Martina A. Clarke

Information needs and information-seeking behaviour analysis of primary care physicians and nurses: a literature review

BACKGROUND The increase in the adoption of electronic health records (EHR) has contributed to physicians and nurses experiencing information overload. To address the problem of information overload, an assessment of the information needs of physicians and nurses will assist in understanding what they view as useful information to make patient care more efficient. OBJECTIVE To analyse studies that assessed the information needs and information-seeking behaviour of physicians and nurses in a primary care setting to develop a better understanding of what information to present to physicians when they making clinical decisions. METHOD A literature review of studies was conducted with a comprehensive search in PubMed, cinahl, scopus, as well as examination of references from relevant papers and hand-searched articles to identify articles applicable to this review. RESULTS Of the papers reviewed the most common information needs found among physicians and nurses were related to diagnoses, drug(s) and treatment/therapy. Colleagues remain a preferred information source among physicians and nurses; however, a rise in Internet usage is apparent. CONCLUSION Physicians and nurses need access to the Internet and job-specific resources to find practitioner-oriented information. In addition, effective usage of resources is important for improving patient care.

Health information needs, sources, and barriers of primary care patients to achieve patient-centered care: A literature review

To synthesize findings from previous studies assessing information needs of primary care patients on the Internet and other information sources in a primary care setting. A systematic review of studies was conducted with a comprehensive search in multiple databases including OVID MEDLINE, CINAHL, and Scopus. The most common information needs among patients were information about an illness or medical condition and treatment methods, while the most common information sources were the Internet and patients’ physicians. Overall, patients tend to prefer the Internet for the ease of access to information, while they trust their physicians more for their clinical expertise and experience. Barriers to information access via the Internet include the following: socio-demographic variables such as age, ethnicity, income, education, and occupation; information search skills; and reliability of health information. Conclusion: Further research is warranted to assess how to create accurate and reliable health information sources for both Internet and non-Internet users.

Physician Information Needs and Electronic Health Records (EHRs): Time to Reengineer the Clinic Note

Background: Primary care physicians face cognitive overload daily, perhaps exacerbated by the form of electronic health record documentation. We examined physician information needs to prepare for clinic visits, focusing on past clinic progress notes. Methods: This study used cognitive task analysis with 16 primary care physicians in the scenario of preparing for office visits. Physicians reviewed simulated acute and chronic care visit notes. We collected field notes and document highlighting and review, and we audio-recorded cognitive interview while on task, with subsequent thematic qualitative analysis. Member checks included the presentation of findings to the interviewed physicians and their faculty peers. Results: The Assessment and Plan section was most important and usually reviewed first. The History of the Present Illness section could provide supporting information, especially if in narrative form. Physicians expressed frustration with the Review of Systems section, lamenting that the forces driving note construction did not match their information needs. Repetition of information contained in other parts of the chart (eg, medication lists) was identified as a source of note clutter. A workflow that included a patient summary dashboard made some elements of past notes redundant and therefore a source of clutter. Conclusions: Current ambulatory progress notes present more information to the physician than necessary and in an antiquated format. It is time to reengineer the clinic progress note to match the workflow and information needs of its primary consumer.

Addressing human computer interaction issues of electronic health record in clinical encounters

Electronic Health Records (EHRs) are known to reduce medical errors and store comprehensive patient information, and they also impact the physician-patient interaction during clinical encounters. This study reviewed the literature to (1) identify the most common challenges to patient-physician relations while using an EHR during a clinical visit, (2) discuss limitations of the research methodologies employed, and (3) suggest future research directions related to addressing human computer interaction issues when physicians use an EHR in clinical encounters.

