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Patterns of Use of Handheld Clinical Decision Support Tools in the Clinical Setting

UAB Center for Outcomes and Effectiveness Research and Education (COERE), Birmingham, Alabama, Department of Pediatrics, UAB Health Services and Outcomes Research Training Program, Birmingham, Alabama, fyu{at}peds.uab.edu

Thomas K. Houston, MD, MPH

UAB Center for Outcomes and Effectiveness Research and Education (COERE), Birmingham, Alabama, Department of Medicine, Birmingham Veterans Affairs Medical Center, Birmingham, Alabama, Deep South Center on Effectiveness Research, Birmingham, Alabama

Midge N. Ray, RN, MSN

UAB Center for Outcomes and Effectiveness Research and Education (COERE), Birmingham, Alabama, Department of Health Services Administration University of Alabama at Birmingham

Duriel Q. Garner

Department of Health Services Administration University of Alabama at Birmingham

Eta S. Berner, EdD

UAB Center for Outcomes and Effectiveness Research and Education (COERE), Birmingham, Alabama, Department of Health Services Administration University of Alabama at Birmingham

Objectives. To assess the patterns of use of handheld clinical decision support tools by internal medicine residents in clinical settings. Methods. Eighty-two internal medicine residents were given personal digital assistants (PDAs) containing a suite of clinical decision support (CDS) programs. A tracking program was used to prospectively track program use during the study period, and a follow-up survey regarding self-reported program use was administered after the study period. Patterns of program use from the tracking data were compared to the data from the self-report survey. Results. Sixty-eight residents were followed using the tracking data. Residents used an average of 1.81 CDS programs (SD: 1.57; range, 0—5) per month. Forty-nine residents completed the self-report survey. Residents reported using an average of 3.15 (SD: 1.61) and 3.92 (SD: 1.40) CDS programs during a typical clinic session and inpatient day, respectively. In both inpatient and outpatient settings and for both methods of assessing program use, 2 programs (Epocrates and MedCalc) were used more often than the other programs. No association was observed between age, gender, race, and PGY level with the use of handheld clinical decision support tools for either tracked or self-report data. The self-report data show higher estimates of CDS program use than the tracking data in the clinical setting. Conclusions. The data show that physicians prefer to use certain handheld CDS tools in clinical settings. Drug references and medical calculators have been consistently used more than clinical prediction rules and diagnostic systems. Self-report survey instruments may overestimate recorded use of CDS programs.

Key Words: decision support systems • clinical • computers • handheld • decision making • computer assisted • internal medicine.

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