This post was contributed by Stefan Schulz. Stefan Schulz (@ErgoEye) is a physical therapist specializing in ergonomics and onsite occupational rehabilitation with PreCare, Inc. As PreCare's Manager of Research & Development, he designs injury prevention programs for corporate clients that focus on ergonomic solutions, training, and Return-to-Work.

Stefan Schulz, MSPT

Electronic record keeping in the health care industry is not without its ironies.

One minute, my posture-conscious self is educating a patient with thoracic outlet syndrome on keeping her shoulders back during the constant data entry tasks of her accounting job. The very next minute, I find myself contorted into absurd positions while documenting the therapy session on my netbook. Not a minute into the SOAP note, my upper traps are stiffening up, and my left pinky is starting to tingle. It’s do as I say, not as I do, I guess.

Sure, the introduction of an electronic record keeping system has had its ergonomic upsides. No more repetitive handwriting of patient information on each page. No more carrying of heavy charts. Now that I can send progress notes to doctors by the click of a mouse, dealing with fax machines seems almost primitive in retrospect. But then, no one told me about that aching neck and the tingling finger when a “paper-less” system was advertised as the solution to all my grievances about paperwork.

As a physical therapist specializing in ergonomics consulting, I’m now in the position of having to eat my own words. The musculoskeletal effects of sustained awkward postures of the neck and shoulder combined with the repetitive movements of the hands and wrist are well known – and no other modern device breeds this kind of situation as efficiently as a laptop:

-        Laptop screens are, by virtue of sitting low on the work surface, at the ideal height to promote the collapse of the entire vertebral column into a flexed position, with a forward head and rounded shoulders. They’re made for portability, not for comfort.
-        The small size of the laptop screen (and I do sincerely hope for the eventual demise of the netbook craze) promotes eye strain and increases the repetitions of mouse clicks due to the necessity of constant scrolling
-        Built-in touchpads are awkward and frustrating to use and they should just go away.
-       There is not one built-in laptop keyboard in the marketplace today that even attempts to address the problem of awkward wrist positions that are associated with carpal tunnel syndrome

The cards are stacked high against any serious attempt at using a laptop safely and efficiently.

Nevertheless, by using simple principles consistently through the day of using a work laptop with a less-than ideal form factor, I have settled on the following points to keep myself from turning into my own patient:

1.     Mind the chin tuck

A chin tuck is a movement of the head about an axis that goes straight through the ears. Performing a chin tuck in order to view the too-low screen of a laptop is a much preferred biomechanical strategy to slouching: It effectively lengthens the shortened suboccipital muscles and avoids the compression on the thoracic outlet that would invariably result from an otherwise rounded thoracic spine posture.

2.     Get yourself a real mouse

Even a travel size mouse will make you more efficient in your daily documentation than would be possible with a built-in mouse pad. Anything that makes you more efficient is good ergonomics - you won’t want to go without one after trying it for just one day.

3.     Ditch the built-in keyboard!

Admittedly, carrying an external keyboard is a harder sell, but I’ll give it my best pitch: Modern, Bluetooth-enabled travel keyboards are extremely portable and dramatically improve the quality of mobile computing comfort. I have actually come to like their simple design, clean lines, and especially small footprint enough for me to use this one as my preferred keyboard at home (for a more extensive range of adjustments in a travel keyboard, consider the Goldtouch Go).

While the dramatic increase in typing comfort over the cramped claustrophobia of a netbook keyboard is immediate, I believe the main advantage of ditching the built-in keyboard to be the opportunity to get the screen up to eye level. There are so many opportunities to place a laptop screen in a better viewing position, by propping it up or placing it on any number of items - even on the dash in the car (when making up documentation in a parking lot, while sitting in the passenger seat). Without an external keyboard, typing is impossible with any attempt at achieving visual comfort by the appropriate placement of the laptop screen.

All of these ideas together have given me the opportunity to truly appreciate the advantages of paperless record keeping, when before it was just…a pain.

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