Experiences of Electronic Health Records’ and Client Information Systems’ Use on a Mobile Device and Factors Associated With Work Time Savings Among Practical Nurses: Cross-Sectional Study

Background The transmission of clinical information in nursing predominantly occurs through digital solutions, such as computers and mobile devices, in today’s era. Various technological systems, including electronic health records (EHRs) and client information systems (CISs), can be seamlessly integrated with mobile devices. The use of mobile devices is anticipated to rise, particularly as long-term care is increasingly delivered in environments such as clients’ homes, where computers are not readily accessible. However, there is a growing need for more user-centered data to ensure that mobile devices effectively support practical nurses in their daily activities. Objective This study aims to analyze practical nurses’ experiences of using EHRs or CISs on a mobile device in their daily practice. In addition, it aims to examine the factors associated with work time savings when using EHRs/CISs on a mobile device. Methods A cross-sectional study using an electronic survey was conducted in spring 2022. A total of 3866 practical nurses participated in the survey based on self-assessment. The sample was limited to practical nurses who used EHRs or CISs on a mobile device and worked in home care or service housing within the social welfare or health care sector (n=1014). Logistic regression analysis was used to explore the factors associated with work time savings. Results The likelihood of perceiving work time savings was higher among more experienced EHR/CIS users compared with those with less experience (odds ratio [OR] 1.59, 95% CI 1.30-1.94). Participants with 0-5 years of work experience were more likely to experience work time savings compared with those who had worked 21 years or more (OR 2.41, 95% CI 1.43-4.07). Practical nurses in home care were also more likely to experience work time savings compared with those working in service housing (OR 1.95, 95% CI 1.23-3.07). A lower grade given for EHRs/CISs was associated with a reduced likelihood of experiencing work time savings (OR 0.76, 95% CI 0.66-0.89). Participants who documented client data in a public area were more likely to experience work time savings compared with those who did so in the nurses’ office (OR 2.33, 95% CI 1.27-4.25). Practical nurses who found documentation of client data on a mobile device easy (OR 3.05, 95% CI 2.14-4.34) were more likely to experience work time savings compared with those who did not. Similarly, participants who believed that documentation of client data on a mobile device reduced the need to memorize things (OR 4.10, 95% CI 2.80-6.00) were more likely to experience work time savings compared with those who did not. Conclusions To enhance the proportion of practical nurses experiencing work time savings, we recommend that organizations offer comprehensive orientation and regular education sessions tailored for mobile device users who have less experience using EHRs or CISs and find mobile devices less intuitive to use.


