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DOI: 10.4338/ACI-2016-06-RA-0083
Measuring Practicing Clinicians’ Information Literacy
An Exploratory Analysis in the Context of Panel ManagementCorrespondence to:
Publication History
Received:
01 June 2016
Accepted:
05 February 2016
Publication Date:
20 December 2017 (online)
Summary
Background: As healthcare moves towards technology-driven population health management, clinicians must adopt complex digital platforms to access health information and document care. Objectives: This study explored information literacy, a set of skills required to effectively navigate population health information systems, among primary care providers in one Veterans’ Affairs (VA) medical center.
Methods: Information literacy was assessed during an 8-month randomized trial that tested a population health (panel) management intervention. Providers were asked about their use and comfort with two VA digital tools for panel management at baseline, 16 weeks, and post-intervention. An 8-item scale (range 0-40) was used to measure information literacy (Cronbach’s α=0.84). Scores between study arms and provider types were compared using paired t-tests and ANOVAs. Associations between self-reported digital tool use and information literacy were measured via Pearson’s correlations.
Results: Providers showed moderate levels of information literacy (M= 27.4, SD 6.5). There were no significant differences in mean information literacy between physicians (M=26.4, SD 6.7) and nurses (M=30.5, SD 5.2, p=0.57 for difference), or between intervention (M=28.4, SD 6.5) and control groups (M=25.1, SD 6.2, p=0.12 for difference). Information literacy was correlated with higher rates of self-reported information system usage (r=0.547, p=0.001). Clinicians identified data access, accuracy, and interpretability as potential information literacy barriers.
Conclusions: While exploratory in nature, cautioning generalizability, the study suggests that measuring and improving clinicians’ information literacy may play a significant role in the implementation and use of digital information tools, as these tools are rapidly being deployed to enhance communication among care teams, improve health care outcomes, and reduce overall costs.
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Keywords
Information systems - information literacy - health services needs and demand - informatics - human engineering or usability
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Conflicts of interest
Several authors (BED, KJB, SES, MDS) are employed at either the VA New York Harbor Healthcare Systems in New York, New York, or the Richard L Roudebush Veterans Affairs Medical Center in Indianapolis, Indiana. As such, they receive at least a portion of their annual salary from the U.S. Department of Veterans Affairs.
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References
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- 2 Zeldes N, Baum N. Information overload in medical practice. The Journal of medical practice management : MPM 2011; 26 (Suppl. 05) 314-316.
- 3 Jha AK, Burke MF, DesRoches C, Joshi MS, Kralovec PD, Campbell EG, Buntin MB. Progress toward meaningful use: hospitals’ adoption of electronic health records. The American journal of managed care 2011; 17 12 Spec No. SP117-SP124.
- 4 Xierali IM, Hsiao CJ, Puffer JC, Green LA, Rinaldo JC, Bazemore AW, Burke MT, Phillips Jr. RL. The rise of electronic health record adoption among family physicians. Annals of family medicine 2013; 11 (Suppl. 01) 14-19.
- 5 Whipple EC, Dixon BE, McGowan JJ. Linking health information technology to patient safety and quality outcomes: a bibliometric analysis and review. Inform Health Soc Care 2013; 38 (Suppl. 01) 1-14.
- 6 Black AD, Car J, Pagliari C, Anandan C, Cresswell K, Bokun T, McKinstry B, Procter R, Majeed A, Sheikh A. The impact of eHealth on the quality and safety of health care: a systematic overview. PLoS medicine 2011; 8 (Suppl. 01) e1000387.
- 7 Chaudhry B, Wang J, Wu S, Maglione M, Mojica W, Roth E, Morton SC, Shekelle PG. Systematic review: impact of health information technology on quality, efficiency, and costs of medical care. Annals of Internal Medicine 2006; 144 (Suppl. 10) 742-752.
- 8 Nadkarni PM, Ohno-Machado L, Chapman WW. Natural language processing: an introduction. J Am Med Inform Assoc 2011; 18 (Suppl. 05) 544-551.
