Title Page

Contents

Abstract 11

Chapter 1. INTRODUCTION 13

1.1. Background 13

1.2. Necessity 14

1.3. Objectives 15

Chapter 2. Literature review for the workflow improvement of mEMR 16

2.1. Introduction and method 16

2.2. Results 17

2.3. Discussion 19

Chapter 3. Simulation study for identifying the effectiveness of mEMR 21

3.1. Introduction 21

3.2. Methods 22

3.2.1. Study Participants 24

3.2.2. Study Scenarios and Sensitivity Analysis 24

3.3. Results 26

3.3.1. Main Outcome 26

3.3.2. Sensitivity Analysis 28

3.3.3. Survey 29

3.4. Discussion 30

3.4.1. Principal Findings 30

3.4.2. Upside and downside 31

3.4.3. Limitations 33

3.5. Conclusion 34

Chapter 4. Identifying workflow improvement with mEMR in ED 35

4.1. Introduction 35

4.2. Method 36

4.2.1. Study Setting 36

4.2.2. Mobile Electronic Medical Records 37

4.2.3. Specialty Consultation Process 37

4.2.4. Study Subjects 38

4.2.5. Data Collection and Processing 39

4.2.6. Outcome Measures and Sensitivity Analysis 40

4.2.7. Statistical Analysis 41

4.3. Results 41

4.3.1. Characteristics of the Subjects 41

4.3.2. Log data 45

4.3.3. Pearson's product-moment correlation 46

4.4. Discussion 49

4.4.1. Principal Findings 49

4.4.2. mEMR in Real ED Flow 51

4.4.3. Limitations 52

4.5. Conclusion 53

Chapter 5. Identifying workflow improvement with mEMR in overall hospital 54

5.1. Introduction 54

5.2. Method 56

5.2.1. Study Setting 56

5.2.2. Interns' Clinical Task Implementation Process 56

5.2.3. Outcome Measures and Sensitivity Analysis 58

5.2.4. Survey 58

5.2.5. Statistical Analysis 59

5.3. Results 59

5.3.1. Characteristics of the Subjects 59

5.3.2. Log Data Analysis 61

5.3.3. Statistical Outcomes 62

5.3.4. SUS Survey Outcome 63

5.4. Discussion 64

5.4.1. Principal Results 64

5.4.2. Limitations 66

5.5. Conclusions 67

Chapter 6. Conclusion 68

6.1. Discussion 68

6.2. Suggestion for future work 70

6.3. Conclusion 72

References 73

논문요약 79

Table 1. Summary of included articles 17

Table 2. Characteristics of participants. 26

Table 3. Comparison of time spent on specific tasks. 29

Table 4. Scores of system usability scale. 29

Table 5. Demographics of patients related to specialty consultations. 42

Table 6. Number of consultation cases by department. 43

Table 7. Demographics of doctors related to specialty consultations. 44

Table 8. Subgroup analysis 48

Table 9. Comparison between high and low frequency users among specialty doctors who had left log record during the consultation... 50

Table 10. Information about study subjects during the study period. 59

Table 11. Total number of logs with a list-level feature 61

Table 12. SUS scores to assess the intern task item in mEMR (n＝15). 63

Figure 1. Overall schematic description of the hospital information system architecture relationship at the Samsung Medical Center. (DARWIN: data analytics... 23

Figure 2. Usage scene when the mobile electronic medical records (mEMR) communicate with the near-field communication (NFC) system and the display of... 24

Figure 3. Schematic view of simulation scenarios. (a) Locating the patient. (b) Looking up laboratory results for the patient. (ED: emergency department; PC:... 25

Figure 4. Flow of locating the patient and the scenario place in the emergency department (CT: computed tomography; NFC: near-field communication; PC:... 26

Figure 5. Graphical view of main results. (a) Locating the patient. (b) Looking up laboratory results for the patient (NFC: near-field communication; PC: personal computer). 28

Figure 6. Specialty consultation process flow and outcome measurement of the study. The primary outcome was a measurement of the interval between consultation... 38

Figure 7. Flowchart of patient inclusion in the specialty consultation process. 42

Figure 8. Median interval time and log frequency of doctors who used mEMR in specialty consultation. 45

Figure 9. Correlation between consultation completion interval time and mEMR frequency. 47

Figure 10. Correlation between consultation response interval time and mEMR frequency. 48

Figure 11. Flowchart of an intern's clinical task process. 57

Figure 12. Screenshot of intern tasks from Mobile DARWIN (mDARWIN). 58

Figure 13. Task completion time interval and frequency of mobile electronic medical record (mEMR) usage among 4 intern groups divided by quantile of mEMR usage. 62

Figure 14. Summary of the interviews with interns on mobile EMR. 64