Experiences of electronic health records' and client information systems' use on a mobile device and factors associated with work time savings among practical nurses: A cross-sectional study
Satu Paatela, Maiju Kyytsönen, Kaija Saranto, Ulla-Mari Kinnunen, Tuulikki Vehko Please make my preprint PDF available only to logged-in users; I understand that my title and abstract will remain visible to all users.Only make the preprint title and abstract visible.
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Introduction
Information and Communication Technology (ICT) including electronic health records (EHRs) and client information systems (CISs) have become an increasingly important part of healthcare and social services in Finland [1][2][3][4].In fact, EHR has been a common tool in Finnish healthcare for a long time, and from 2010 onwards EHR availability has been 100% in public and private facilities [5].EHR includes a comprehensive collection of patient health information (e.g., narrative texts and laboratory data), and the collected data can be used in the care processes of the patient [6].Instead, CISs are more commonly used in public social welfare sector for accessing, storing and using client information and documents [3,4].Over the decades, the Finnish Ministry of Social Affairs and Health has guided the construction of technological infrastructure and related legislative work nationally with the eHealth and eWelfare strategy aiming to strengthen the effective use of data to support service renewal and the well-being of citizens [7].
With the development of the ICT infrastructure, the clinical information in nursing is nowadays mainly transmitted via digital solutions such as computers and mobile devices [8].Particularly, mobile devices such as smartphones and tablets are commonly used in the healthcare sector [9,10], and nurses are known to use EHR on mobile devices three times more often compared to doctors in a hospital environment [11].Different technological systems such as EHRs can be integrated with mobile devices [9,[11][12][13], and this allows social and healthcare professionals to document client data and exchange information related to the clients and service assignments in the system regardless of the time and location [11,13].Thus, the ability to receive nursing information via a mobile device can promote the mobility and portability of care and enhance service flexibility [9,12].In previous studies, nurses have been reported to perceive mobile devices as beneficial in their daily practice [14,15].Mobile device use has been found to support nurses' workflow processes [11,[16][17][18] as nurses need to spend less time on clinical documentation [17].In fact, it is important to recognize that the use of different technological systems such as EHRs itself has been shown to provide nurses with more time for direct patient care and inter-professional communication [19].Moreover, mobile devices have been reported to be useful for planning work, handling notes [14] and saving time for nurses [14,20,21].Mobile devices may also reduce duplicate documentation [13] and potential documentation errors [17,20] because client data can be documented at the time of its occurrence.Additionally, improved decisionmaking is one of the main advantages [9,20].Mobile devices continuously provide the latest information on the situation of the clients, which can improve safety and the quality of care [14,18].For instance, in home care settings workers can review and plan real-time nursing interventions and tasks in the clients' home environment [13,16] because the daily assignments can be seen directly on the mobile device.The use of mobile devices can also contribute to client empowerment as nurses have easier access to clinical information and they can reply to clients' questions more readily [17].
On the other hand, some challenges have emerged related to the use of EHR/CIS on a mobile device.According to a recent study, the use of EHR on a mobile device can negatively affect nurses' well-being since the use of mobile devices may increase time pressure and stress at work due to functional problems and changing information systems [10].Particularly in home care settings, challenges have been reported to be technical issues, including usability problems, because information systems that are used on a mobile device are not always developed to meet the specific needs of different working environments [22].This in turn may lead to reduced workflows [22].Additionally, poor signal connectivity [18] and increased data security threats are involved [17,18,23] when using mobile devices.Also, some of the recent studies have observed that the use of EHR itself may negatively impact the quality of communication between nurses and patients because nurses' attention is more focused on the documentation tool such as computers rather than on the patient [24,25].More generally, lack of digital competence can affect how different digital tools are adopted in practice [26,27].
The European Union has promoted digitalization in society, including public services, with political consensus through the Digital Decade policy programme [28].The change in the demographic structure especially forces social and healthcare services to invest even more in technological solutions [29] such as mobile documentation [22].An aging population increases the need to provide long-term care in home environments [30] and therefore, using EHR and CIS on a mobile device is expected to grow as computers for professionals are rarely available at the patients' bedside in the home environment [14].In the Finnish context, practical nurses often take care of needs related to the activities of daily living, for instance in home care and service housing.Practical nurses in the social and healthcare profession are strictly regulated by law in Finland [31,32].Practical nurses must have completed the Vocational Qualification in Social and Healthcare with 180 awarded competence points [33].Qualified practical nurses are registered in the National Supervisory Authority for Welfare and Health, and they work in a broad range of careers in the social welfare and healthcare sector, early childhood education or schools [34].Practical nurses are the second largest occupational group in Finland and the largest group in the social welfare and healthcare sector in Finland, with 79,800 people working as practical nurses at the end of 2020 [35].
As practical nurses form an important group of professionals, it is justified to study their ways of working and increase our knowledge of practical nurses' experiences of EHR and CIS use on mobile devices.Some of the previous studies have investigated the use of mobile devices from the perspectives of registered nurses, nursing students and doctors [10,11,14,15], but there is still limited understanding of the experiences of practical nurses.More user-centred data is needed to ensure that mobile devices fit into the changing clinical practice [18] and to improve health professionals' workflows in those work environments where mobile devices are commonly used.As patient care becomes increasingly complex [8] and health professionals are constantly required to work more efficiently [36], it is important to study whether mobile devices are as effective tools as they are expected to be in the daily activities of practical nurses [9,11,13,14,16,17].Consequently, the aim of this study was to analyze practical nurses' experiences regarding their use of EHR/CIS on a mobile device in their daily practice in home care and service housing settings in social welfare and healthcare sector.Furthermore, we examined the potential factors associated with work time savings when practical nurses were using EHR/CIS on a mobile device.

Study context
Finland is a Nordic welfare state where all citizens have universal access to healthcare and social welfare services.In the 2000s, long-term care for the elderly and persons with disabilities in Finland has changed from institutional care towards more individualized services [37].In Finland, long-term care is increasingly provided in service housing or in the home environment under social services.Service housing is available for those citizens who need support living independently, and it may contain services such as a meal service, assistance with personal hygiene or different healthcare services [38].However, most of the elderly are still living at home and if necessary, they can receive home care.Home care forms a service entity that covers health-centre-based home nursing and home help services [37,38].A wide variation of different EHRs and CISs are used in Finland, and the same systems can be used in both healthcare and social welfare sectors [6].

