Exploring clinician adoption of a novel evidence request feature in an electronic medical record system

Rebecca N Jerome,Patrick G Arbogast,S Trent Rosenbloom,Nunzia Bettinsoli Giuse

doi:10.3163/1536-5050.96.1.34

Abstract

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. 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 mid-way through the observation period. A focus group and a 25-item survey explored physicians' experiences with the service. 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, McNemar's 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. 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.

Highlights

Practicing clinicians have an obvious imperative to manage and apply information effectively
There was no detectable difference in the proportion of physicians using the evidence-based medicine (EBM) Literature Request service between the 2 time periods (11% utilization in each time period, Pϭ1.0)
The survey results at the end of this study project indicate that the new communication and marketing interventions developed in this project are well received by clinicians, even though they had no effect on the actual use of the EBM Literature Request tool during the first five months of the new strategies

Summary

Introduction

Practicing clinicians have an obvious imperative to manage and apply information effectively. Physicians attempting to identify research relevant to their clinical practice are faced with a number of potential roadblocks. These issues may be contributing to the large proportion of questions encountered during clinical practice that go unpursued [1–8]. A growing number of information resources provide ready access to evidence-based syntheses of the clinical research literature (e.g., UpToDate, MDConsult, Cochrane Database of Systematic Reviews). These resources attempt to assist clinicians with quick access to readily available answers. Numerous investigations continue to demonstrate significant gaps between research evidence and the clinical care provided in a broad range of clinical specialties [25–32], underscoring the need for additional, systematic ways to integrate evidence into clinical practice

Methods

Results

Discussion

Conclusion