Healthc Inform Res.  2012 Sep;18(3):164-170. 10.4258/hir.2012.18.3.164.

Clinical Care Improvement with Use of Health Information Technology Focusing on Evidence Based Medicine

• Peyman RH
• Ahmadi M
• Aziz R
• Zahra S
• Farahnaz S
• Nader M

• KMID: 2229466
• DOI: http://doi.org/10.4258/hir.2012.18.3.164

Abstract

OBJECTIVES
Healthcare institutions need timely patient information from various sources at the point-of-care. Evidence-based medicine (EBM) is a tool for proper and efficient incorporation of the results of research in decision-making. Characteristics of medical treatment processes and practical experience concerning the effect of EBM in the clinical process are surveyed.
METHODS
A cross sectional survey conducted in Tehran hospitals in February-March 2012 among 51 clinical residents. The respondents were asked to apply EBM in clinical decision-making to answer questions about the effect of EBM in the clinical process. A valid and reliable questionnaire was used in this study.
RESULTS
EBM provides a framework for problem solving and improvement of processes. Most residents (76%) agreed that EBM could improve clinical decision making. Eighty one percent of the respondents believed that EBM resulted in quick updating of knowledge. They believed that EBM was more useful for diagnosis than for treatment. There was a significant association between out-patients and in-patients in using electronic EBM resources.
CONCLUSIONS
Research findings were useful in clinical practice and decision making. The computerized guidelines are important tools for improving clinical process quality. When learning how to use IT, methods of search and evaluation of evidence for diagnosis, treatment and medical education are necessary. Purposeful use of IT in clinical processes reduces workload and improves decision-making.

Keyword

Therapeutic Process; Evidence-Based Medicine; Decision Making; Health Information Technology; Guideline

MeSH Terms

Cross-Sectional Studies
Decision Making
Delivery of Health Care
Education, Medical
Electronics
Electrons
Evidence-Based Medicine
Humans
Learning
Medical Informatics
Outpatients
Problem Solving
Surveys and Questionnaires

Reference

1. Maheu MM, Whitten P, Allen A. E-Health, telehealth, and telemedicine: a guide to start-up and success. 2001. San Francisco: Jossey-Bass.

2. Sim I, Gorman P, Greenes RA, Haynes RB, Kaplan B, Lehmann H, et al. Clinical decision support systems for the practice of evidence-based medicine. J Am Med Inform Assoc. 2001. 8(6):527–534.

3. Smith RG, Farquhar A. The road ahead for knowledge management: an AI perspective. AI Mag. 2000. 21(4):17–40.

4. Panzarasa S, Madde S, Quaglini S, Pistarini C, Stefanelli M. Evidence-based careflow management systems: the case of post-stroke rehabilitation. J Biomed Inform. 2002. 35(2):123–139.

5. Rezaei hachesoo P, Habibi S, Fozonkhah S. Information technology, an effective tool in reducing and preventing medical errors: suggestions for improvement. Health Inf Manag. 2007. 4(1):90–97.

6. Vegoda P. Introducing the IHE (Integrating the Healthcare Enterprise) concept. J Healthc Inf Manag. 2002. 16(1):22–24.

7. Zargar M. Principle and concepts of information technology. 2001. Tehran: Behineh Publication.

8. Kwak YS. Electronic health record: definition, categories and standards. J Korean Soc Med Inform. 2005. 11(1):1–15.

9. Seo JW, Kim KH, Choi JW, Ha KS, Chin HJ, Kim JU, et al. Implementation of electronic medical records at Seoul National University Hospital. J Korean Soc Med Inform. 2006. 12(3):213–225.

10. Ahmadi M, Rezaeehachesoo P, Shahmoradi L. Electronic health record: standards and evaluation. 2009. Tehran: Jafari Publication.

11. Lester WT, Grant RW, Barnett GO, Chueh HC. Randomized controlled trial of an informatics-based intervention to increase statin prescription for secondary prevention of coronary disease. J Gen Intern Med. 2006. 21(1):22–29.

12. Brennan TA, Leape LL. Adverse events, negligence in hospitalized patients: results from the Harvard Medical Practice Study. Perspect Healthc Risk Manage. 1991. 11(2):2–8.

13. Institute of Medicine, Committee on Quality of Health Care in America. Crossing the quality chasm: a new health system for the 21st century. 2001. Washington: National Academy Press.

14. Van Bemmel JH, Musen MA, Helder JC. Handbook of medical informatics. 1997. Heidelberg: Springer-Verlag.

15. Lenz R, Reichert M. IT support for healthcare processes: premises, challenges, perspectives. Data Knowl Eng. 2007. 61(1):39–58.

16. Decruyenaere J, De Turck F, Vanhastel S, Vandermeulen F, Demeester P, de Moor G. On the design of a generic and scalable multilayer software architecture for data flow management in the intensive care unit. Methods Inf Med. 2003. 42(1):79–88.

17. Criswell DF, Parchman ML. Handheld computer use in U.S. family practice residency programs. J Am Med Inform Assoc. 2002. 9(1):80–86.

18. Fox J, Johns N, Rahmanzadeh A. Disseminating medical knowledge: the PROforma approach. Artif Intell Med. 1998. 14(1-2):157–181.