Study design and Sample
This study was a cross-sectional study based on an electronic survey.The data was collected in spring 2022 during a three-week time period using a convenience sampling method.At the end of 2020, there were 79,800 employed practical nurses in Finland [35] who worked in social welfare and healthcare sector or in a school or in early childhood education and care.Potential respondents were invited to take part in the survey via an e-mail from two trade unions (The Finnish Union of Practical Nurses and The Union of Public and Welfare Sectors).The electronic survey was delivered to 54,030 members of the trade unions aged 18-65.Use of EHR/CIS was stated as the study theme in the cover letter.However, according to the previous studies, all members of the trade unions do not use EHR/CIS in their daily practice, because practical nurses in the social services may still use alternative solutions to support documentation [6].Two reminders were sent to the potential participants and a total of 3,866 practical nurses responded to the survey, resulting in a response rate of 7.2%.
In this study, the inclusion criteria for participation were that 1) the respondents should work as practical nurses and use an EHR or CIS and 2) not work in a school or in early childhood education and care.These inclusion criteria were presented in the first two questions of the survey and the survey closed for those potential respondents who did not meet the criteria.
The analysis was further restricted to practical nurses who answered that they use EHR or CIS on a mobile device and work in home care or service housing (n=1,014).Respondents working in other places of employment were excluded as the number of mobile device users was limited.1.

Data analysis
The data were analysed using the statistical software IBM SPSS Statistics Version 29.0.0.0 (241).The characteristics of the study participants were described using percentages (%).A binary logistic regression analysis was conducted to examine the association between independent and dependent variables.The 'Documentation of client data on a mobile device saves working time' item was used as a dependent variable and 10 items were used as independent variables in the analysis.In establishing a model for the relationship between independent and dependent variables, we first tested the significance of each independent variable individually according to Wald´s F test.Based on the P-values (P<.05) of Wald´s F test, the items 'Age' and 'I can document everything I need on a mobile device' were excluded from the regression analysis model.We included eight other independent variables one by one in the model using a forward stepwise selection method.At each step, variables were chosen for the final model according to their effect on the model's goodness-of-fit measure, Nagelkerke R Square (R

Ethical considerations
We considered ethical issues related to different phases of this study.Ethical approval for the study was provided by the Finnish Institute for Health and Welfare THL/1206/6.02.01/2022.Study participants were offered written information on the research and data processing in a covering letter and Privacy Notice [46].Participants did not receive any compensation for their participation in the study.The research group has been committed to protecting the anonymity of the participants throughout the study process.

Practical nurses' experiences of documenting client data on a mobile device
The most common place to document client data on a mobile device was next to the client (537/1,014, 53%

Factors associated with work time savings when using EHR/CIS on a mobile device
Several factors were associated with work time savings when using EHR/CIS on a mobile device (Table 4).Experience of using EHR/CIS, work experience, the workplace, the grade given for the EHR/CIS, the statements 'documentation of patient data on a mobile device is easy' and 'documentation of patient data on a mobile device reduces the need to memorize things' had statistically significant associations with work time savings.
Practical nurses who considered themselves to be more experienced EHR/CIS users were more likely to perceive work time savings.Participants who had worked 0-5 years as a practical nurse were 2.41 times more likely to experience work time savings compared to those who had worked 21 years or more.Practical nurses who had worked 16-20 years had a lower likelihood of experiencing work time savings than those who had worked for 21 years or more.Furthermore, practical nurses who worked in home care settings were 1.95 times more likely to report work time savings compared to those participants who worked in service housing.Giving a lower grade for EHR/CIS was associated with a lower likelihood of experiencing work time savings.Participants who documented client data in a public area were 2.33 times more likely to experience work time savings compared to those who documented client data at the (nurses') office.Moreover, those practical nurses who reported that the documentation of client data on a mobile device was easy, were 3.05 times more likely to experience work time savings compared to others.Practical nurses who reported that the documentation of client data on a mobile device reduced their need to memorize things were 4.10 times more likely to experience work time savings compared to those who did not find mobile devices helpful in memorizing things.

