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Accuracy of PoC Resources to Answer Clinical Questions
Ann McKibbon MLS PhDAssociate ProfessorClinical Epidemiology & BiostatisticsMcMaster Universitymckib@mcmaster.ca
POC Information Resources
Tremendous need for themAlready used heavily Traditionally thought of as being
– Positive– Neutral
Problems with content (itself or its application)Problems with use (system or user)
We need to address the challenges – Complexities – Their possible dark side
Information Needs in Practice
External information is vital in healthcare Numbers consistent over time, countries, disciplines, settings,
training levels
Clinic setting– Covell et al 1985 0.7 need/patient– Ramos et al 2003 0.8 need/patient
Hospital setting– Osheroff et al 1991 15/patient/day– Currie et al 2003 11/hour with EMRs
(range 1 – 25)
• Clinicians use electronic resources during patient care time• 89% of them believe that electronic systems improve care• 75% of questions were answered
Problems with Information
Finding Time Recognizing needs Complexities
– Resources– Marketing/packaging
Systems– Move to simpler ones
Inability of resources to provide answers
Trust of producers & systems
Interpreting Time Recognizing needs Formulating questions Synthesizing evidence Coming up with the answer
– Matching evidence with clinical situation and patient
Application Trust of producers & systems
Seeking Information
Most use external resources– People/peers– Electronic information resources– Non electronic resources
Half of questions are pursued– 40% evidence found easily– 30% evidence found with difficulty– 30% evidence not found
Time to Find
MEDLINE Use Times per Search
43 minutes in Oregon 24 minutes in Iowa 23 minutes in Hamilton
Non MEDLINE times (e.g., PIER, UptoDate, CE, Google) range of 3 to 7 minutes
Sackett and Straus: On wards, resources will not be used if search time is > 30 seconds
Complexities of Systems
Size– MEDLINE 17,000,000
Version control– Cochrane reviews– Clinical practice guidelines
Multiplicity of resources– Numbers and kinds
Packaging of systems Data itself
Complexity of Systems
Clinicians often use systems poorly:
Scenario: Is PSA (prostate-specific antigen) a better biochemical predictor than alkaline phosphatase for detecting recurrent prostate cancer?
Approach: OVID MEDLINEprostate cancer (18K citations)reads for 5 minutesquitsprovides answer
Packaging—Cochrane Reviews
Whole content Cochrane Collaboration Database vendor (Wiley) PUBMED OVID
– MEDLINE– EBMR Cochrane Library– EBMR Full Text– EBMR All
InfoRetriever Google Scholar
Partial content ACP Journal Club Evidence Based Medicine Evidence Based Nursing InfoPOEMs OVID—EBMR ACP J Club Clinical Evidence Google Evidence-Based Guidelines …
Abstracts or full text? Free or pay?
Inability to Get Correct Answers
From Peers
Dutch study (Schaffsma) of 14 physicians Asked peers for answers to 12 questions 47% correct
Inability to Get Correct Answers
From Peers
Dutch study (Schaffsma) of 14 physicians Asked peers for answers to 12 questions 47% correct
– If evidence provided 83% correct– If evidence not available 35% correct
Inability to Get Correct Answers
From Electronic Information Resources
Medical, NP students: 45% right to 77% right
Australian GPs: 29% right to 50% right
McKibbon study: 39% right to 42% right
Inability to Get Correct Answers
From Electronic Information Resources
Medical, NP students: 45% to 77% 12% right wrong
Australian GPs: 29% to 50% 7% right wrong
McKibbon Study: 39% to 42% 11% right wrong
Providing Answers—EKGs
Electrocardiogram with computer interpretation
30 Internal Medicine residents (year 2 or 3)
Accuracy Without e-interpretation of data 48.9% With e-interpretation of data 55.4%
Providing Answers—EKGs
Electrocardiogram with computer interpretation30 Internal Medicine Residents (year 2 or 3)
Accuracy Without e-interpretation of data 48.9% With e-interpretation of data 55.4%
– If e-interpretration correct 68.1%– If e-interpretation wrong 48.3%
Trust
Producers of information trusted– WHO technical document
Trust of technology– Social conformity– Less vigilance – Diffusion of responsibility – Belief in infallibility
of technology
Summary
Good systems exist although…
…systems that provide– right answer – to right question– at the right time– in the right format– with little or no effort
May not be here yet But we are getting closer…
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