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Appl Clin Inform 2015; 06(02): 305-317
DOI: 10.4338/ACI-2014-11-RA-0104
DOI: 10.4338/ACI-2014-11-RA-0104
Point-of-Care Knowledge-Based Resource Needs of Clinicians
A Survey from a Large Academic Medical Center
Further Information
Correspondence to:
Marc A. Ellsworth, MD
Division of Neonatal Medicine
200 1st Street SW
Rochester, MN 55905, USA
Email: ellsworth.marc@mayo.edu
Publication History
received:
12 November 2014
accepted:
09 March 2015
Publication Date:
19 December 2017 (online)
Summary
Objective: To better understand the literature searching preferences of clinical providers we conducted an institution-wide survey assessing the most preferred knowledge searching techniques.
Materials and Methods: A survey regarding literature searching preferences was sent to 1862 unique clinical providers throughout Mayo Clinic. The survey consisted of 25 items asking respondents to select which clinical scenarios most often prompt literature searches as well as identify their most preferred knowledge resources.
Results: A total of 450 completed surveys were returned and analyzed (24% response rate). 48% of respondents perform literature searches for more than half of their patient interactions with 91% of all searches occurring either before or within 3 hours of the patient interaction. When a search is performed 57% of respondents prefer synthesized information sources as compared to only 13% who prefer original research. 82% of knowledge searches are performed on a workstation or office computer while just 10% occur on a mobile device or at home.
Conclusion: Providers in our survey demonstrate a need to answer clinical questions on a regular basis, especially in the diagnosis and therapy domains. Responses suggest that most of these searches occur using synthesized knowledge sources in the patient care setting within a very short time from the patient interaction.
Citation: Ellsworth MA, Homan JM, Cimino JJ, Peters SG, Pickering BW, Herasevich V. Point-of-care knowledge-based resource needs of clinicians: A survey from a large academic medical center. Appl Clin Inf 2015; 6: 305–317
http://dx.doi.org/10.4338/ACI-2014-11-RA-0104
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Keywords
Electronic health records - evidence-based medicine - information storage and retrieval - point of care technology - user-computer interface
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Conflict of Interest
None of the authors have any financial or conflict of interest disclosures to report.
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References
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- 2 Ely JW, Osheroff JA, Chambliss ML, Ebell MH, Rosenbaum ME. Answering physicians’ clinical questions: obstacles and potential solutions. J Am Med Inform Assoc 2005; 12 (Suppl. 02) 217-224.
- 3 Collins SA, Currie LM, Bakken S, Cimino JJ. Information needs, Infobutton Manager use, and satisfaction by clinician type: a case study. J Am Med Inform Assoc 2009; 16 (01) 140-142.
- 4 Westbrook JI, Coiera EW, Gosling AS. Do online information retrieval systems help experienced clinicians answer clinical questions?. J Am Med Inform Assoc 2005; 12 (03) 315-321.
- 5 McKibbon KA, Fridsma DB. Effectiveness of clinician-selected electronic information resources for answering primary care physicians’ information needs. J Am Med Inform Assoc 2006; 13 (06) 653-659.
- 6 Hoogendam A, Stalenhoef AF, Robbe PF, Overbeke AJ. Answers to questions posed during daily patient care are more likely to be answered by UpToDate than PubMed. J Med Internet Res 2008; 10 (04) e29.
- 7 Gonzalez-Gonzalez AI, Dawes M, Sanchez-Mateos J, Riesgo-Fuertes R, Escortell-Mayor E, Sanz-Cuesta T, Hernandez-Fernandez T. Information needs and information-seeking behavior of primary care physicians. Ann Fam Med 2007; 5 (04) 345-352.
- 8 Del Fiol G, Workman TE, Gorman PN. Clinical questions raised by clinicians at the point of care: a systematic review. JAMA Intern Med 2014; 174 (05) 710-718.
- 9 Green ML, Ciampi MA, Ellis PJ. Residents’ medical information needs in clinic: are they being met?. Am J Med 2000; 109 (Suppl. 03) 218-223.
- 10 Schwartz K, Northrup J, Israel N, Crowell K, Lauder N, Neale AV. Use of on-line evidence-based resources at the point of care. Fam Med 2003; 35 (Suppl. 04) 251-256.
- 11 Sackett DL, Straus SE. Finding and applying evidence during clinical rounds: the ,,evidence cart“. JAMA 1998; 280 (15) 1336-1338.
- 12 Soma DB, Homme JH, Jacobson RM. Using tablet computers to teach evidence-based medicine to pediatrics residents: a prospective study. Acad Pediatr 2013; 13 (06) 546-550.