Principal results
The aim of the study was to analyze practical nurses' experiences of using EHR/CIS on a mobile device in their daily practice.Our study findings revealed that practical nurses' experiences of documenting client data on a mobile device were relatively good.Two-thirds of the participants perceived that mobile devices were effective tools in their daily practice, as mobile devices helped them in saving working time.A vast majority of the participants agreed that using EHR/ CIS on a mobile device reduced the need to memorize things.On the other hand, the participants least agreed with the statement that they could document everything they needed on a mobile device.
We also examined factors associated with work time savings when practical nurses were using EHR/CIS on a mobile device.Experience with the EHR/CIS, work experience, the workplace, the grade awarded for the EHR/CIS, the statements 'documentation of patient data on a mobile device is easy' and 'documentation of patient data on a mobile device reduces the need to memorize things' were all associated with practical nurses' experiences of work time savings.

Limitations
This study includes some limitations.First, the response rate (7.2%) remained fairly low, which is typical for web-based and longer surveys [47], as well as surveys targeted at healthcare professionals [48].Some of the email addresses of the potential respondents may not have been correct because of job changes or other reasons and some did not open the email related to the survey at all, so the actual response rate may have been higher if calculated for only those who actually received the invitation to the survey.Eventually, 85.3% of survey clicks led to responding to the survey.The data was collected during the national industrial action organized by the trade unions, which may have complicated answering the survey, as well as different work-related factors that practical nurses may encounter in their daily work such as rush and interruptions since many union members use their work e-mail as their contact information.Additionally, the used convenience sampling method may limit the generalizability of the results.On the other hand, the age structure of the respondents was equivalent with those who belong to national trade unions [49].The survey could also be answered in the two official languages of Finland (Finnish and Swedish), which may have encouraged speakers of both languages to answer.
Second, practical nurses form a common occupational group in Finland, but it may be a lesserknown occupational title in other parts of the world.In fact, healthcare professionals with wide variations of occupational titles may provide long-term care internationally.Nevertheless, we suggest that our study results can be utilized in those nursing professions such as registered nurses and healthcare assistants who use mobile devices as a documentation tool in their daily practice.Additionally, it should be noted that Finland has used ICT tools extensively in healthcare for a long time [5] and in general the usage of mobile data in Finland is most extensive when compared globally [50].Therefore, the study results could be utilized in similar countries where ICT development is at the same stage.
Third, the survey was tailored for the first time for practical nurses in Finland as were the questions related to mobile device use in the survey.We can assume the respondents understood the different items of the instrument relatively well, since the proportion of missing data was low.The instrument was pre-tested with 20 practical nurses before the survey was sent to the participants.
In the future, work time saving should be studied among users of specific EHR/CIS brands, since the grading of the system by the respondents was strongly associated with experiencing work time savings.Research should also be conducted in specific work environments as the care processes and needs of professionals differ, for example, in home care and in service housing.Therefore, a subgroup analysis for practical nurses in home care and service housing separately would be a good add-on for future studies.Another significant research topic would be to examine the barriers practical nurses may experience, when the documentation is done next to the patient using a mobile device.

