[Mobile and digital documentation of inpatient treatments : use of personal digital assistants in addition with the ClinicCoach(c) software].
BACKGROUND
Documentation of the individual treatment course is essential from medical as well as economic and forensic aspects. With increasing hospital computerization the conventional hardcopy form of record keeping is seen to be associated with high outlays and restrictiveness.


METHODS
Clinicians engaged consistently in the development of a personal digital assistant (PDA)-based electronic record system (Clinic Coach(c)), which maps the entire course of inpatient treatments. The system's effectiveness was reviewed by means of a standardized questionnaire and analysis of 8,595 data sets relating to PPR and wound findings.


RESULTS
In patients undergoing surgery wound findings and PPR were documented in 83.6% and in 94.3% respectively. The ClinicCoach(c) System was rated more effective than paper-based documentation by 78.4% of the testing healthcare workers.


CONCLUSIONS
The combination of PDAs and ClinicCoach(c) is a reliable and to clinical routine well adapted system that allows digital documentation at the bedside.
Homayounfar
K
K
Klinik für Unfall-, Hand- und Wiederherstellungschirurgie, Klinikum Kassel GmbH, Kassel, Deutschland.
Spiller
J
J
von Stillfried
F
F
Raible
M
M
D034201:Computers, Handheld; D006801:Humans; D007297:Inpatients; D016347:Medical Records Systems, Computerized; D011785:Quality Assurance, Health Care; D012984:Software; D011795:Surveys and Questionnaires