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- 10 Dixon BE, Jones JF, Grannis SJ. Infection preventionists’ awareness of and engagement in health information exchange to improve public health surveillance. American journal of infection control 2013; 41 (Suppl. 09) 787-792.
- 11 Cusack CM, Hripcsak G, Bloomrosen M, Rosenbloom ST, Weaver CA, Wright A, Vawdrey DK, Walker J, Mamykina L. The future state of clinical data capture and documentation: a report from AMIA’s 2011 Policy Meeting. J Am Med Inform Assoc 2013; 20 (Suppl. 01) 134-140.
- 12 Walji MF, Kalenderian E, Tran D, Kookal KK, Nguyen V, Tokede O, White JM, Vaderhobli R, Ramoni R, Stark PC, Kimmes NS, Schoonheim-Klein ME, Patel VL. Detection and characterization of usability problems in structured data entry interfaces in dentistry. Int J Med Inform 2013; 82 (Suppl. 02) 128-138.
- 13 Minshall S. A review of healthcare information system usability & safety. Studies in health technology and informatics 2013; 183: 151-156.
- 14 Flanagan ME, Saleem JJ, Millitello LG, Russ AL, Doebbeling BN. Paper- and computer-based worka-rounds to electronic health record use at three benchmark institutions. Journal of the American Medical Informatics Association: JAMIA. 2013; 20 e1 e59-e66.
- 15 Saleem JJ, Flanagan ME, Russ AL, McMullen CK, Elli L, Russell SA, Bennett KJ, Matthias MS, Rehman SU, Schwartz MD, Frankel RM. You and me and the computer makes three: variations in exam room use of the electronic health record. J Am Med Inform Assoc 2014; 21 e1 e147-e151.
- 16 Frankel RM. Computers in the Examination Room. JAMA internal medicine 2016; 176 (Suppl. 01) 128-129.
- 17 Duke P, Frankel RM, Reis S. How to integrate the electronic health record and patient-centered communication into the medical visit: a skills-based approach. Teaching and learning in medicine 2013; 25 (Suppl. 04) 358-365.
- 18 Ratanawongsa N, Barton JL, Lyles CR, Wu M, Yelin EH, Martinez D, Schillinger D. Association Between Clinician Computer Use and Communication With Patients in Safety-Net Clinics. JAMA internal medicine 2016; 176 (Suppl. 01) 125-128.
- 19 Grannis SJ, Egg J, Overhage JM. Reviewing and managing syndromic surveillance SaTScan datasets using an open source data visualization tool. AMIA Annu Symp Proc. 2005: 967.
- 20 Chui KK, Wenger JB, Cohen SA, Naumova EN. Visual analytics for epidemiologists: understanding the interactions between age, time, and disease with multi-panel graphs. PloS one 2011; 6 (Suppl. 02) e14683.
- 21 Cinnamon J, Schuurman N. Injury surveillance in low-resource settings using Geospatial and Social Web technologies. Int J Health Geogr 2010; 9: 25.
- 22 Dixon BE, Jabour AM, Phillips EO, Marrero DG. An informatics approach to medication adherence assessment and improvement using clinical, billing, and patient-entered data. J Am Med Inform Assoc 2014; 21 (Suppl. 03) 517-521.
- 23 Dolan JG, Veazie PJ, Russ AJ. Development and initial evaluation of a treatment decision dashboard. BMC Med Inform Decis Mak 2013; 13: 51.
- 24 Duke JD, Li X, Grannis SJ. Data visualization speeds review of potential adverse drug events in patients on multiple medications. Journal of biomedical informatics 2010; 43 (Suppl. 02) 326-331.
- 25 Dixon BE, Alzeer AH, Phillips EO, Marrero DG. Integration of Provider, Pharmacy, and Patient-Reported Data to Improve Medication Adherence for Type 2 Diabetes: A Controlled Before-After Pilot Study. JMIR medical informatics 2016; 4 (Suppl. 01) e4.
- 26 Norman CD, Skinner HA. eHealth Literacy: Essential Skills for Consumer Health in a Networked World. J Med Internet Res 2006; 8 (Suppl. 02) e9.
