A Review of:
Jerome, Rebecca N., Nunzia Bettinsoli Giuse, S. Trent Rosenbloom, and Patrick G. Arbogast. “Exploring Clinician Adoption of a Novel Evidence Request Feature in an Electronic Medical Record System.” Journal of the Medical Library Association 96.1 (Jan. 2008): 34-41, with online appendices.
Abstract
Objective – To examine physician use of an Evidence-Based Medicine (EBM) literature request service available to clinicians through the institution’s electronic medical record system (EMR). Specifically, the authors posed the following questions: 1) Did newly implemented marketing and communication strategies increase physicians’ use of the service? 2) How did clinicians rate the relevance of the information provided? 3) How was the information provided used and shared?
Design – Ten-month, prospective, observational study employing a questionnaire, statistics, a focus group, and a “before and after marketing intervention” analysis.
Setting – Adult primary care outpatient clinic in an academic medical centre.
Subjects – Forty-eight attending and 89 resident physicians.
Methods – In 2003, a new service was introduced that allowed physicians in the Adult Primary Care Center clinic to request evidence summaries from the library regarding complex clinical questions. Contact with the library was through the secure messaging feature of the institution’s electronic medical record (EMR). From March through July 2005, the librarian employed “standard” publicity methods (e-mail, flyers, posters, demonstrations) to promote the service. A focus group in July 2005 provided feedback about the service as well as recommendations about communicating its availability and utility. New communication methods were implemented, including a monthly electronic “current awareness” newsletter, more frequent visits by the librarian during resident clinic hours, and collaborations between the librarian and residents preparing for morning report presentations. At the end of the study period, a 25-item Web-based questionnaire was sent to the 137 physicians with access to the service.
Main Results – During the 10-month study period, 23 unique users submitted a total of 45 questions to the EBM Literature Request Service. More questions were from attending physicians than residents: 36 (80%) vs. 9 (20%). At least one of the 23 users asked 12 (26%) of the questions. Utilization did not significantly change after the mid-study intervention. At the end of the study, 48 physicians (35%) completed the survey (32 attending physicians and 16 residents). While 94% of the respondents indicated awareness of the service, only 40% indicated using it. The 19 who used the service, on average, agreed that the information provided was relevant and “sometimes leads to a change in my clinical practice” (p.37). Those who indicated that they shared the information (n=15) mostly did so with other attending physicians and residents, but also mentioned sharing with fellows, patients, and nurses. Information was typically shared verbally but also by distributing a printout, forwarding by e-mail, and forwarding within the EMR message system. The information was used primarily for general self-education, instruction of trainees, and confirmation of a current plan.
Conclusion – The newly implemented marketing and communication strategies did not significantly increase the use of the EBM Literature Request Service. Those who used the service found it relevant and often shared the information with others. Based on a small number of respondents and survey information, the librarian-provided EBM Literature Request Service was “well-received” (39).
User Manuals for a Primary Care Electronic Medical Record System: A Mixed-Methods Study of User- and Vendor-Generated Documents
