JMIR Publications

ABSTRACT

Background:

Electronic health records (EHRs) are widely used in health care systems across the U.S. to help clinicians access patient medical histories in one central location. As medical knowledge expands, clinicians are increasingly using evidence-based point-of-care information (POCI) resources to facilitate clinical decision-making in medical practices. While these tools can improve clinical outcomes, few studies have assessed clinicians’ opinions on integrating them with EHRs.

Objective:

This study aims to analyze clinician perspectives and perceived effectiveness of using POCI resources to find medication- and disease-related information in clinical practice, as well as their integration with EHRs.

Methods:

Semi-structured interviews were conducted with ten clinicians from various roles and specialties between December 2021 and January 2022 at Brigham and Women’s Hospital (BWH) in Boston, Massachusetts. A content analysis approach was used to examine participants’ responses and feedback on their current use of POCI resources, barriers and facilitators, mobile application use, and recommendations for improved integration.

Results:

Most participants were female (60%), were under 40 years of age (90%), and had less than 10 years of experience in clinical practice (80%). While UpToDate was the most preferred disease-related information resource (90%), preferences for medication-related¬ POCI resources varied, with a few favoring Micromedex (20%), Lexicomp (20%), BWH-specific drug administration guidelines (20%), UpToDate (20%), or Medscape (10%). Most used their preferred tools on a weekly basis. Most clinicians preferred comprehensive POCI tools with clear, navigable layouts that eased and quickened the search for information. Features, like heavy text density, lack of citations, and frequent logins to access the tool, were viewed as barriers that limited content legibility, credibility, and accessibility. Access-related, tool-specific, and integration-related barriers were reported to negatively impact clinical workflow. Most participants (80%) reported currently using mobile applications, reasoning that they facilitated quick and convenient searches for information; however, frequent updates, time-consuming logins, and high text density on a smaller screen posed a challenge. Most participants favored further integration of POCI resources with EHRs, with all reporting them being currently available as embedded links that launch externally. Some recommended that further integration would allow us to leverage existing POCI tool features, like chatbots and knowledge links, as well as aspects of artificial intelligence (AI) and machine learning, such as predictive algorithms and personalized alert systems to enhance EHR functionality.

Conclusions:

Participants favored integration which would improve usability and optimize workplace efficiency by reducing the amount of time spent seeking answers to their medication- and disease-related questions. Recommendations on integration highlighted the need for stakeholder input in developing clinical decision support tools and interfaces that leverage advancements in AI and machine learning while not compromising user experience or increasing time spent on tasks.