Impact of clinical information-retrieval technology on physicians: A literature review of quantitative, qualitative and mixed methods studies

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Summary

Purpose:

This paper appraises empirical studies examining the impact of clinical information-retrieval technology on physicians and medical students.

Methods:

The world literature was reviewed up to February 2004. Two reviewers independently identified studies by scrutinising 3368 and 3249 references from bibliographic databases. Additional studies were retrieved by hand searches, and by searching ISI Web of Science for citations of articles. Six hundred and five paper-based articles were assessed for relevance. Of those, 40 (6.6%) were independently appraised by two reviewers for relevance and methodological quality. These articles were quantitative, qualitative or of mixed methods, and 26 (4.3%) were retained for further analysis. For each retained article, two teams used content analysis to review extracted textual material (quantitative results and qualitative findings).

Results:

Observational studies suggest that nearly one-third of searches using information-retrieval technology may have a positive impact on physicians. Two experimental and three laboratory studies do not reach consensus in support of a greater impact of this technology compared with other sources of information, notably printed educational material. Clinical information-retrieval technology may affect physicians, and further research is needed to examine its impact in everyday practice.

Introduction

Clinical information-retrieval technology is widely used. However, few studies examine the impact of this technology on physicians in clinical practice [1], and this impact is equivocal compared with that of clinical decision support systems [2]. Information-retrieval technology has greatly improved access to information over the last 50 years [3], [4]. In medicine, this technology may contribute to continuing education [1], and provides general information (health education/promotion, disease prevention, diagnosis, prognosis, treatment), which is potentially applicable for decision-making about multiple patients [5]. This information may include text documents, images, sound or movies [6], and derives from databases that merge or link digital libraries, computerised clinical practice guidelines or computerised synopses, electronic journals or textbooks, and medical websites.

Impact is defined as an effect or influence of the use of clinical information-retrieval technology. Given that impact of passive dissemination of printed educational material is controversial [7], does clinical information-retrieval technology matter? For their part, decision support systems are based on algorithms, matching general information with patient-related data to provide patient-specific recommendations [8]. In line with Simon [9], these systems are used for programmed decision-making. Clinical decision support systems push physicians to apply patient-specific information and the impact of many systems is well-established [10], [11], [12], [13].

Information-retrieval technology improves access to updated medical knowledge at the moment of need and at the point of care [14], [15], [16], [17], compared with usual sources of information, namely colleagues, pocket notes, printed textbooks or journals [18]. This technology offers clinicians potential advantages for meeting information needs [14], [15], [17], [19], [20], [21], [22], [23], [24], [25], dealing with clinical questions [24], [26], [27], [28], [29], [30], [31], solving clinical problems [20], [25], [29], supporting decision-making [24], [28], [32], [33], overcoming the limits of memory [16], [20], [34], and fulfilling an educational objective [35], [36].

However, few studies have focused on the impact of clinical information-retrieval technology on physicians, and a previous literature review found only three studies that assessed clinical impact [37]. Recently, from interviews with family physicians, Pluye and Grad [16] proposed an impact assessment scale. This scale consists of six types of cognitive impact at four levels: high positive impact (practice improvement, learning and recall), moderate positive impact (confirmation and reassurance), no impact and negative impact (frustration). The present article reviews the medical literature regarding the impact of clinical information-retrieval technology on physicians, and it specifically aims to examine this impact according to the proposed scale.

Section snippets

Searching and selection

All types of empirical studies were reviewed using a strategy derived from the Cochrane Reviewers’ Handbook (Fig. 1) [38]. From September to December 2003, study identification in bibliographic databases was done independently by a health researcher (P.P.) and a clinical librarian (L.D.). Considering the absence of a specific standardised term, two different strategies were concurrently employed. P.P. reviewed all studies identified by Hersh and Hickam [37] on the use and impact of

Study characteristics

The 26 retained studies are described in Appendix B and methodological characteristics are presented in Table 1. Twenty-five studies provide quantitative results and six qualitative findings (five mixing both). Of the latter, two studies score less than 50% regarding qualitative methodology and two analyse narratives outside impact. Thus, qualitative knowledge of impact is grounded in two studies using the critical incident technique [16], [29]. Impact was self-reported by participants in 19

Discussion

Our findings reveal substantial variation of the frequency of searches using clinical information-retrieval technology that may have a cognitive impact on physicians and medical students (self-assessment). In our opinion, the most plausible estimates of the frequency of searches with positive impact are results of four observational studies: 20, 36, 36 and 39% [21], [28], [29], [30]. Given that self-assessments are subject to bias, even these studies may overestimate positive impact. Moreover,

Conclusion

The present review suggests clinical information-retrieval technology may positively affect clinical practice and further research in everyday practice is recommended. New platforms combine multiple databases with clinical decision support systems and this combination will facilitate the evaluation of the differential impact of information-retrieval technology. Our findings should encourage the use of this technology and its continued development.

Acknowledgements

Pierre Pluye holds a Postdoctoral Fellowship of the Canadian Institutes of Health Research, Ottawa, Canada (MFE 64581). He is a member of the Advisory Panel of the Cochrane Qualitative Research Methods Group (The International Cochrane Collaboration). The methodology of the present literature review was presented at the Cochrane Colloquium in Ottawa on October 2004 (#O-088). The original data set is available on request from the corresponding author (NVivo database).

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