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.

Fig. 1

Exemplary simulation of the impact of time changes within work processes on the efficiency index (I _eff; y-axis). Rounded mean data from a pilot study were included in this simulation (50, 90 and 30 min for preparing, conducting and post-processing ward rounds, respectively). In the simulation, percentaged changes were applied to each work process individually. Four different scenarios are shown (x-axis displays changes in percent): Reduction of all work process times (solid line), reduction of preparation and post-processing time with increased ward round conduction time (dashed line), increase of all work process times (dotted line), increase of preparation and post-processing period and reduction of ward round time (dotted and dashed line). The simulation shows that the I _eff reflects both changes in the ratio of preparing, conducting, and post-processing ward rounds as well as time changes within each of these work processes (see “Outcome measures” paragraph in the “Methods” section for details).Combined effects of changes in total time and relative time shifts may reinforce each other if both effects are in the same direction. They may also weaken each other when the direction of effect between the two differs (data not shown for presentational purposes)

Fig. 2

Figure displays the study design. Horizontal bars represent the three teams of physicians that participated in the study. Shaded areas indicate periods in the interventional condition. The dashed vertical line at week six displays the date for scheduled rotation of physicians between teams and hence marks the transition between phase I and phase II of the study (see “Methods” section for details). Teams participated in both conditions. Note that the randomised introduction period (phase I) was followed by a subsequent classic block design (phase II)

Fig. 3

Flowchart displaying the make-up of data points at the end of data collection. Most significant causes of dropout were due to ward rounds made in a team and lack of time documentation

Fig. 4

Mean values of time required to carry out ward round work processes in minutes for interventional and control conditions. The time required for preparing and post-processing ward rounds decreased significantly through tablet use. No effects of tablet use on time required for carrying out ward rounds were observed. Errors bars indicate the standard error of the mean

Fig. 5

Mean values for time required to carry out work processes associated with ward rounds. Looking up medical records required significantly less time when tablets were used. Tablet use was also associated with a significant increase in physicians’ time spent at the bedside. Errors bars indicate the standard error of the mean