Comparison with prior work
As far as we know, this was the first time practical nurses' experiences on their use of EHR/CIS on a mobile device was studied.We were particularly interested in examining whether the use of EHR/CIS on a mobile device saves practical nurses working time and which factors were associated with work time savings.In the healthcare sector, saving work time is an important issue, as nursing professionals need to carry out numerous tasks in their daily practice and they should have more time for immediate patient care and spend less time on indirect patient care such as working with documentation [21].
In this study, we found that two-thirds of the practical nurses who worked in home care or service housing perceived work time savings when they were using EHR/CIS on a mobile device.Similar work time savings have been reported in previous studies of healthcare professionals [14,20,21].This study showed that documenting client data in a public area, for example in a corridor of a housing service, made work time savings over two times more likely than documenting at the (nurses') office, where computers are typically available.However, it should be noted, that documenting sensitive client data on mobile devices in a public area may involve some increased security threats such as the loss or theft of the mobile device [23] and therefore mobile technology tools should provide critical security functions and organizations should have clear policies on how to manage mobile devices [51].
Based on our study results, work experience was associated with work time savings when using EHR/CIS on a mobile device.In this study participants who had worked 0-5 years as a practical nurse or equivalent were over two times more likely to experience work time savings compared to those who had worked for over 21 years.We assume that practical nurses with less work experience may perceive work time savings more often because they are more used to working with new technologies in their daily practice and they may have received orientation to using mobile devices more recently.It is interesting to notice that in our analysis we did not find age to be significantly associated with work time savings when using EHR/CIS on a mobile device.However, age can affect how the use of mobile devices is perceived, as previous study results have indicated that older nurses are less likely to use smartphones or agree that they bring benefits in acute care settings [52].
We also found that those practical nurses who worked in home care settings were almost two times more likely to report work time savings compared to practical nurses who worked in service housing.This finding is not very surprising, as home care is dependent on mobility and requires the use of ICT tools at patients' homes [22], which encourages integrating mobile technology in the daily practices of the workers.An important prerequisite for the benefits of using mobile technology is that mobile devices should integrate well with the used information systems [18], such as EHR and CIS.It could be assumed that mobile devices bring work time savings for practical nurses particularly in home care settings because mobile devices enable the documentation of client data right after the daily tasks are completed [13], for instance, next to the client.However, while in this study practical nurses frequently documented data next to the client, it was not a statistically significant factor for work time savings.Since mobile devices enable users to document client data immediately after meeting the client, it may reduce the need for healthcare professionals to memorize things.Based on our study results, those practical nurses who experienced that the documentation of client data reduced the need to memorize things were four times more likely to report work time savings compared to those practical nurses who did not find mobile devices helpful in reduced the need to memorize things.
Our study findings indicated that those practical nurses who reported that the documentation of client data on a mobile device was easy were over three times more likely to experience work time savings compared to those practical nurses who did not find mobile devices as easy to use.Additionally, Zhang et al. [53] found that nursing professionals in home care settings perceived mobile devices to be useful if the tools are easy to use.Overall, the usability problems related to health information systems including EHR are well acknowledged [2,54], but the received data is often based on using these systems on a computer.It should be noted that the use of EHR/CIS specifically on mobile devices may pose additional challenges for social and healthcare professionals.For instance, previous studies have revealed that mobile devices are difficult to use, too small for daily practice [16], do not work properly at all times [13], and may be unstable because of the possible Internet connection problems [18,22].
In this study, the grade given by the respondents for the EHR/CIS on a mobile device seems to be a factor that was also associated with work time savings.More precisely, a lower grade given for the EHR/CIS was associated with a lower likelihood of experiencing work time savings.Since the grade for the EHR/CIS can be thought of as reflecting the user satisfaction to some extent, the finding highlights the importance of investing in user satisfaction concerning the practical nurses' EHR/CIS use on mobile devices.User satisfaction has been an area of special interest in some previous studies [9,15] and its effects are known to be wider than those related to work time savings.According to Hsiao & Chen [9] user satisfaction affects nurses' intention of continuing to use information systems on mobile devices and the perceived usefulness is often related to user satisfaction.Additionally, the quality of the information system and support from managers effectively predict user satisfaction [15], as well as technology adoption in general [18].It should be noted that those healthcare professionals who are more experienced users of the information systems may have important proposals for improvements [9] and therefore these users should particularly be involved in the development of EHR/CIS to ensure the user satisfaction of the system interfaces.
Practical nurses' experience of using EHR/CIS should also be considered when evaluating the potential work time savings.Based on our study results, those practical nurses who had more experience in using EHR/CIS were more likely to experience work time savings.Similarly, Villalba-Mora et al. [26] found that those healthcare professionals who used health information technologies such as EHR more frequently perceived these tools to be more useful.Additionally, previous experience of digital technologies is important, since it supports healthcare professionals in adopting mobile devices in their daily practices [18].

Conclusions
This study expanded the current knowledge of the existing literature on the use of EHR/CIS on a mobile device by practical nurses in their daily practice and factors associated with work time savings.Our study results revealed that two-thirds of the practical nurses perceived mobile devices as useful in home care and service housing settings, since participants reported that documenting client data on a mobile device saved their working time.Experience in using EHR/CIS, work experience, the workplace, the grade given for the EHR/CIS, the statements 'documentation of patient data on a mobile device is easy' and 'documentation of patient data on a mobile device reduces the need to memorize things' were all significantly associated with practical nurses' experiences of work time savings.Based on our findings, we recommend that special attention should be paid to those mobile device users who are less experienced in using EHR/CIS or do not find mobile devices as easy to use.Organizations should offer these healthcare professionals comprehensive orientation and regular education on the use of EHR/CIS on mobile devices.User satisfaction is another issue that should be considered if the aim is to achieve work time savings among those healthcare professionals who use EHR/CIS on a mobile device since work time saving were more often experienced by those practical nurses who gave a higher grade for their EHR/CIS.Therefore, we suggest that end users, particularly those with more experience in using EHR/CIS, should be involved in the development of EHR/CIS to ensure better user satisfaction of system interfaces.

