***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Abstract Objective . Nowadays , registration of patient data on paper is gradually being replaced by registration using an intensive care information system ( ICIS ) . The aim of this study was to evaluate the effect of the use of an ICIS on nursing activity . Design . R and omized controlled trial with a crossover design . Setting . An 18-bed medical-surgical ICU in a teaching hospital . Patients , nurses and interventions . During a 6week period 145 consecutive adult patients admitted to the ICU after uncomplicated cardiothoracic surgery were r and omized into two groups : for one group the documentation was carried out using a paper-based registration ( Paper ) , in the second group an ICIS was used for documentation . Measurements and results . The nursing activities for these patients were studied during two separate periods : the admission period and the registration phase ( the period directly following the admission procedure ) . The duration of the admission procedure was measured by time-motion analysis and the nursing activities in the registration phase were studied by work sampling methodology . All nursing activities during the registration phase were grouped in four main categories : patient care , documentation , unit-related and personal time . The duration of the admission procedure was longer in the ICIS group ( 18.1±4.1 versus 16.8±3.1 min , p<0.05 ) . In the registration phase , a 30 % reduction in documentation time ( Paper 20.5 % of total nursing time versus ICIS 14.4 % , p<0.001 ) , corresponding to 29 min ( per 8h nursing shift ) was achieved . This time was completely re-allocated to patient care . Conclusions . The use of the present ICIS in patients after cardiothoracic surgery alters nursing activity ; it reduces the time for documentation and increases the time devoted to patient care . Electronic Supplementary Material is available if you access this article at http://dx.org/10.1007/s00134-002-1542-9 . On that page ( frame on the left side ) , a link takes you directly to the supplementary material Objective To determine the percentage of time that intensive care unit ( ICU ) nurses spend on documentation and other nursing activities before and after installation of a third-generation ICU information system . Design Prospect i ve data collection using real-time time-motion analysis , before and after installation of the ICU information system . Setting A ten-bed surgical ICU at a Veterans Affairs medical center . SubjectsICU nurses . Interventions Installation of a third-generation ICU information system . Measurements and Main Results Ten ICU nurses were studied before and after installation of the ICU information system . Each ICU nurse ’s activities and tasks , during 4-hr observation periods , were categorized in real-time by a nurse observer and recorded in a laptop computer . Each recorded task was automatically time-stamped and logged into a data file . The percentage of time spent on documentation decreased from 35.1 ± 8.3 % to 24.2 ± 7.6 % ( p = .025 ) after the ICU information system was installed . The percentage of time providing direct patient care increased from 31.3 ± 9.2 % to 40.1 ± 11.7 % ( p = .085 ) . The percentage of time doing patient assessment , a direct patient care task , increased from 4.0 ± 4.7 % to 9.4 ± 4.4 % ( p = .001 ) . Conclusions Installation of a third-generation ICU information system decreased the percentage of time  ICU nurses spent on documentation by > 30 % . Almost half of the time saved on documentation was spent on patient assessment , a direct patient care task Computerized  physician order entry ( CPOE )  has been shown to improve quality , and to reduce re source utilization , but most available data suggest that it takes longer to enter orders using CPOE . We had previously implemented a CPOE system , and elected to evaluate its impact on physician time in the new setting . To do this , we performed a prospect i ve study using r and om reminder methodology . Key findings were that interns spent 9.0 % of their time ordering with CPOE , compared to 2.1 % before , although CPOE saved them an additional 2 % of time , so that the net difference was 5 % of their total time . However , this is counterbalanced by decreased time for other personnel such as nursing and pharmacy , and by the quality and efficiency changes . We conclude that while CPOE has many benefits , it represents a major process change , and organizations must factor this in when they implement it This article describes a comparative study that examined the frequencies of nursing activities , when using a clinical information system ( CIS ) and a paper-based documentation system in an Australian intensive care unit . The study unit had half the beds equipped with a CIS , and the remaining beds used paper documentation . Work sampling methodology was used to observe nurses working with both systems . Though there were differences for all activities between the environments and the directions of the differences were logical , none were statistically significant using a chi-square test ( P = .11 - 0.65 ) , probably because of the small sample size . This study established that work sampling methodology using a r and om timer is a valid and relatively easy method to capture work activity in the clinical area . Although this article does not provide definitive information regarding the benefits of a CIS over manual documentation , a number of important method ological issues are discussed , including the study design , procedure , use of dedicated observers , and the distinction between basic versus fully optioned systems . Future research should evaluate the efficiency , impact on patient outcomes and nursing practice , and cost effectiveness of fully optioned systems OBJECTIVE To measure the impact on  nursing activity of introducing computerized medical records into intensive care units ( ICUs ) . DESIGN Prospect i ve data collection monitoring the activity of ICU nurses before and after installation of a computerized charting system .  