For this paper, we used the American Health Information Management Association's definition of the electronic medical record: the computerization of health record content and associated processes usually referring to an electronic medical health record in a physician office setting or a computerized system of files23. Since we could not find a standard definition for a handheld EMR, we defined it as the computerization of health record content and associated processes available through a handheld computer, personal digital assistant (PDA) or tablet. Thus, for purposes of this study, handheld EMRs were not required to be integrated to or interfaced with a hospital medical record system.
We searched MEDLINE, CINAHL, EMBASE, and the Cochrane Library from 1966 to September 2005 using the following search strategy: handheld technology AND electronic medical record AND randomized controlled trial. For handheld technology, the following terms were used: computer peripherals; computers, handheld; handheld; mobile; pda; personal digital assistant; palm pilot; palmtop; point of care; tablet; and wireless. The electronic medical record search used the following terms: computer communication network; electronic chart; e-chart; epr; ehr; electronic health record; electronic patient record; hospital information systems; and medical records. To identify randomized controlled trials (RCTs), we used the search strategy that has been developed and refined by the Cochrane Effective Practice and Organization of Care Group24. We retrieved potentially relevant articles and reviewed their reference lists for additional articles. The full search strategy is available from the authors upon request. There were no language restrictions.
Articles describing randomized trials or systematic reviews of randomized trials were included. We included studies if 1)we were able to extract relevant data, 2)they included an intervention group that used a handheld electronic medical record for patient care and a control group that was either a desktop EMR or the paper chart, 3)the users of the handheld EMR were clinicians, and 4)the outcomes had to be relevant to clinical care such as a decrease in errors, improved review of information, improved ordering of medications or tests, improved documentation or improved satisfaction.
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