- 13 Schardt C, Adams MB, Owens T, Keitz S, Fontelo P. Utilization of the PICO framework to improve searching PubMed for clinical questions. BMC Med Inform Decis Mak 2007; 7: 16.
- 14 Schilling LM, Steiner JF, Lundahl K, Anderson RJ. Residents’ patient-specific clinical questions: opportunities for evidence-based learning. Acad Med 2005; 80 (01) 51-56.
- 15 Haynes RB. Of studies, syntheses, synopses, summaries, and systems: the ,,5S“ evolution of information services for evidence-based healthcare decisions. Evid Based Med 2006; 11 (Suppl. 06) 162-164.
- 16 Mickan S, Tilson JK, Atherton H, Roberts NW, Heneghan C. Evidence of effectiveness of health care professionals using handheld computers: a scoping review of systematic reviews. J Med Internet Res 2013; 15 (10) e212.
- 17 Gavino AI, Ho BL, Wee PA, Marcelo AB, Fontelo P. Information-seeking trends of medical professionals and students from middle-income countries: a focus on the Philippines. Health Info Libr J 2013; 30 (04) 303-317.
- 18 Cimino JJ. An integrated approach to computer-based decision support at the point of care. Trans Am Clin Climatol Assoc 2007; 118: 273-288.
- 19 Cimino JJ. Use, usability, usefulness, and impact of an infobutton manager. AMIA Annu Symp Proc 2006: 151-155.
- 20 Del Fiol G, Haug PJ, Cimino JJ, Narus SP, Norlin C, Mitchell JA. Effectiveness of topic-specific infobuttons: a randomized controlled trial. J Am Med Inform Assoc 2008; 15 (06) 752-759.
- 21 Maviglia SM, Yoon CS, Bates DW, Kuperman G. KnowledgeLink: impact of context-sensitive information retrieval on clinicians’ information needs. J Am Med Inform Assoc 2006; 13 (01) 67-73.
- 22 Fuller SS, Ketchell DS, Tarczy-Hornoch P, Masuda D. Integrating knowledge resources at the point of care: opportunities for librarians. Bull Med Libr Assoc 1999; 87 (04) 393-403.
- 23 Schwartz LM, Iobst B. Planning for the integration of the digital library, clinical decision support, and evidence at the point of care. Med Ref Serv Q 2008; 27 (02) 146-157.
- 24 Cimino JJ, Overby CL, Devine EB, Hulse NC, Jing X, Maviglia SM, Del Fiol G. Practical choices for info-button customization: experience from four sites. AMIA Annu Symp Proc 2013; 2013: 236-245.
- 25 Harris PA, Taylor R, Thielke R, Payne J, Gonzalez N, Conde JG. Research electronic data capture (REDCap) –a metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inform 2009; 42 (02) 377-381.
- 26 Thiele RH, Poiro NC, Scalzo DC, Nemergut EC. Speed, accuracy, and confidence in Google, Ovid, PubMed, and UpToDate: results of a randomised trial. Postgrad Med J 2010; 86 1018 459-465.
- 27 Davies K. Quantifying the information needs of doctors in the UK using clinical librarians. Health Info Libr J 2009; 26 (04) 289-297.
- 28 Dorr DA, Tran H, Gorman P, Wilcox AB. Information needs of nurse care managers. AMIA Annu Symp Proc. 2006: 913.
- 29 Ely JW, Osheroff JA, Gorman PN, Ebell MH, Chambliss ML, Pifer EA, Stavri PZ. A taxonomy of generic clinical questions: classification study. BMJ 2000; 321 7258 429-432.
- 30 Cimino JJ, Jing X, Del Fiol G. Meeting the electronic health record ,,meaningful use“ criterion for the HL7 infobutton standard using OpenInfobutton and the Librarian Infobutton Tailoring Environment (LITE). AMIA Annu Symp Proc 2012; 2012: 112-120.
- 31 Del Fiol G, Curtis C, Cimino JJ, Iskander A, Kalluri AS, Jing X, Hulse NC, Long J, Overby CL, Schardt C, Douglas DM. Disseminating context-specific access to online knowledge resources within electronic health record systems. Stud Health Technol Inform 2013; 192: 672-676.
- 32 Del Fiol G, Huser V, Strasberg HR, Maviglia SM, Curtis C, Cimino JJ. Implementations of the HL7 Context-Aware Knowledge Retrieval (,,Infobutton“) Standard: challenges, strengths, limitations, and uptake. J Biomed Inform 2012; 45 (04) 726-735.