- 27 Safahieh Hajar, Asemi A. Computer literacy skills of librarians: a case study of Isfahan University libraries, Iran. The Electronic Library 2010; 28 (Suppl. 01) 89-99.
- 28 Dixon BE, Newlon CM. How do future nursing educators perceive informatics? Advancing the nursing informatics agenda through dialogue. J Prof Nurs 2010; 26 (Suppl. 02) 82-89.
- 29 Neuwirth EE, Schmittdiel JA, Tallman K, Bellows J. Understanding panel management: a comparative study of an emerging approach to population care. The Permanente journal 2007; 11 (Suppl. 03) 12-20.
- 30 Eichner J, Dullabh P. Accessible Health Information Technology (IT) for Populations with Limited Literacy: A Guide for Developers and Purchasers of Health IT. Rockville, MD: Agency for Healthcare Research and Quality; 2007
- 31 Schaefer CT. Integrated review of health literacy interventions. Orthop Nurs 2008; 27 (Suppl. 05) 302-317.
- 32 Forster M. A phenomenographic investigation into Information Literacy in nursing practice – Preliminary findings and methodological issues. Nurse education today 2012.
- 33 Rao G, Kanter SL. Physician numeracy as the basis for an evidence-based medicine curriculum. Academic medicine : journal of the Association of American Medical Colleges 2010; 85 (Suppl. 11) 1794-1799.
- 34 Moyer VA. What we don’t know can hurt our patients: physician innumeracy and overuse of screening tests. Ann Intern Med 2012; 156 (Suppl. 05) 392-393.
- 35 Anderson BL, Obrecht NA, Chapman GB, Driscoll DA, Schulkin J. Physicians’ communication of Down syndrome screening test results: the influence of physician numeracy. Genetics in medicine: official journal of the American College of Medical Genetics 2011; 13 (Suppl. 08) 744-749.
- 36 Anderson BL, Gigerenzer G, Parker S, Schulkin J. Statistical Literacy in Obstetricians and Gynecologists. Journal for healthcare quality : official publication of the National Association for Healthcare Quality 2012.
- 37 Rosland AM, Nelson K, Sun H, Dolan ED, Maynard C, Bryson C, Stark R, Shear JM, Kerr E, Fihn SD, Schectman G. The patient-centered medical home in the Veterans Health Administration. The American journal of managed care 2013; 19 (Suppl. 07) e263-e272.
- 38 Klein S. The Veterans Health Administration: Implementing Patient-Centered Medical Homes in the Nation’s Largest Integrated Delivery System. New York: The Commonwealth Fund; 2011. September. Report No.: Pub. 1537.
- 39 Piette JD, Holtz B, Beard AJ, Blaum C, Greenstone CL, Krein SL, Tremblay A, Forman J, Kerr EA. Improving chronic illness care for veterans within the framework of the Patient-Centered Medical Home: experiences from the Ann Arbor Patient-Aligned Care Team Laboratory. Behav Med Pract Policy Res 2011; 1 (Suppl. 04) 615-623.
- 40 Strauss SM, Jensen AE, Bennett K, Skursky N, Sherman SE, Schwartz MD. Clinicians’ panel management self-efficacy to support their patients’ smoking cessation and hypertension control needs. Transl Behav Med 2015; 5 (Suppl. 01) 68-76.
- 41 Schwartz MD, Jensen A, Wang B, Bennett K, Dembitzer A, Strauss S, Schoenthaler A, Gillespie C, Sherman S. Panel Management to Improve Smoking and Hypertension Outcomes by VA Primary Care Teams: A Cluster-Randomized Controlled Trial. J Gen Intern Med 2015; 30 (Suppl. 07) 916-923.
- 42 Charmaz K. Qualitative interviewing and grounded theory analysis. In: Gubrium J, Holstein J. editors. Handbook of Interview Research: Context & Method. Thousand Oaks, CA: Sage; 2002: 675-694.
- 43 Middleton B, Bloomrosen M, Dente MA, Hashmat B, Koppel R, Overhage JM, Payne TH, Rosenbloom ST, Weaver C, Zhang J. Enhancing patient safety and quality of care by improving the usability of electronic health record systems: recommendations from AMIA. J Am Med Inform Assoc 2013; 20 e1 e2-e8.
