Authors: (including presenting author): :
Chen TYO(1), Leung YK(1), Ling JWY(1), Lau MKK(1), Chao CYL(2), Leung CYY(1)(2)
Affiliation: :
(1)Physiotherapy Department, North Lantau Hospital, (2)Physiotherapy Department, Princess Margaret Hospital
Keyword 1: :
e-Documentation
Keyword 3: :
Quality Improvement
Keyword 4: :
Medical record
Introduction: :
Traditional paper documentation and bulky physical patient folders create significant operational friction in high-volume outpatient settings, reducing time available for direct patient care. In alignment with the hospital authority smart hospital initiative, a stepwise approach on full implementation of paperless medical records management in the physiotherapy outpatient department at North Lantau Hospital (NLTH) was started since 2021. This project outlines the evolution of such "Paperless Strategy" from 2021 to 2025 on the streamlined process flow.
Objectives: :
To evaluate the impact of implementing paperless medical records management on enhancing operational efficiency of physiotherapists
Methodology: :
Multi-stage Quality Improvement (QI) initiatives were implemented using sequential PDSA (Plan-Do-Study-Act) cycles at the Physiotherapy Outpatient Department of NLTH. Phase I (2021–2023) focused on the digital transition through the introduction of e-documentation in the Clinical Management System (CMS) and the elimination of hybrid redundancy. Phase II (2024–Early 2025) involved the cessation of physical referral storage and the transition to template-based e-Triage. Phase III (Late 2025) implemented a pilot protocol to cease the daily retrieval and filing of subsequent appointment patient folders. Post-implementation outcomes were evaluated using two separate staff surveys targeted for both the physiotherapists and the physiotherapy Patient Care Assistants (PCAs). The surveys employed a 5-point Likert scale (1=Strongly Disagree to 5=Strongly Agree) alongside one open-ended qualitative question. The 4-item physiotherapist survey assessed information on medical records retrieval speed, documentation literacy, and clinical safety, while the 3-item PCAs survey evaluated effects on administrative workload reduction and task repurposing capacity.
Result & Outcome: :
Nine physiotherapists and 5 PCAs completed the staff survey. All PCAs strongly agreed that ceasing daily filing significantly reduced their administrative workload. The average time reduced from 30 minutes to 10 minutes on manual patient folders retrievals and filing. The time saved was successfully repurposed for direct patient care procedures and assisting with directing patient flow. All physiotherapists agreed that electronic retrieval was faster than physical folder search, with 88.9% rating this improvement as "Strongly Agree." All physiotherapists reported that e-documentation provided clearer literacy compared to handwritten records, noting that the electronic workflow eliminated the risk of document misplacement and enhanced data privacy. Despite initial learning curves during the early phases, all physiotherapists and PCAs reported successful adaptation to the digital workflow by 2025, with universal confidence expressed in managing cases without physical folders.
The stepwise streamlined workflow for enhancing full implementation of digital record management facilitates clinical effectiveness and reduces administrative burdens that optimize the performance of both physiotherapists and PCAs. It saved the time spent on manual filing and retrieval such that more time could be allocated to direct patient care. Physiotherapists could document progress notes and treatment plans more rapidly, reduce errors from illegible handwriting. The digital records offer encrypted storage, automatic backups, and role-based access that helping a higher patient data protection standard.