- 33 Cimino JJ, Borovtsov DV. Leading a horse to water: using automated reminders to increase use of online decision support. AMIA Annu Symp Proc 2008: 116-120.
- 34 Del Fiol G, Rocha RA, Clayton PD. Infobuttons at Intermountain Healthcare: utilization and infrastructure. AMIA Annu Symp Proc 2006: 180-184.
- 35 Kannampallil TG, Jones LK, Patel VL, Buchman TG, Franklin A. Comparing the information seeking strategies of residents, nurse practitioners, and physician assistants in critical care settings. J Am Med Inform Assoc 2014; 21 e2 e249-e256.
- 36 Cook DA, Enders F, Linderbaum JA, Zwart D, Lloyd FJ. Speed and accuracy of a point of care web-based knowledge resource for clinicians: a controlled crossover trial. Interact J Med Res 2014; 3 (01) e7.
Correspondence to:
Marc A. Ellsworth, MD
Division of Neonatal Medicine
200 1st Street SW
Rochester, MN 55905, USA
Email: ellsworth.marc@mayo.edu
-
References
- 1 Osheroff JA, Forsythe DE, Buchanan BG, Bankowitz RA, Blumenfeld BH, Miller RA. Physicians’ information needs: analysis of questions posed during clinical teaching. Ann Intern Med 1991; 114 (Suppl. 07) 576-581.
- 2 Ely JW, Osheroff JA, Chambliss ML, Ebell MH, Rosenbaum ME. Answering physicians’ clinical questions: obstacles and potential solutions. J Am Med Inform Assoc 2005; 12 (Suppl. 02) 217-224.
- 3 Collins SA, Currie LM, Bakken S, Cimino JJ. Information needs, Infobutton Manager use, and satisfaction by clinician type: a case study. J Am Med Inform Assoc 2009; 16 (01) 140-142.
- 4 Westbrook JI, Coiera EW, Gosling AS. Do online information retrieval systems help experienced clinicians answer clinical questions?. J Am Med Inform Assoc 2005; 12 (03) 315-321.
- 5 McKibbon KA, Fridsma DB. Effectiveness of clinician-selected electronic information resources for answering primary care physicians’ information needs. J Am Med Inform Assoc 2006; 13 (06) 653-659.
- 6 Hoogendam A, Stalenhoef AF, Robbe PF, Overbeke AJ. Answers to questions posed during daily patient care are more likely to be answered by UpToDate than PubMed. J Med Internet Res 2008; 10 (04) e29.
- 7 Gonzalez-Gonzalez AI, Dawes M, Sanchez-Mateos J, Riesgo-Fuertes R, Escortell-Mayor E, Sanz-Cuesta T, Hernandez-Fernandez T. Information needs and information-seeking behavior of primary care physicians. Ann Fam Med 2007; 5 (04) 345-352.
- 8 Del Fiol G, Workman TE, Gorman PN. Clinical questions raised by clinicians at the point of care: a systematic review. JAMA Intern Med 2014; 174 (05) 710-718.
- 9 Green ML, Ciampi MA, Ellis PJ. Residents’ medical information needs in clinic: are they being met?. Am J Med 2000; 109 (Suppl. 03) 218-223.
- 10 Schwartz K, Northrup J, Israel N, Crowell K, Lauder N, Neale AV. Use of on-line evidence-based resources at the point of care. Fam Med 2003; 35 (Suppl. 04) 251-256.
- 11 Sackett DL, Straus SE. Finding and applying evidence during clinical rounds: the ,,evidence cart“. JAMA 1998; 280 (15) 1336-1338.
- 12 Soma DB, Homme JH, Jacobson RM. Using tablet computers to teach evidence-based medicine to pediatrics residents: a prospective study. Acad Pediatr 2013; 13 (06) 546-550.
- 13 Schardt C, Adams MB, Owens T, Keitz S, Fontelo P. Utilization of the PICO framework to improve searching PubMed for clinical questions. BMC Med Inform Decis Mak 2007; 7: 16.
- 14 Schilling LM, Steiner JF, Lundahl K, Anderson RJ. Residents’ patient-specific clinical questions: opportunities for evidence-based learning. Acad Med 2005; 80 (01) 51-56.
- 15 Haynes RB. Of studies, syntheses, synopses, summaries, and systems: the ,,5S“ evolution of information services for evidence-based healthcare decisions. Evid Based Med 2006; 11 (Suppl. 06) 162-164.
- 16 Mickan S, Tilson JK, Atherton H, Roberts NW, Heneghan C. Evidence of effectiveness of health care professionals using handheld computers: a scoping review of systematic reviews. J Med Internet Res 2013; 15 (10) e212.
