title: Tablet computers with mobile electronic medical records enhance clinical routine and promote bedside time: a controlled prospective crossover study.
abstract: Demographic changes require physicians to deliver needed services with fewer resources. Neurology as an interdisciplinary domain involves complex diagnostic procedures and time-consuming data handling. Tablet PCs might streamline clinical workflow through mobile access to patient data. This study examined the impact of tablets running an electronic medical record on ward round performance. We hypothesised that tablet use should reduce ward round time and decrease the time needed to check medical records thereby increasing physicians' bedside availability. Nine resident neurologists participated in a controlled prospective crossover trial over 14 weeks. In the experimental condition, tablets were used in addition to the established medical record. In the control condition, physicians used established systems only. The combined primary outcome measure included changes in total ward round time and relative time shifts between associated work processes. The secondary outcome measure was physicians' time required to check a medical record vs. physicians' bedside time. There was a significant main effect on the primary outcome measure (p = 0.01). Tablet use accelerated preparing (p = 0.004) and post-processing (p < 0.001) of ward rounds. Time for conducting ward rounds was unaffected (p = 0.19). Checking medical records was faster with tablets (p = 0.001) increasing physicians' bedside time (p < 0.001). Tablet use led to significant time savings during preparing and post-processing of ward rounds. It was further associated with time savings during checking medical data and an increase in physicians' bedside time. Tablets may facilitate clinical data handling and promote workflow.
authors.affiliation: Department of Neurology, Charité-Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany, robert.fleischmann@charite.de.
authors.forename: Robert
authors.initials: R
authors.lastname: Fleischmann
authors.forename: Julian
authors.initials: J
authors.lastname: Duhm
authors.forename: Hagen
authors.initials: H
authors.lastname: Hupperts
authors.forename: Stephan A
authors.initials: SA
authors.lastname: Brandt
mesh_terms: D000328:Adult; D000704:Analysis of Variance; D034201:Computers, Handheld; D018592:Cross-Over Studies; D057286:Electronic Health Records / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010820:Physicians; D010818:Practice Patterns, Physicians'; D011446:Prospective Studies; D013997:Time Factors; D055815:Young Adult