- 44 Holden RJ, Voida S, Savoy A, Jones JF, Kulanthaivel A. Human Factors Engineering and Human-Computer Interaction: Supporting User Performance and Experience. In: Finnell JT, Dixon BE. editors. Clinical Informatics Study Guide: Text and Review. Zurich: Springer International Publishing; 2016: 287-307.
- 45 Rao G. Physician numeracy: essential skills for practicing evidence-based medicine. Family medicine 2008; 40 (Suppl. 05) 354-358.
- 46 Storie D, Campbell S. Determining the information literacy needs of a medical and dental faculty1. Journal of the Canadian Health Libraries Association 2012; 33 (Suppl. 02) 48-59.
Correspondence to:
-
References
- 1 Singh H, Spitzmueller C, Petersen NJ, Sawhney MK, Sittig DF. Information overload and missed test results in electronic health record-based settings. JAMA internal medicine 2013; 173 (Suppl. 08) 702-704.
- 2 Zeldes N, Baum N. Information overload in medical practice. The Journal of medical practice management : MPM 2011; 26 (Suppl. 05) 314-316.
- 3 Jha AK, Burke MF, DesRoches C, Joshi MS, Kralovec PD, Campbell EG, Buntin MB. Progress toward meaningful use: hospitals’ adoption of electronic health records. The American journal of managed care 2011; 17 12 Spec No. SP117-SP124.
- 4 Xierali IM, Hsiao CJ, Puffer JC, Green LA, Rinaldo JC, Bazemore AW, Burke MT, Phillips Jr. RL. The rise of electronic health record adoption among family physicians. Annals of family medicine 2013; 11 (Suppl. 01) 14-19.
- 5 Whipple EC, Dixon BE, McGowan JJ. Linking health information technology to patient safety and quality outcomes: a bibliometric analysis and review. Inform Health Soc Care 2013; 38 (Suppl. 01) 1-14.
- 6 Black AD, Car J, Pagliari C, Anandan C, Cresswell K, Bokun T, McKinstry B, Procter R, Majeed A, Sheikh A. The impact of eHealth on the quality and safety of health care: a systematic overview. PLoS medicine 2011; 8 (Suppl. 01) e1000387.
- 7 Chaudhry B, Wang J, Wu S, Maglione M, Mojica W, Roth E, Morton SC, Shekelle PG. Systematic review: impact of health information technology on quality, efficiency, and costs of medical care. Annals of Internal Medicine 2006; 144 (Suppl. 10) 742-752.
- 8 Nadkarni PM, Ohno-Machado L, Chapman WW. Natural language processing: an introduction. J Am Med Inform Assoc 2011; 18 (Suppl. 05) 544-551.
- 9 Chapman WW, Nadkarni PM, Hirschman L, D’ Avolio LW, Savova GK, Uzuner O. Overcoming barriers to NLP for clinical text: the role of shared tasks and the need for additional creative solutions. J Am Med Inform Assoc 2011; 18 (Suppl. 05) 540-543.
- 10 Dixon BE, Jones JF, Grannis SJ. Infection preventionists’ awareness of and engagement in health information exchange to improve public health surveillance. American journal of infection control 2013; 41 (Suppl. 09) 787-792.
- 11 Cusack CM, Hripcsak G, Bloomrosen M, Rosenbloom ST, Weaver CA, Wright A, Vawdrey DK, Walker J, Mamykina L. The future state of clinical data capture and documentation: a report from AMIA’s 2011 Policy Meeting. J Am Med Inform Assoc 2013; 20 (Suppl. 01) 134-140.
- 12 Walji MF, Kalenderian E, Tran D, Kookal KK, Nguyen V, Tokede O, White JM, Vaderhobli R, Ramoni R, Stark PC, Kimmes NS, Schoonheim-Klein ME, Patel VL. Detection and characterization of usability problems in structured data entry interfaces in dentistry. Int J Med Inform 2013; 82 (Suppl. 02) 128-138.
