PubMed · 11220078
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G F Nash, N Donnelly, E F Nash, L F Turner. 2001. Knowledge and the Internet.. https://doi.org/10.1177/014107680109400118
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OBJECTIVE: To describe medical students' attitudes toward placing orders during training, and the effect of computerized provider order entry (CPOE) on their learning experiences. DESIGN: Prospective, controlled study of all 143 Johns Hopkins University School of Medicine students who began the Basic Medicine clerkship between March 2003 and April 2004 at one of three teaching hospitals: one using CPOE, one paper orders, and one that began using CPOE midway through this study. MEASUREMENTS: Survey of students at the start and after the first month of the clerkship. RESULTS: Ninety-six percent of students responded. Students expressed a desire to place 100% of orders for their patients. Ninety-five percent of students believed that placing orders helps students learn what tests and treatments patients need. Eighty-four percent reported that being unavailable due to conferences and teaching sessions was a significant barrier to participating in the ordering process. Students at hospitals using CPOE reported placing significantly fewer of their patients' follow-up orders compared to students at hospitals using paper orders (25% vs. 50%, p < 0.01) and were more likely to report that their resident or intern did not want them to enter orders (40% vs. 16%, p < 0.01). Comparisons of students at hospitals using CPOE to each other showed that these differences were attributable to one of the hospitals. Thirty-two percent of students at both hospitals using CPOE reported that the extra length of time required for housestaff to review their orders in the computer was a significant barrier. CONCLUSION: Hospitals need to ensure that the educational potential of medical students' clinical experiences is maximized when implementing CPOE.
OBJECTIVE: To determine the effectiveness of Internet-based audit and feedback to physicians to improve care for diabetes and hypertension. DESIGN: Time-series analysis of an intervention. METHODS: The study setting was Harvard Vanguard Medical Associates, a 14-site multispecialty group in greater Boston. The study period was July 1997-June 1999. PARTICIPANTS: were 12 primary care internal medicine residents who provided care to adult patients with diabetes (n = 76 pre-intervention and n = 88 post-intervention), hypertension (n = 329 pre-intervention and n = 338 post-intervention), or both (n = 62 pre-intervention and n = 71 post-intervention). We determined the proportion of each resident's patients whose care fulfilled national guidelines for quality (i.e. diabetes patients had hemoglobin testing in the previous 6 months or hypertension patients received a beta-blocker or diuretic in the same time period). After meeting individually with each resident to obtain informed consent and to encourage participation, we sent each resident information for accessing his or her practice profile on a secure website. The main outcome measures were (i) the proportion of resident physicians who accessed their profiles and (ii) change following the intervention in the proportion of patients whose care followed national guidelines. RESULTS: Over a 1-year period, only four of the 12 residents accessed their websites. One of the residents visited her site three times, while the other three residents visited their sites once each. In interrupted time-series analyses, the intervention had no discernible effect on adherence to practice guidelines for diabetes or hypertension. CONCLUSION: The lack of participation in this Internet-based intervention may have important implications for the development of future programs that require physicians to interact with technology to improve quality of care.
OBJECTIVES: This article proposes a model for dimensions involved in user evaluation of clinical information systems (CIS). The model links the dimensions in traditional CIS evaluation and the dimensions from the human-computer interaction (HCI) perspective. PROPOSED METHOD: In this article, variables are defined as the properties measured in an evaluation, and dimensions are defined as the factors contributing to the values of the measured variables. The proposed model is based on a two-step methodology with: (1) a general review of information systems (IS) evaluations to highlight studied variables, existing models and frameworks, and (2) a review of HCI literature to provide the theoretical basis to key dimensions of user evaluation. RESULTS: The review of literature led to the identification of eight key variables, among which satisfaction, acceptance, and success were found to be the most referenced. DISCUSSION: Among those variables, IS acceptance is a relevant candidate to reflect user evaluation of CIS. While their goals are similar, the fields of traditional CIS evaluation, and HCI are not closely connected. Combining those two fields allows for the development of an integrated model which provides a model for summative and comprehensive user evaluation of CIS. All dimensions identified in existing studies can be linked to this model and such an integrated model could provide a new perspective to compare investigations of different CIS systems.