Rotherham NHS Foundation Trust
Taking clinical annotation from paper to patient record
Rotherham NHS Foundation Trust is an NHS organisation delivering a broad range of acute and specialist services across the Rotherham area.
Medical professionals have long relied on hand-drawn sketches to explain procedures and document clinical observations. A diagram of a patient's elbow, annotated during a consultation, is a valuable clinical record. On paper, it is also a fragile one: hard to store, harder to retrieve, and impossible to link reliably to a digital patient record.
The Problem
Paper-based clinical annotation is a workflow that has not kept pace with the digital infrastructure around it.
NHS trusts are investing heavily in electronic health records and digital patient management. But within consultations, the act of sketching a diagram for a patient remains analogue. That creates a gap: a clinician can create a useful record in a moment, but getting it into the patient's digital file requires scanning, manual upload or simply leaving it out altogether.
The result is clinical documentation that is incomplete, inconsistently stored and difficult to act on.
The Challenge
Paper diagrams that belonged nowhere
Doctors and nurses at Rotherham NHS Foundation Trust were annotating body diagrams by hand during consultations, particularly when explaining upcoming procedures to patients. Those drawings had no clear home in the digital record system. Without a way to capture and attach them digitally, they were either kept on paper or lost entirely.
An integration requirement from the outset
Any solution needed to connect directly to the trust's existing electronic health record infrastructure. Creating a standalone drawing tool would solve half the problem. The annotation needed to link automatically to the correct patient record, without manual steps from the clinician.
Replacing freehand without losing flexibility
Clinical annotation is inherently freehand. A tool that forced clinicians into rigid forms or templates would not reflect how they actually work. The solution needed to support free sketching alongside structured shape tools, so that clinicians who are more comfortable with precision drawing could work in the way that suited them.
The Solution
The Curve built a web-based annotation platform for Rotherham NHS Foundation Trust that allows medical professionals to sketch and annotate clinical diagrams digitally, directly within a consultation, on any web-supported device including tablets.
The platform provides a library of pre-loaded anatomical diagrams, such as an arm, a joint or a limb, onto which clinicians can draw freehand, add shapes, arrows and labels, and build a clear visual record of what was discussed or what a procedure will involve. Once complete, the annotation is saved and exported directly to the patient's record in the trust's electronic health record system, removing the need for scanning or manual filing.
Our Approach
Building a clinical-grade drawing tool
The annotation interface was designed for use in a clinical setting: responsive, intuitive and fast to load on a tablet. The tool supports freehand drawing alongside structured elements including shapes, arrows and annotation labels, giving clinicians the flexibility to work in the way that suits their practice.
Integrating with the patient record system
A core requirement from the outset was that completed annotations should flow directly into the trust's existing patient record infrastructure, with no additional steps for the clinician. The Curve built this integration from the ground up, ensuring that a saved annotation was automatically associated with the correct patient file.
Designing for the ward environment
The platform was designed to be accessible on any web-supported device, reflecting the reality that clinicians at Rotherham are working across wards and departments with tablets and shared screens rather than fixed workstations. The interface required no specialist hardware and no software installation.
The Results
Digital annotation embedded in the clinical record: Clinicians can now annotate body diagrams digitally during a consultation and have those annotations automatically saved to the relevant patient record. The gap between what was drawn and what was documented is closed.
A paperless annotation workflow: The need to scan hand-drawn diagrams or file paper records separately is removed. Clinical documentation is captured at the point of care and stored where it belongs, without additional administrative steps.
A tool built for how clinicians actually work: The combination of freehand drawing and structured shape tools means clinicians are not constrained by the technology. Whether sketching a quick explanation for a patient or building a precise procedural diagram, the platform accommodates both.
Clinical annotation has always been part of how doctors communicate with patients and document what matters. What changed at Rotherham was where that annotation ended up. By building a platform that captures the sketch and connects it to the patient record in one step, The Curve gave clinicians a tool that works the way they do, without adding to the documentation burden at the end of a consultation.