- 13 Minshall S. A review of healthcare information system usability & safety. Studies in health technology and informatics 2013; 183: 151-156.
- 14 Flanagan ME, Saleem JJ, Millitello LG, Russ AL, Doebbeling BN. Paper- and computer-based worka-rounds to electronic health record use at three benchmark institutions. Journal of the American Medical Informatics Association: JAMIA. 2013; 20 e1 e59-e66.
- 15 Saleem JJ, Flanagan ME, Russ AL, McMullen CK, Elli L, Russell SA, Bennett KJ, Matthias MS, Rehman SU, Schwartz MD, Frankel RM. You and me and the computer makes three: variations in exam room use of the electronic health record. J Am Med Inform Assoc 2014; 21 e1 e147-e151.
- 16 Frankel RM. Computers in the Examination Room. JAMA internal medicine 2016; 176 (Suppl. 01) 128-129.
- 17 Duke P, Frankel RM, Reis S. How to integrate the electronic health record and patient-centered communication into the medical visit: a skills-based approach. Teaching and learning in medicine 2013; 25 (Suppl. 04) 358-365.
- 18 Ratanawongsa N, Barton JL, Lyles CR, Wu M, Yelin EH, Martinez D, Schillinger D. Association Between Clinician Computer Use and Communication With Patients in Safety-Net Clinics. JAMA internal medicine 2016; 176 (Suppl. 01) 125-128.
- 19 Grannis SJ, Egg J, Overhage JM. Reviewing and managing syndromic surveillance SaTScan datasets using an open source data visualization tool. AMIA Annu Symp Proc. 2005: 967.
- 20 Chui KK, Wenger JB, Cohen SA, Naumova EN. Visual analytics for epidemiologists: understanding the interactions between age, time, and disease with multi-panel graphs. PloS one 2011; 6 (Suppl. 02) e14683.
- 21 Cinnamon J, Schuurman N. Injury surveillance in low-resource settings using Geospatial and Social Web technologies. Int J Health Geogr 2010; 9: 25.
- 22 Dixon BE, Jabour AM, Phillips EO, Marrero DG. An informatics approach to medication adherence assessment and improvement using clinical, billing, and patient-entered data. J Am Med Inform Assoc 2014; 21 (Suppl. 03) 517-521.
- 23 Dolan JG, Veazie PJ, Russ AJ. Development and initial evaluation of a treatment decision dashboard. BMC Med Inform Decis Mak 2013; 13: 51.
- 24 Duke JD, Li X, Grannis SJ. Data visualization speeds review of potential adverse drug events in patients on multiple medications. Journal of biomedical informatics 2010; 43 (Suppl. 02) 326-331.
- 25 Dixon BE, Alzeer AH, Phillips EO, Marrero DG. Integration of Provider, Pharmacy, and Patient-Reported Data to Improve Medication Adherence for Type 2 Diabetes: A Controlled Before-After Pilot Study. JMIR medical informatics 2016; 4 (Suppl. 01) e4.
- 26 Norman CD, Skinner HA. eHealth Literacy: Essential Skills for Consumer Health in a Networked World. J Med Internet Res 2006; 8 (Suppl. 02) e9.
- 27 Safahieh Hajar, Asemi A. Computer literacy skills of librarians: a case study of Isfahan University libraries, Iran. The Electronic Library 2010; 28 (Suppl. 01) 89-99.
- 28 Dixon BE, Newlon CM. How do future nursing educators perceive informatics? Advancing the nursing informatics agenda through dialogue. J Prof Nurs 2010; 26 (Suppl. 02) 82-89.
- 29 Neuwirth EE, Schmittdiel JA, Tallman K, Bellows J. Understanding panel management: a comparative study of an emerging approach to population care. The Permanente journal 2007; 11 (Suppl. 03) 12-20.
- 30 Eichner J, Dullabh P. Accessible Health Information Technology (IT) for Populations with Limited Literacy: A Guide for Developers and Purchasers of Health IT. Rockville, MD: Agency for Healthcare Research and Quality; 2007
- 31 Schaefer CT. Integrated review of health literacy interventions. Orthop Nurs 2008; 27 (Suppl. 05) 302-317.