Experiences of electronic health record systems among physicians were measured for the
first time in Finland in a national survey in 2010[39,40].Since then, the survey has been developed further and repeated in 2014, 2017, 2021 for physicians and tailored for registered nurses in 2017[41- 43]  and for social care professionals (educated at university or university of applied sciences) in 2020[44,45].From 2014 these national surveys have been conducted as part of 'Monitoring and assessment of social welfare and healthcare information system services' (STePS) -projects[6].For the first time in 2022, the survey was tailored and conducted for practical nurses as well.The survey was pre-tested with 20 practical nurses before the data collection.The questions related to EHR/CIS use on a mobile device were of special interest because it is an elementary part of the of many practical nurses.Consequently, this study focused specifically on the use of a mobile device for the purpose of documenting client data.A total of 11 variables from the survey were covered in this study.The 'Documentation of client data on a mobile device saves working time' variable was used as an outcome measure.In order to understand what kind of factors are connected to work time savings, the following variables were used: 'Age', 'Work experience', 'Workplace', 'Experience in using EHR/CIS', 'Grade for EHR/CIS', 'Most common place to document client data on a mobile device', 'Received sufficient training to document client data on a mobile device', 'Documentation of client data on a mobile device is easy', 'Documentation of client data on a mobile device reduces the need to memorize', 'I can document everything I need on a mobile device'.Nine variables were re-coded in the analysis and two variables were included as a continuous variable.The 5-point Likert scale was specified in five different variables as: 1= fully agree, 2= agree, 3= neither agree nor disagree, 4= disagree, 5= fully disagree.The response options were re-coded as: 1,2= yes and 3,4,5=no to focus the attention to the phenomena we were interested in and to secure enough respondents in all categories.The included variables are presented in Table

a
Documentation of client data on a mobile device is easyDocumentation of client data on a mobile device is easy.5-point Likert scale Binary variables: 1,2= yes 3,4,5= no Documentation of client data on a Documentation of client data on a mobile device 5-point Likert scale Binary variables: 1,2= yes The 5-point Likert scale is specified as: 1= fully agree, 2= agree, 3= neither agree nor disagree, 4= disagree, 5= fully disagree.

Table 1 .
The included variables in the analysis.a Documentation of client data on a mobile device reduces the need to memorize'.The 'Received sufficient training to document client data on a mobile device' item was omitted from the final model, because it was no longer statistically significant (P=.08) after adjusting the final variable to the model.The fully adjusted model's R 2 N was 0.372.Variance inflation factor (VIF) was used to secure a model without multicollinearity: the values indicated low correlation, which is acceptable in a regression model.The results of the fully adjusted regression analysis model are presented with P-values, VIF, odds ratios (ORs) and their 95 % confidence intervals (CI) in Table4.
2 N), and based on the P-values of Wald's F test.The fully adjusted model included seven independent variables: 'Experience in using EHR/CIS', 'Work experience', 'Workplace', 'Grade for EHR/CIS', 'Most common place to document client data on a mobile device', 'Documentation of client data on a mobile device is easy' and '

Table 3
).Some of the practical nurses documented client data in the car, at the (nurses') office or in a public area.Mobile device users were relatively pleased with the training they had received to document client data on a mobile device (661/1,014, 65.2%).Most of the mobile device users (648/1,014, 63.9%) perceived it was easy to document client data on a mobile device.Two thirds of the practical nurses (667/1,014, 65. 8%) evaluated that the documentation of client data on a mobile device saved their working time.Moreover, a vast majority of the mobile device users (785/1,014, 77.4%) agreed that the documentation of client data on a mobile device reduced the need to memorize things.Less than half (418/1,014, 41.2 %) of the participants agreed they could document everything they need on a mobile device.(Table3.)