Impact of Clinicians' Use of Electronic Knowledge Resources on Clinical and Learning Outcomes: Systematic Review and Meta-Analysis

Abstract

BackgroundClinicians use electronic knowledge resources, such as Micromedex, UpToDate, and Wikipedia, to deliver evidence-based care and engage in point-of-care learning. Despite this use in clinical practice, their impact on patient care and learning outcomes is incompletely understood. A comprehensive synthesis of available evidence regarding the effectiveness of electronic knowledge resources would guide clinicians, health care system administrators, medical educators, and informaticians in making evidence-based decisions about their purchase, implementation, and use.ObjectiveThe aim of this review is to quantify the impact of electronic knowledge resources on clinical and learning outcomes.MethodsWe searched MEDLINE, Embase, PsycINFO, and the Cochrane Library for articles published from 1991 to 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.ResultsOf 10,811 studies screened, we identified 25 eligible studies published between 2003 and 2016. A total of 5 studies were randomized trials, 22 involved physicians in practice or training, and 10 reported potential conflicts of interest. A total of 15 studies compared electronic knowledge resources with no intervention. Of these, 7 reported clinician behaviors, with a pooled SMD of 0.47 (95% CI 0.27 to 0.67; P<.001), and 8 reported objective patient effects with a pooled SMD of 0.19 (95% CI 0.07 to 0.32; P=.003). Heterogeneity was large (I2>50%) across studies. When compared with other resources—7 studies, not amenable to meta-analytic pooling—the 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. A total of 2 studies compared different implementations of the same electronic knowledge resource.ConclusionsUse of electronic knowledge resources is associated with a positive impact on clinician behaviors and patient effects. We found statistically significant associations between the use of electronic knowledge resources and improved clinician behaviors and patient effects. When compared with other resources, the use of electronic knowledge resources was associated with increased success in answering clinical questions, with variable impact on speed. Comparisons of different implementation strategies of the same electronic knowledge resource suggest that there are benefits from allowing clinicians to choose to access the resource, versus automated display of resource information, and from integrating patient-specific information. A total of 4 studies compared different commercial electronic knowledge resources, with variable results. Resource implementation strategies can significantly influence outcomes but few studies have examined such factors.

Use of online knowledge base in primary health care and correlation to health care quality: An observational study

“…Previous research has focused on interventions to either increase the use of, or nd new ways of using, electronic knowledge sources, whereas this study speci cally examined the effect of the use of a knowledge base on patient outcome measures in two nationwide registries. Earlier studies have found that use of register data may play a vital role in patient care (12,15,36). Furthermore, an excess of research has been devoted to evaluating electronic knowledge sources by employing self-reported use, which is prone to biases (37-39).…”

“…Online knowledge bases have been shown to increase the application of evidence-based medicine in clinical practice (11)(12)(13). In this study, we used Lobach's de nition of a knowledge base: "Electronic (computer-based) resources comprising distilled (synthesized) or curated information that allows clinicians to select content germane to a speci c patient to facilitate medical decision making" (14).…”

The exploration of use of an online knowledge base on patient experiences and health care quality: An observational cohort study in primary health care

“…Previous research has focused on interventions to either increase the use of, or find new ways of using, electronic knowledge sources, whereas this study specifically examined the effect of the use of a KB on patient outcome measures in two nationwide registries. Earlier studies have found that use of register data may play an vital role in patient care (12,15,32). Furthermore, an excess of research has been devoted to evaluating electronic knowledge sources by employing self-reported use, which is prone to biases (33)(34)(35).…”

“…In this study, we used Lobach's definition of a KB: "Electronic (computer-based) resources comprising distilled (synthesized) or curated information that allows clinicians to select content germane to a specific patient to facilitate medical decision making" (14). The use of KBs is associated with a positive impact on clinician behavior and patient outcomes, and evidence suggests that use of KBs may be associated with improved knowledge and patient outcomes (12,15,16).…”

How searching under time pressure impacts clinical decision making

“…Of these questions, many are often left unanswered, as demonstrated by 3 studies in the United States where 63.8% (702/1,101), 44.9% (477/1,062), and 70.2% (207/295) of medical questions raised by clinicians were left unanswered [3][4][5]. Yet, answering clinical questions correctly has a significant impact on patient outcomes and health system efficiency [6][7][8][9][10].…”