SETTING A six-bed coronary care unit and an eight-bed medical ICU at the Minneapolis VA Medical Center . SUBJECTS Registered nurses providing intensive care services . INTERVENTIONS Installation of a Clinical Information System that computerized the ICU medical records . MEASUREMENTS AND MAIN RESULTS Before computer installation , nurses spent 24 % of their time manipulating data ( 7 % gathering and 17 % charting ) . After installation , charting time decreased to 10 % , and data gathering time decreased to 4 % , while 10 % of time was spent at computer terminals entering or review ing data . The total time manipulating data post-installation was thus 24 % ( i.e. , unchanged from previous ) . Computerized charting did not alter time spent in patients ' rooms ( 43 % pre- and 43 % postinstallation ) compared with time spent at the central station ( 37 % pre- and 36 % post-installation ) or elsewhere ( 20 % pre- and 21 % postinstallation ) . Relative time spent at various tasks varied between units and from shift to shift , but the net effect of computerized charting was that nurses had more time available at the central station for monitoring , and that the computer terminals were used primarily in the patient rooms . CONCLUSIONS Computerized charting will not necessarily provide ICU nurses with a net excess of time for tasks unrelated to manipulating data OBJECTIVE To study the effect of an Internet-based personal health record on the empowerment of patients undergoing IVF .  DESIGN R and omized clinical trial . SETTING Patients undergoing IVF and intracytoplasmic sperm injection ( ICSI )  in an academic research environment . PATIENT(S ) We selected patients who were undergoing an IVF or ICSI treatment , have an Internet connection , and speak fluent Dutch . INTERVENTION(S ) An Internet-based personal health record that provides patients with general and personal information concerning their given treatment and that also provides facilities for communication with fellow patients and physicians . MAIN OUTCOME MEASURE(S ) Patient empowerment ( measured as a multidimensional concept consisting of self-efficacy , actual and perceived knowledge , and involvement in the decision process ) , patient satisfaction , meaning of infertility problems , social support , anxiety , and depression . RESULT ( S ) A total of 91 female and 89 male participants were suitable for analysis . No significant differences were observed in per person change in patient empowerment . We did not find any significant differences regarding per person change in patient satisfaction , the meaning of infertility problems , social support , anxiety , and depression . CONCLUSION ( S ) Usage of the personal health record did not have any effects on patient empowerment , but , at the same time , the study did not find that the personal health record had any significant adverse effects either The purpose of this project was to study the applicability of pen-based computer technology to home health care through the development of a pen-based computer system for a Hospital/Community-Patient Review Instrument ( H/C-PRI ) used for nursing home placement . The sample included nurses ( n = 12 ) from the four regional Visiting Nurse Service of New York offices , as well as all patients on whom a H/C-PRI was completed during the pre-period ( n = 238 ) and patients on whom a H/C-PRI was completed during the post-period ( n = 238 ) . The quality of documentation was higher for patients whose H/C-PRI was performed using the pen-based computer ( 0 % calculation errors ) than for those patients whose H/C-PRI was documented in the usual manner ( 11 % calculation errors ) BACKGROUND To determine whether a Web-based diabetes case management program based in an electronic medical record can improve glycemic control ( primary outcome ) and diabetes-specific self-efficacy ( secondary outcome ) in adults with type 1 diabetes , a pilot r and omized controlled trial was conducted . METHODS A 12-month r and omized trial tested a Web-based case management program in a diabetes specialty clinic . Patients 21 - 49 years old with type 1 diabetes receiving multiple daily injections with insulin glargine and rapid-acting analogs who had a recent A1C > 7.0 % were eligible for inclusion . Participants were r and omized to receive either ( 1 ) usual care plus the nurse-practitioner-aided Web-based case management program ( intervention ) or ( 2 ) usual clinic care alone ( control ) . We compared patients in the two study arms for changes in A1C and self-efficacy measured with the Diabetes Empowerment Scale . RESULTS A total of 77 patients were recruited from the diabetes clinic and enrolled in the trial . The mean baseline A1C among study participants was 8.0 % . We observed a nonsignificant decrease in average A1C ( -0.48 ; 95 % confidence interval -1.22 to 0.27 ; P = 0.160 ) in the intervention group compared to the usual care group . The intervention group had a significant increase in diabetes-related self-efficacy compared to usual care ( group difference of 0.30 ; 95 % confidence interval 0.01 to 0.59 ; P = 0.04 ) . CONCLUSIONS Use of a Web-based case management program was associated with a beneficial treatment effect on self-efficacy , but change in glycemic control did not reach statistical significance in this trial of patients with moderately poorly controlled type 1 diabetes . Larger studies may be necessary to further clarify the intervention 's impact on health outcomes 
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We found mixed outcomes across both patient and HCP groups , with approximately half of the review s showing positive changes with record access .
Patients believe that record access increases their perception of control ; however , outcome measures thought to create psychological concerns ( such as patient anxiety as a result of seeing their medical record ) are still unanswered .
Nurses are more likely than physicians to gain time efficiencies by using a PAEHR system with the main concern from physicians being the security of the PAEHRs .
CONCLUSIONS This review implements a novel scoring system , which shows there is a lack of rigorous empirical testing that separates the effect of record access from other existing disease management programs .
Current research is too targeted within certain clinical groups ' needs , and although there are positive signs for the adoption of PAEHRs , there is currently insufficient evidence about the effect of PAEHRs on health outcomes for patients or HCPs