19. Covell DG, Uman GC, Manning PR. Information needs in office practice: are they being met? Ann Intern Med. 1985. 103(4):596–599.

20. Miksch S, Shahar Y, Johnson P. In : Motta E, Harmelen F, Pierret-Golbreich C, Filby I, Wijngaards N, editors. Asbru: a task-specific, intention-based, and time-oriented language for representing skeletal plans. Proceedings of the 7th Workshop on Knowledge Engineering: Methods and Language; 1997 Jan 22-24; Milton Keynes, UK.

21. Quaglini S, Dazzi L, Gatti L, Stefanelli M, Fassino C, Tondini C. Supporting tools for guideline development and dissemination. Artif Intell Med. 1998. 14(1-2):119–137.

22. Sadeghi M, Khanjani N, Motamedi F, Saber M, Rad GS. Familiarity of medical residents at Kerman Medical University with evidence based medicine databases. J Res Med Sci. 2011. 16(10):1372–1377.

23. Kim S, Choi J. Improving the performance of text categorization models used for the selection of high quality articles. Healthc Inform Res. 2012. 18(1):18–28.

24. Tilburt JC. Evidence-based medicine beyond the bedside: keeping an eye on context. J Eval Clin Pract. 2008. 14(5):721–725.

25. Collins J. Evidence-based medicine. J Am Coll Radiol. 2007. 4(8):551–554.

26. Hillman BJ. Noninterpretive skills for radiology residents: critical thinking: deciding whether to incorporate the recommendations of radiology publications and presentations into practice. AJR Am J Roentgenol. 2000. 174(4):943–946.

27. Hawkins RC. The evidence based medicine approach to diagnostic testing: practicalities and limitations. Clin Biochem Rev. 2005. 26(2):7–18.

28. Sackett DL, Rosenberg WM, Gray JA, Haynes RB, Richardson WS. Evidence based medicine: what it is and what it isn't. BMJ. 1996. 312(7023):71–72.

29. Sackett DL, Straus SE. Finding and applying evidence during clinical rounds: the "evidence cart". JAMA. 1998. 280(15):1336–1338.

30. Crowley SD, Owens TA, Schardt CM, Wardell SI, Peterson J, Garrison S, et al. A Web-based compendium of clinical questions and medical evidence to educate internal medicine residents. Acad Med. 2003. 78(3):270–274.

31. Ohno-Machado L, Gennari JH, Murphy SN, Jain NL, Tu SW, Oliver DE, et al. The guideline interchange format: a model for representing guidelines. J Am Med Inform Assoc. 1998. 5(4):357–372.

32. Greenes RA, Lorenzi NM. Audacious goals for health and biomedical informatics in the new millennium. J Am Med Inform Assoc. 1998. 5(5):395–400.

33. Stead WW, Miller RA, Musen MA, Hersh WR. Integration and beyond: linking information from disparate sources and into workflow. J Am Med Inform Assoc. 2000. 7(2):135–145.

34. Shiffman RN, Brandt CA, Liaw Y, Corb GJ. A design model for computer-based guideline implementation based on information management services. J Am Med Inform Assoc. 1999. 6(2):99–103.

35. Habai S, Rezaei P, Tabaghi R. Enhancing information literacy as a base of developing evidence-based nursing. Health Inf Manag. 2010. 7(3):371–378.

36. Oliveri RS, Gluud C, Wille-Jorgensen PA. Hospital doctors' self-rated skills in and use of evidence-based medicine: a questionnaire survey. J Eval Clin Pract. 2004. 10(2):219–226.

37. Kelly MP, Moore TA. The judgement process in evidence-based medicine and health technology assessment. Social Theory Health. 2012. 10(1):1–19.

38. Rosenberg W, Donald A. Evidence based medicine: an approach to clinical problem-solving. BMJ. 1995. 310(6987):1122–1126.

39. Jette DU, Bacon K, Batty C, Carlson M, Ferland A, Hemingway RD, et al. Evidence-based practice: beliefs, attitudes, knowledge, and behaviors of physical therapists. Phys Ther. 2003. 83(9):786–805.

40. Retsas A. Barriers to using research evidence in nursing practice. J Adv Nurs. 2000. 31(3):599–606.

41. Heiwe S, Kajermo KN, Tyni-Lenne R, Guidetti S, Samuelsson M, Andersson IL, et al. Evidence-based practice: attitudes, knowledge and behaviour among allied health care professionals. Int J Qual Health Care. 2011. 23(2):198–209.

42. Habibi SH, Farzi J, Lotfollahzade R. Information seeking behaviour in Ardebil general physicians and their approach towards electronic resources. J Ardebil Univ Med Sci. 2008. 8(2):136–141.

43. Park M. Development of evidence based nursing practice guideline document model for electronic distribution. J Korean Soc Med Inform. 2004. 10(2):147–159.

44. Peleg M, Tu S, Bury J, Ciccarese P, Fox J, Greenes RA, et al. Comparing computer-interpretable guideline models: a case-study approach. J Am Med Inform Assoc. 2003. 10(1):52–68.

45. Fischer S, Stewart TE, Mehta S, Wax R, Lapinsky SE. Handheld computing in medicine. J Am Med Inform Assoc. 2003. 10(2):139–149.