- 32 Forster M. A phenomenographic investigation into Information Literacy in nursing practice – Preliminary findings and methodological issues. Nurse education today 2012.
- 33 Rao G, Kanter SL. Physician numeracy as the basis for an evidence-based medicine curriculum. Academic medicine : journal of the Association of American Medical Colleges 2010; 85 (Suppl. 11) 1794-1799.
- 34 Moyer VA. What we don’t know can hurt our patients: physician innumeracy and overuse of screening tests. Ann Intern Med 2012; 156 (Suppl. 05) 392-393.
- 35 Anderson BL, Obrecht NA, Chapman GB, Driscoll DA, Schulkin J. Physicians’ communication of Down syndrome screening test results: the influence of physician numeracy. Genetics in medicine: official journal of the American College of Medical Genetics 2011; 13 (Suppl. 08) 744-749.
- 36 Anderson BL, Gigerenzer G, Parker S, Schulkin J. Statistical Literacy in Obstetricians and Gynecologists. Journal for healthcare quality : official publication of the National Association for Healthcare Quality 2012.
- 37 Rosland AM, Nelson K, Sun H, Dolan ED, Maynard C, Bryson C, Stark R, Shear JM, Kerr E, Fihn SD, Schectman G. The patient-centered medical home in the Veterans Health Administration. The American journal of managed care 2013; 19 (Suppl. 07) e263-e272.
- 38 Klein S. The Veterans Health Administration: Implementing Patient-Centered Medical Homes in the Nation’s Largest Integrated Delivery System. New York: The Commonwealth Fund; 2011. September. Report No.: Pub. 1537.
- 39 Piette JD, Holtz B, Beard AJ, Blaum C, Greenstone CL, Krein SL, Tremblay A, Forman J, Kerr EA. Improving chronic illness care for veterans within the framework of the Patient-Centered Medical Home: experiences from the Ann Arbor Patient-Aligned Care Team Laboratory. Behav Med Pract Policy Res 2011; 1 (Suppl. 04) 615-623.
- 40 Strauss SM, Jensen AE, Bennett K, Skursky N, Sherman SE, Schwartz MD. Clinicians’ panel management self-efficacy to support their patients’ smoking cessation and hypertension control needs. Transl Behav Med 2015; 5 (Suppl. 01) 68-76.
- 41 Schwartz MD, Jensen A, Wang B, Bennett K, Dembitzer A, Strauss S, Schoenthaler A, Gillespie C, Sherman S. Panel Management to Improve Smoking and Hypertension Outcomes by VA Primary Care Teams: A Cluster-Randomized Controlled Trial. J Gen Intern Med 2015; 30 (Suppl. 07) 916-923.
- 42 Charmaz K. Qualitative interviewing and grounded theory analysis. In: Gubrium J, Holstein J. editors. Handbook of Interview Research: Context & Method. Thousand Oaks, CA: Sage; 2002: 675-694.
- 43 Middleton B, Bloomrosen M, Dente MA, Hashmat B, Koppel R, Overhage JM, Payne TH, Rosenbloom ST, Weaver C, Zhang J. Enhancing patient safety and quality of care by improving the usability of electronic health record systems: recommendations from AMIA. J Am Med Inform Assoc 2013; 20 e1 e2-e8.
- 44 Holden RJ, Voida S, Savoy A, Jones JF, Kulanthaivel A. Human Factors Engineering and Human-Computer Interaction: Supporting User Performance and Experience. In: Finnell JT, Dixon BE. editors. Clinical Informatics Study Guide: Text and Review. Zurich: Springer International Publishing; 2016: 287-307.
- 45 Rao G. Physician numeracy: essential skills for practicing evidence-based medicine. Family medicine 2008; 40 (Suppl. 05) 354-358.
- 46 Storie D, Campbell S. Determining the information literacy needs of a medical and dental faculty1. Journal of the Canadian Health Libraries Association 2012; 33 (Suppl. 02) 48-59.