How Does Learnability of Primary Care Resident Physicians Increase After Seven Months of Using an Electronic Health Record? A Longitudinal Study

Background Electronic health records (EHRs) with poor usability present steep learning curves for new resident physicians, who are already overwhelmed in learning a new specialty. This may lead to error-prone use of EHRs in medical practice by new resident physicians. Objective The study goal was to determine learnability gaps between expert and novice primary care resident physician groups by comparing performance measures when using EHRs. Methods We compared performance measures after two rounds of learnability tests (November 12, 2013 to December 19, 2013; February 12, 2014 to April 22, 2014). In Rounds 1 and 2, 10 novice and 6 expert physicians, and 8 novice and 4 expert physicians participated, respectively. Laboratory-based learnability tests using video analyses were conducted to analyze learnability gaps between novice and expert physicians. Physicians completed 19 tasks, using a think-aloud strategy, based on an artificial but typical patient visit note. We used quantitative performance measures (percent task success, time-on-task, mouse activities), a system usability scale (SUS), and qualitative narrative feedback during the participant debriefing session. Results There was a 6-percentage-point increase in novice physicians’ task success rate (Round 1: 92%, 95% CI 87-99; Round 2: 98%, 95% CI 95-100) and a 7-percentage-point increase in expert physicians’ task success rate (Round 1: 90%, 95% CI 83-97; Round 2: 97%, 95% CI 93-100); a 10% decrease in novice physicians’ time-on-task (Round 1: 44s, 95% CI 32-62; Round 2: 40s, 95% CI 27-59) and 21% decrease in expert physicians’ time-on-task (Round 1: 39s, 95% CI 29-51; Round 2: 31s, 95% CI 22-42); a 20% decrease in novice physicians mouse clicks (Round 1: 8 clicks, 95% CI 6-13; Round 2: 7 clicks, 95% CI 4-12) and 39% decrease in expert physicians’ mouse clicks (Round 1: 8 clicks, 95% CI 5-11; Round 2: 3 clicks, 95% CI 1-10); a 14% increase in novice mouse movements (Round 1: 9247 pixels, 95% CI 6404-13,353; Round 2: 7991 pixels, 95% CI 5350-11,936) and 14% decrease in expert physicians’ mouse movements (Round 1: 7325 pixels, 95% CI 5237-10,247; Round 2: 6329 pixels, 95% CI 4299-9317). The SUS measure of overall usability demonstrated only minimal change in the novice group (Round 1: 69, high marginal; Round 2: 68, high marginal) and no change in the expert group (74; high marginal for both rounds). Conclusions This study found differences in novice and expert physicians’ performance, demonstrating that physicians’ proficiency increased with EHR experience. Our study may serve as a guideline to improve current EHR training programs. Future directions include identifying usability issues faced by physicians when using EHRs, through a more granular task analysis to recognize subtle usability issues that would otherwise be overlooked.

Toward a patient-centered ambulatory after-visit summary: Identifying primary care patients’ information needs

ABSTRACT Objective: The purpose of this study was to determine the information needs of primary care patients as they review clinic visit notes to inform information that should be contained in an after-visit summary (AVS).Method: We collected data from 15 patients with an acute illness and 14 patients with a chronic disease using semi-structured interviews. The acute patients reviewed seven major sections, and chronic patients reviewed eight major sections of a simulated, but realistic visit note to identify relevant information needs for their AVS. Results: Patients in the acute illness group identified the Plan, Assessment and History of Present Illness the most as important note sections, while patients in the chronic care group identified Significant Lab Data, Plan, and Assessment the most as important note sections. Discussion: This study was able to identify primary care patients’ information needs after clinic visit. Primary care patients have information needs pertaining to diagnosis and treatment, which may be the reason why both patient groups identified Plan and Assessment as important note sections. Future research should also develop and assess an AVS based on the information gathered in this study and evaluate its usefulness among primary care patients. Practice Implications: The results of this study can be used to inform the development of an after-visit summary that assists patients to fully understand their treatment plan, which may improve treatment adherence.

Comparing Electronic Health Record Usability of Primary Care Physicians by Clinical Year.

