founder of a company providing web-based signout and task management for resident teams (www.theList.md).