Improving patient care quality, safety, and efficiency with the help of clinical decision support tools is one of the core objectives in the meaningful use of electronic health records (EHRs). Successful adoption of support systems depends on the usefulness of delivered information, its relevance to the clinical task and each individual patient, ease of system navigation, and integration with clinical workflow. In 2009, the National Institutes of Health in collaboration with the National Library of Medicine developed and implemented a decision support system to enhance evidence-based practice activities called the EBP InfoBot. This system provides the clinician with a variety of information and resources to assist with clinical decision making by automatically extracting select patient information directly from the EHR, spell checking and mapping free-text data to SNOWMED or UMLS terms, searching appropriate databases, and displaying a summary of evidence at the point of care. The purpose of this study was to evaluate the EBP InfoBot to determine frequency of use, relevance, and usefulness of the system output for decision support and evidence based practice activities.Methods/process/procedures
A nonexperimental, descriptive, survey design study was conducted in a large Mid-Atlantic research hospital where approximately 900 clinical research nurses and research nurse coordinators could potentially utilize the EBP InfoBot. The facility has 256 beds with more than 19 000 outpatient encounters each year. Evaluation methods included automatic tracking of usage, electronic surveys, and focus groups. Survey data were collected over a 3-month period following integration with the EHR. Online surveys were available following each encounter with the decision support output. Usage data were collected over a 3-year period using automated tracking that was part of the system.Results
Nearly 30 000 transactions occurred between August 2009 and August 2012 related to InfoBot usage. Micromedex, generic searches, clinical trials, and definitions were high on the list of most used activities. Clinical guidelines and standards of practice were the least used items partly because this feature was not available the first year. The majority (70%) of respondents indicated there was adequate information available, with 30% requesting expansion to additional resources. Mean scores for “usefulness” and “relevance” ranged from 3.5 and greater, indicating a high level of satisfaction with information provided in all categories. Recommended enhancements from the focus groups included the ability to change search parameters, increase the number of articles from 10 to 15, and add Pill Box images for quick identification of medications.Discussion/outcomes
Overall, survey results indicated the system was easy to use, and information and resources were relevant and useful for clinical care. Availability of the EBP InfoBot from within the EHR provided clinicians with easy access to educational and evidence-based resources, which can enhance clinical decision making. Future research should focus on evaluating the impact of these resources on patient care outcomes. Future development will include expanding functionality to support the EBP needs of physicians and other clinicians. There are also implications for consumer use of the EBP InfoBot as a way to educate patients and manage their care.