Authors: (including presenting author): :
Chiu YC(1), Ho L(1), Fung YS(1), Lam CM(1)
Affiliation: :
(1)Occupational Therapy Department, Tuen Mun Hospital
Keyword 1: :
SMART e-Click
Keyword 2: :
e-Documentation
Keyword 3: :
Documentation efficiency
Keyword 4: :
Artificial Intelligence
Introduction: :
The significance of adopting the e-Documentation in clinical practice lies in its ability to enhance the efficiency, accuracy, and overall quality of services. Since August 2025, Tuen Mun Hospital(TMH) has implemented e-Documentation in surgical wards. As core members of the clinical team, occupational therapists enter comprehensive assessment results and progress notes for each patient. Inspired by the established system from Pok Oi Hospital’s Occupational Therapy(OT) Department, the OT team serving TMH’s surgical wards developed SMART e-Click — a novel intranet-based tool created with artificial intelligence (AI)-assisted coding. This system converts simple click selections into fully formatted and structured notes, greatly improving efficiency while minimizing errors. Key features include iPad compatibility for intuitive touch-based selection of common assessment options, automatic summation of assessment scores, and customizable templates tailored to different diagnostic groups.
Objectives: :
(1) To compare the documentation efficiency of occupational therapists in inputting in-patient OT assessment notes using SMART e-Click versus by using conventional template in Clinical Management System(CMS). (2) To evaluate therapists’ perceived usability, confidence in output, and their acceptance of the SMART e-Click.
Methodology: :
A paired within-subjects crossover study involved 20 occupational therapists at TMH with no prior SMART e-Click experience. Each therapist will dummy-input the in-patient progress note using both conventional template and SMART e-Click in CMS. The time to complete the documentation was recorded. Secondly, the usability, confidence, content coverage, efficiency, and overall experience were assessed via a 5-point Likert questionnaire with direct comparative items.
Result & Outcome: :
Mean documentation time was significantly reduced by 67% (p< 0.001), from 597 seconds using conventional template to 197 seconds using SMART e-Click. Paired comparisons of questionnaire responses confirmed significant advantages for SMART e-Click over conventional template in overall experience (mean difference+2.2, p< 0.001), ease of use (mean difference+2.4, p< 0.001), efficiency (mean difference+2.7, p< 0.001), and confidence (mean difference+1.9, p< 0.001); content coverage showed small advantage for SMART e-Click (mean difference+0.8, p=0.011). Overall, 100% of therapists preferred SMART e-Click. The innovative SMART e-Click substantially improves documentation efficiency while achieves excellent usability, clinical confidence and user acceptance. This tool demonstrates clear benefits and is ready to roll out in the NTWC Occupational Therapy Department.
