JMIR Publications

ABSTRACT

Background:

Clinicians use electronic knowledge resources, such as Micromedex, UpToDate, and Wikipedia, to deliver evidence-based care and engage in point-of-care learning. The impact of such resources remains uncertain.

Objective:

To quantify the impact of electronic knowledge resources on clinical and learning outcomes.

Methods:

We searched MEDLINE, Embase, PsycINFO, and Cochrane Library, 1991-2017. Two authors independently screened studies for inclusion and extracted outcomes related to knowledge, skills, attitudes, behaviors, patient effects, and cost. We used random effects meta-analysis to pool standardized mean differences (SMDs) across studies.

Results:

Of 10,811 studies screened, we identified 25 eligible studies published between 2003-2016. Five studies were randomized trials, 22 involved physicians in practice or training, and 10 reported potential conflicts of interest. Fifteen studies compared electronic knowledge resources with no intervention. Of these, seven reported clinician behaviors, with pooled SMD 0.47 (95% CI, 0.27 to 0.67; P<.001), and eight reported objective patient effects with pooled SMD 0.19 (95% CI, 0.07 to 0.32; P=.003). Heterogeneity was large (I2>50%) across studies. When compared with other resources (seven studies, not amenable to meta-analytic pooling), use of electronic knowledge resources was associated with increased frequency of answering questions and perceived benefits on patient care, with variable impact on time to find an answer. Two studies compared different implementations of the same electronic knowledge resource; findings suggest benefits from allowing clinicians to choose to access the resource (vs automated display of resource information) and from integrating options to incorporate user-entered patient data to provide patient-specific information and recommendations.

Conclusions:

Use of electronic knowledge resources is associated with positive impact on clinician behaviors and patient effects. Resource implementation strategies can significantly influence outcomes, but few studies have examined such factors.