Authors (including presenting author) :
KWAN CK(1), CHEUNG PC(1)
Affiliation :
(1) Department of Physiotherapy, Tin Shui Wai Hospital
Introduction :
Introduction
On July 23, 2024, all wards at Tin Shui Wai Hospital (TSWH) transitioned to an electronic documentation system known as e-Doc. A staff survey indicated that desktop stations, Clinical Management System on Wheel system (COWS), and Notebook on Wheel system (NOWS) demonstrated superior efficiency compared to iPads, both with and without keyboards. Notably, 0% of staff preferred iPads for note entry, and only 5% chose them for note viewing. The reasons behind this preference discrepancy remain unclear. iPads and iPad Pros offer lower implementation costs, require less physical space, and boast more durable batteries. In contrast, COWS and NOWS provide a complete CMS experience with enhanced note entry capabilities.
Objectives :
Objectives
The primary aim of this study was to evaluate the time taken to complete new referred case e-Doc across 4 devices: COWS, NOWS, iPad Pro, and iPad.
The secondary aim of this study was to assess the feasibility of using different devices on completing e-Doc.
The Third aim of the study was to share the experience on using different devices on completing e-Doc.
Methodology :
Methodology
The study involved 8 physiotherapists (3 male) aged 22 to 34 years from the TSWH Physiotherapy inpatient team. Prior to the experiment, each physiotherapist received a briefing on the study's purpose and procedure, followed by practice sessions on all devices.
Each physiotherapist completed a standardized test protocol, which included:
1. Filling out an Allied Health progress note.
2. Reviewing 1 laboratory results, 1 radiology results, e-Vital, and the admission note.
3. Logging out and logging into the CMS system twice.
All participants reviewed the same case information within e-Doc, and the order of device usage was randomized for each physiotherapist.
The equipment specifications for the devices were as follows:
• COWS: Fast logon system, keyboard, optical mouse, CMS, with a wheel stand.
• NOWS: Fast logon system, keyboard, optical mouse, CMS, with a wheel stand.
• iPad Pro: iOS version 17.5.1, CMS 4XE, Vital Signs, Radiology Results, and Lab Results apps, without the original magic keyboard.
• iPad: iOS version 17.5.1, running the same apps as the iPad Pro, without the original smart keyboard.
• Handwriting: Pen and integrated progress note, CMS workstation.
The time required to complete a new physiotherapy progress note was measured simultaneously using a stopwatch by an observer.
Result & Outcome :
Result
All physiotherapists successfully completed a new referred case physiotherapy progress note for e-Doc across all mobile platforms. Throughout the testing, all devices functioned effectively without errors or system hang-ups, although the iPads exhibited longer loading times when switching between apps. The mean completion times for the new case progress notes were as follows:
• NOWS: 246±40s (4min 6s)
• COWS: 266±45s (4min 26s)
• iPad Pro: 396±47s (6min 36s)
• iPad: 554±99s (9min 14s)
• Handwriting: 423±63s (7mins 3s)
The analysis revealed that there were significant differences in performance between four mobile platforms. However, there was no significant difference between COWS and NOWS (p=0.35) and Hand writing and iPad Pro(p=0.85). Overall, the results suggest that the NOWS and COWS outperform other devices in terms of the measured performance metrics.
Conclusion
The results suggest that all mobile platforms are capable of completing new referred case progress notes, indicating their feasibility for physiotherapists utilizing e-Doc in the ward. However, the iPad posed challenges in typing due to its smaller screen size, highlighting the potential benefits of using a keyboard. Overall, while COWS and NOWS provided the most efficient documentation experience, iPads remain a viable option, particularly in settings where cost and space are significant considerations. Further research may explore the reasons behind staff preferences and the potential for improving iPad usability in clinical documentation tasks.
