Patient safety is an increasingly important issue in care delivery. The Institute of Medicine report estimates that 44000 to 94000 deaths are caused annually from medical errors1. Studies estimate that 3-17% of inpatients experience adverse events significant enough to prolong hospitalization, cause significant morbidity, or lead to death2-10. Errors can be caused by a number of factors including lack of information about the patient or lack of knowledge about a therapy. In a study of errors in medication prescribing, 30% were related to knowledge in drug therapy and 29% were due to a lack of patient information11. Decreased uptake of the evidence by the practitioner or patient can also cause errors of omission12.
Handheld computers may improve quality of care by saving clinicians time in the accessing, retrieving and recording of data, allowing clinicians to focus more on patient care 13-15. They can also provide clinical decision support at the point-of-care such as during electronic prescribing16. Improving access to knowledge databases at the point-of-care may also improve translation of knowledge into practice17. As well, many groups feel that mobile access to electronic medical records is the only way forward for certain complex care areas such as the emergency department18,19.
Surveys estimate that approximately half of practicing physicians own a handheld computer20,21. Recent focus group sessions of 54 doctors from a variety of practice settings in the United States revealed that many use mobile computers in clinical practice, and some use them to access the electronic medical record22. They perceived the benefits to be improved productivity and accessibility of information as well as great potential to improve patient safety and quality of care. However, the true benefit of handheld computers is unclear and to help understand this issue, we conducted a systematic review of the evidence for mobile or handheld electronic medical records (EMRs) in improving patient care.
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