Pluye P et al. 2004 "How information retrieval technology may impact on physician practice: an organizational case study in family medicine."

Pluye P, Grad RM. How information retrieval technology may impact on physician practice: an organizational case study in family medicine. J Eval Clin Pract 2004;10(3):413-430.
"Rationale: Information retrieval technology tends to become nothing less than crucial in physician daily practice, notably in family medicine. Nevertheless, few studies examine impacts of this technology and their results appear controversial. Aims and objectives: Our article aims to explore these impacts using the medical literature, an organizational case study and the literature on organizations. Methods: The case study was embedded in an evaluation of the implementation of medical and pharmaceutical databases on handheld computers in a Canadian family medicine centre. Six physicians were interviewed on specific events relative to the use of these databases and on their general perception of impacts of this use on clinical decision making and the doctor-patient relationship. A thematic data analysis was performed concomitantly by both authors. Results and conclusion: Findings indicate six types of impact: practice improvement, reassurance, learning, confirmation, recall and frustration. These findings are interpreted in accordance with both a medical and organizational perspective. The fit with the literature on inter-organizational memory supports the transferability of the findings. In turn, this fit suggests how information retrieval technology may change physician routine. This study suggests a new basis for evaluating the impact of information retrieval technology in daily clinical practice. In conclusion, our paper encourages policy-makers to develop, and physicians to use, this technology."

To explore the impacts of handheld information retrieval technology on physician daily practice "using the medical literature, an organizational case study, and the literature on organizations."

Tools Used
Type Clinic
Primary care
Type Specific
Family practice
Small and/or medium
Type of Health IT
Informational resource
Type of Health IT Functions
The informational resource "was the first evidence-based medicine database for family medicine available on handheld computer...By design, the information presented by [the software] is highly filtered for both clinical relevance to primary care and validity." It "combines information retrieval technology with decision support systems. Examples of information retrieval technology include all Cochrane systematic review abstracts, [Patient-Oriented Evidence That Matters (POEMs)] published monthly in journals such as the British Medical Journal and the Journal of Family Practice, and summaries of treatment guidelines. Examples of decision support systems are decision and prediction rules for diagnosis or risk assessment."
Workflow-Related Findings
Participants who used their handheld device weekly or more often "perceived impacts in both decision making and doctor-patient relationships. This impact consisted in being reassured by the availability of the databases on the [handheld device]."
Several of the participants who used their handheld device weekly or more often indicated that it improved their practice. One said the software "increases your ability to access information and to make decisions..., if you use it in an interactive way with the patient...This up-to-date information facilitated and improved the doctor-patient relationship. The decision making together was better because we had more current information."
In using the software, "participants learned new knowledge or updated their knowledge. As participant 4 said, "I was trying to find treatments for depression and [the program] was useful because I was able to look at a few things with the patient to review what is the current evidence"."
In using the software, "participants recalled forgotten knowledge. For example, participant 4 said: "I couldn't remember the name of a medication used for the treatment of obesity and it turned out its Sibutramine. I looked up obesity treatment and it was great. It was with the patient, and I said: Ah, there is some evidence. So it was really helpful. Here I had it. Boom, I found it. Otherwise, it would take a long time. I would have had to leave the room and go find somebody"."
In using the software "participants confirmed their knowledge, as illustrated by participant 5: "I was with the resident in the teaching room, and the resident was being argumentative (laugh) when I made a suggestion that he should put his diabetic patient on aspirin. He wanted the evidence, and I know the evidence is out there. I was able to find enough information on [the program] to prove something to him"."
"Participants felt frustrated when they did not find information [in the program]. As participant 4 put it, "there was a patient who had the hiccups and I wanted to look up the treatment. I didn't know if there was anything more current. and I could not figure out how to actually get information on 'hiccups' [within the software]. I couldn't find it. So it was frustrating, and the resident was sitting there and I was trying madly to find it and I finally gave up"."
Study Design
Only postintervention (no control group)
Study Participants
"Family physicians working at least part time at the centre were approached to participate...Participants were board-certified family physicians in active office practice who were also involved in the hospital care of their patients."