- 17 Gavino AI, Ho BL, Wee PA, Marcelo AB, Fontelo P. Information-seeking trends of medical professionals and students from middle-income countries: a focus on the Philippines. Health Info Libr J 2013; 30 (04) 303-317.
- 18 Cimino JJ. An integrated approach to computer-based decision support at the point of care. Trans Am Clin Climatol Assoc 2007; 118: 273-288.
- 19 Cimino JJ. Use, usability, usefulness, and impact of an infobutton manager. AMIA Annu Symp Proc 2006: 151-155.
- 20 Del Fiol G, Haug PJ, Cimino JJ, Narus SP, Norlin C, Mitchell JA. Effectiveness of topic-specific infobuttons: a randomized controlled trial. J Am Med Inform Assoc 2008; 15 (06) 752-759.
- 21 Maviglia SM, Yoon CS, Bates DW, Kuperman G. KnowledgeLink: impact of context-sensitive information retrieval on clinicians’ information needs. J Am Med Inform Assoc 2006; 13 (01) 67-73.
- 22 Fuller SS, Ketchell DS, Tarczy-Hornoch P, Masuda D. Integrating knowledge resources at the point of care: opportunities for librarians. Bull Med Libr Assoc 1999; 87 (04) 393-403.
- 23 Schwartz LM, Iobst B. Planning for the integration of the digital library, clinical decision support, and evidence at the point of care. Med Ref Serv Q 2008; 27 (02) 146-157.
- 24 Cimino JJ, Overby CL, Devine EB, Hulse NC, Jing X, Maviglia SM, Del Fiol G. Practical choices for info-button customization: experience from four sites. AMIA Annu Symp Proc 2013; 2013: 236-245.
- 25 Harris PA, Taylor R, Thielke R, Payne J, Gonzalez N, Conde JG. Research electronic data capture (REDCap) –a metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inform 2009; 42 (02) 377-381.
- 26 Thiele RH, Poiro NC, Scalzo DC, Nemergut EC. Speed, accuracy, and confidence in Google, Ovid, PubMed, and UpToDate: results of a randomised trial. Postgrad Med J 2010; 86 1018 459-465.
- 27 Davies K. Quantifying the information needs of doctors in the UK using clinical librarians. Health Info Libr J 2009; 26 (04) 289-297.
- 28 Dorr DA, Tran H, Gorman P, Wilcox AB. Information needs of nurse care managers. AMIA Annu Symp Proc. 2006: 913.
- 29 Ely JW, Osheroff JA, Gorman PN, Ebell MH, Chambliss ML, Pifer EA, Stavri PZ. A taxonomy of generic clinical questions: classification study. BMJ 2000; 321 7258 429-432.
- 30 Cimino JJ, Jing X, Del Fiol G. Meeting the electronic health record ,,meaningful use“ criterion for the HL7 infobutton standard using OpenInfobutton and the Librarian Infobutton Tailoring Environment (LITE). AMIA Annu Symp Proc 2012; 2012: 112-120.
- 31 Del Fiol G, Curtis C, Cimino JJ, Iskander A, Kalluri AS, Jing X, Hulse NC, Long J, Overby CL, Schardt C, Douglas DM. Disseminating context-specific access to online knowledge resources within electronic health record systems. Stud Health Technol Inform 2013; 192: 672-676.
- 32 Del Fiol G, Huser V, Strasberg HR, Maviglia SM, Curtis C, Cimino JJ. Implementations of the HL7 Context-Aware Knowledge Retrieval (,,Infobutton“) Standard: challenges, strengths, limitations, and uptake. J Biomed Inform 2012; 45 (04) 726-735.
- 33 Cimino JJ, Borovtsov DV. Leading a horse to water: using automated reminders to increase use of online decision support. AMIA Annu Symp Proc 2008: 116-120.
- 34 Del Fiol G, Rocha RA, Clayton PD. Infobuttons at Intermountain Healthcare: utilization and infrastructure. AMIA Annu Symp Proc 2006: 180-184.
- 35 Kannampallil TG, Jones LK, Patel VL, Buchman TG, Franklin A. Comparing the information seeking strategies of residents, nurse practitioners, and physician assistants in critical care settings. J Am Med Inform Assoc 2014; 21 e2 e249-e256.
- 36 Cook DA, Enders F, Linderbaum JA, Zwart D, Lloyd FJ. Speed and accuracy of a point of care web-based knowledge resource for clinicians: a controlled crossover trial. Interact J Med Res 2014; 3 (01) e7.