Impact and User Satisfaction of a Clinical Information Portal Embedded in an Electronic Health Record

摘要

In 2008, a clinical information tool was developed and embedded in the electronic health record system of an academic medical center. In 2009, the initial information tool, Clinical-e, was superseded by a portal called Clinical Focus, with a single search box enabling a federated search of selected online information resources. To measure the usefulness and impact of Clinical Focus, a survey was used to gather feedback about users' experience with this clinical resource. The survey determined what type of clinicians were using this tool and assessed user satisfaction and perceived impact on patient care decision making. Initial survey results suggest the majority of respondents found Clinical Focus easy to navigate, the content easy to read, and the retrieved information relevant and complete. The majority would recommend Clinical Focus to their colleagues. Results indicate that this tool is a promising area for future development. Keywords: electronic health record, user satisfaction, knowledge-based library resources, clinical decision supportIntroductionThe University of Pittsburgh Health Sciences Library System (HSLS) supports the educational, research, clinical, and service activities of the health sciences community of the University of Pittsburgh and the University of Pittsburgh Medical Center (UPMC) through development and provision of innovative information resources and services. UPMC includes 15 tertiary, specialty, and community hospitals; 400 outpatient sites and doctors' offices; and rehabilitation and long-term care facilities. HSLS receives budget support from UPMC to provide systemwide access to licensed online resources. Linking these knowledge-based information resources into the electronic health record has been described as a long-standing informatics goal.~(1)In 2004, the library director was invited to participate in the UPMC-wide Physician Advisory Committee (PAC) for the eRecord, as the medical center's electronic health record system is known. The PAC is chaired by the chief medical information officer, and its membership includes physicians and other health professionals, together with representatives from Information Services and Health Information Management. The eRecord, at the time of this study, had over 3.8 million unique patient records and more than 32,000 active users, including more than 5,000 physicians employed by or affiliated with UPMC. It also offers 200 clinical applications from more than 120 vendors, including Epic and Cerner.By 2006, a “key physician” was identified who had a vision that the eRecord could improve practice by delivering not only patient-specific data directly to the clinician, but also context-specific knowledge-based information. A library development team was initiated to work with this physician to learn more about the eRecord and clinical information needs at the point of care, and to identify full-text information resources and appropriate technology, in order to design a clinical tool to be placed within the eRecord.The result of this collaboration was the development of a tool named Clinical-e, which consisted of a search box with subject tabs to provide users with quick access to designated knowledge-based information resources to be used at the point of care through the eRecord.~(2) Each of the five subject tabs (diagnosis, diseases, drugs, evidence-based medicine, and patient education) offered a federated search of a different pool of full-text information resources. Clinical-e used the Velocity search platform from Vivisimo as its search interface. Search results were organized “on the fly” into meaningful categories using clustering technology and were directly accessible from the results page. Structured usability testing and focus groups with PAC physicians aided development, and in 2008 Clinical-e was embedded in the eRecord. The decision to place Clinical-e in the eRecord was made by the PAC. The development of Clinical-e was the beginning of an evolutionary approach in the design of an eRecord clinical information tool.In the fall of 2009, the embedded tab-based search box was replaced by a Web portal accessible via links from the eRecord and also from the library's public Web page. This updated tool, renamed Clinical Focus, enabled users to look for information on a disease, symptom, drug, procedure, or test using one simple search box. Vivisimo's Velocity remained the federated search engine, but the selected full-text knowledge-based resources were changed to include ACP PIER (American College of Physicians' Physicians Information and Education Resource), BMJ Clinical Evidence, Cochrane Reviews, Micromedex, and UpToDate. Figure ?Figure11 shows the search page for Clinical Focus.