Objectives: To examine usability gaps among primary care resident physicians by clinical year: year 1 (Y1), year 2 (Y2), and year 3 (Y3) when using electronic health record (EHR). Methods: Twenty-nine usability tests with video analysis were conducted involving triangular method approach. Performance metrics of percent task success rate, time on task, and mouse activities were compared along with subtask analysis among the three physician groups. Results: Our findings showed comparable results for physicians of all three years in mean performance measures, specifically task success rate (Y1: 95%, Y2: 98%, Y3: 95%). However, varying usability issues were identified among physicians from all three clinical years. Twenty-nine common usability issues across five themes emerged during sub task analysis: inconsistencies, user interface issues, structured data issues, ambiguous terminologies, and workarounds. Discussion and Conclusion: This study identified varying usability issues for users of the EHR with different experience level, which may be used to potentially increase physicians’ performance when using an EHR. While three physician groups showed comparable performance metrics, these groups encountered numerous usability issues that should be addressed for effective EHR training and patient care.

What Learnability Issues Do Primary Care Physicians Experience When Using CPOE

Objective: To determine learnability gaps between expert and novice primary care physicians when using a computerized physician order entry (CPOE). Method: Two rounds of lab-based usability tests using video analyses with triangular method approach were conducted to analyze learnability gaps between ten novice and six expert physicians. Results: There was a 14 percent point increase in novice physicians’ task success rate (p = 0.29) and an 11 percent point increase in expert physicians’ task success rate between round one and round two (p = 0.64). There was an 8 % decrease in novice physicians’ time on task between round one and round two (p = 0.83) and a 12 % decrease in expert physicians’ time on task between round one and round two (p = 0.47). There was a 17 % decrease in novice physicians’ mouse clicks between round one and round two (p = 0.97) and a 20 % decrease in expert physicians’ mouse clicks between round one and round two (p = 0.80). There was a 5 % increase in novice physicians’ mouse movements between round one and round two (p = 0.67) and an 8 % decrease in expert physicians’ mouse movements between round one and round two (p = 0.99). Conclusion: Future directions include identifying usability issues faced by physicians when using the EHR through subtask analysis.

Usability of Mobile Applications Supporting Training in Diagnostic Decision-Making by Radiologists

The objective of this study is to systematically review the usability of mobile applications currently available in radiology to support training in diagnostic decision-making. Two online stores with major market share (Google Play and iTunes) were searched. A multi-step review process was utilized by three usability investigators and five radiology experts to identify eligible applications and extract usability reviews. From 381 applications that were initially identified, user reviews of final 52 applications revealed 79 usability issues. Usability issues were categorized according to Nielsen’s heuristic usability evaluation principles (HE). The top three most frequent types of usability issues were: Naturalness (43), Simplicity (43), and Efficient Interactions (21). Examples of the most frequent usability issues were: lack of information, lack of labeling, and details about images. This study demonstrates the urgent need of usability test to provide evidence-based guidelines to help choose mobile applications that will yield educational and clinical benefits.

Toward Successful Implementation of Speech Recognition Technology: A Survey of SRT Utilization Issues in Healthcare Settings.

Purpose To evaluate physician utilization of speech recognition technology (SRT) for medical documentation in two hospitals. Methods A quantitative survey was used to collect data in the areas of practice, electronic equipment used for documentation, documentation created after providing care, and overall thoughts about and satisfaction with the SRT. The survey sample was from one rural and one urban facility in central Missouri. In addition, qualitative interviews were conducted with a chief medical officer and a physician champion regarding implementation issues, training, choice of SRT, and outcomes from their perspective. Results Seventy-one (60%) of the anticipated 125 surveys were returned. A total of 16 (23%) participants were practicing in internal medicine and 9 (13%) were practicing in family medicine. Fifty-six (79%) participants used a desktop and 14 (20%) used a laptop (2%) computer. SRT products from Nuance were the dominant SRT used by 59 participants (83%). Windows operating systems (Microsoft, Redmond, WA) was used by more than 58 (82%) of the survey respondents. With regard to user experience, 42 (59%) participants experienced spelling and grammatical errors, 15 (21%) encountered clinical inaccuracy, 9 (13%) experienced word substitution, and 4 (6%) experienced misleading medical information. Conclusions This study shows critical issues of inconsistency, unreliability, and dissatisfaction in the functionality and usability of SRT. This merits further attention to improve the functionality and usability of SRT for better adoption within varying healthcare settings.