Jerome RN et al. 2008 "Exploring clinician adoption of a novel evidence request feature in an electronic medical record system."
Reference
Jerome RN, Giuse NB, Rosenbloom ST, et al. Exploring clinician adoption of a novel evidence request feature in an electronic medical record system. J Med Libr Assoc 2008;96(1):34-41.
Abstract
"Objective: The research evaluated strategies for facilitating physician adoption of an evidence-based medicine literature request feature recently integrated into an existing electronic medical record (EMR) system. Methods: This prospective study explored use of the service by 137 primary care physicians by using service usage statistics and focus group and survey components. The frequency of physicians' requests for literature via the EMR during a 10-month period was examined to explore the impact of several enhanced communication strategies launched midway through the observation period. A focus group and a 25-item survey explored physicians experiences with the service. Results: There was no detectable difference in the proportion of physicians utilizing the service after implementation of the customized communication strategies (11% in each time period, P=1.0, McNemars test). Forty-eight physicians (35%) responded to the survey. Respondents who had used the service (n=19) indicated that information provided through the service was highly relevant to clinical practice (mean rating 4.6, scale 1 "not relevant"-5 "highly relevant"), and most (n=15) reported sharing the information with colleagues. Conclusion: The enhanced communication strategies, though well received, did not significantly affect use of the service. However, physicians noted the relevance and utility of librarian-summarized evidence from the literature, highlighting the potential benefits of providing expert librarian services in clinical workflow."
Objective
To evaluate "strategies for facilitating physician adoption of an evidence-based medicine literature request feature recently integrated into an existing electronic medical record (EMR) system."
Tools Used
Type Clinic
Primary care
Size
Large
Geography
Urban
Other Information
Study clinic is located at the Vanderbilt University Medical Center.
Type of Health IT
Informational resource
Type of Health IT Functions
Evidence based medicine (EBM) literature requests: "In response to a clinical question received through the [EMR] system message basket, the librarian searches the literature, selects the "best" evidence based on methodological rigor and relevance to the question at hand, and summarizes the evidence in a written synthesis that is delivered to the clinician through the EMR system."
Context or other IT in place
Electronic medical records (EMR)
Workflow-Related Findings
"When asked to respond to the statement, 'Information provided by the librarian was relevant to my clinical practice' (scale: 1: strongly disagree 5: strongly agree), participants assigned a mean ranking of 4.6 (range: 4-5)."
"The majority of the physicians (84%) responded that the length of the librarian's written synopsis of the literature was appropriate, although 2 physicians felt that it was too long (11%)."
"When queried regarding turnaround time for the service, most physicians (n=15, 79%) felt it was acceptable, while 3 physicians (16%) indicated that the turnaround time was somewhat too long."
"Seventy-nine percent of the respondents (n=15) indicated that they had shared the information provided by the librarian with others."
"In response to the statement, 'Information provided by the librarian sometimes leads to a change in my clinical practice' (scale: 1=strongly disagree-5=strongly agree), respondents indicated a mean agreement of 3.9 (range: 3-5)."
"Seventy-nine percent (n=15) responded that they had recommended the service to others, primarily to other residents (n=12, 63%) and attending physicians (n=8, 42%)."
"Participants were ... asked to describe how the information provided by the librarian affected their clinical practice ... General self-education or instruction of trainees (n=18, 95%) and confirmation of a current plan (n=11, 58%) were the most frequently selected items. However, other more explicit ways the information changed clinical practice (e.g., implementing a new or different treatment, adding a diagnostic test) were also selected by more than 25% of respondents."
Study Design
Only postintervention (no control group)
Study Participants
The study participants included 137 attending and resident physicians.