Langton Julia M, Blanch Bianca, Pesa Nicole, Park Jae Min, Pearson Sallie-Anne
BMC Med Inform Decis Mak. 2013 Aug 4;13:82. doi: 10.1186/1472-6947-13-82.
Electronic decision support is commonplace in medical practice. However, its adoption at the point-of-care is dependent on a range of organisational, patient and clinician-related factors. In particular, level of clinical experience is an important driver of electronic decision support uptake. Our objective was to examine the way in which Australian doctors at different stages of medical training use a web-based oncology system (http://www.eviq.org.au).
We used logfiles to examine the characteristics of eviQ registrants (2009-2012) and patterns of eviQ use in 2012, according to level of medical training. We also used a web-based survey to evaluate the way doctors at different levels of medical training use the online system and to elicit perceptions of the system's utility in oncology care.
Our study cohort comprised 2,549 eviQ registrants who were hospital-based medical doctors across all levels of training. 65% of the cohort used eviQ in 2012, with 25% of interns/residents, 61% of advanced oncology trainees and 47% of speciality-qualified oncologists accessing eviQ in the last 3 months of 2012. The cohort accounted for 445,492 webhits in 2012. On average, advanced trainees used eviQ up to five-times more than other doctors (42.6 webhits/month compared to 22.8 for specialty-qualified doctors and 7.4 webhits/month for interns/residents). Of the 52 survey respondents, 89% accessed eviQ's chemotherapy protocols on a daily or weekly basis in the month prior to the survey. 79% of respondents used eviQ at least weekly to initiate therapy and to support monitoring (29%), altering (35%) or ceasing therapy (19%). Consistent with the logfile analysis, advanced oncology trainees report more frequent eviQ use than doctors at other stages of medical training.
The majority of the Australian oncology workforce are registered on eviQ. The frequency of use directly mirrors the clinical role of doctors and attitudes about the utility of eviQ in decision-making. Evaluations of this kind generate important data for system developers and medical educators to drive improvements in electronic decision support to better meet the needs of clinicians. This end-user focus will optimise the uptake of systems which will translate into improvements in processes of care and patient outcomes.
电子决策支持在医疗实践中很常见。然而，其在医疗现场的采用取决于一系列与组织、患者和临床医生相关的因素。特别是，临床经验水平是电子决策支持采用的一个重要驱动因素。我们的目标是研究处于不同医学培训阶段的澳大利亚医生使用基于网络的肿瘤学系统（http://www.eviq.org.au）的方式。
我们使用日志文件，根据医学培训水平，研究2009 - 2012年eviQ注册者的特征以及2012年eviQ的使用模式。我们还使用了一项基于网络的调查，以评估处于不同医学培训水平的医生使用该在线系统的方式，并了解他们对该系统在肿瘤护理中效用的看法。
我们的研究队列包括2549名eviQ注册者，他们是各级培训的医院医生。该队列中有65%在2012年使用了eviQ，其中25%的实习医生/住院医生、61%的高级肿瘤学实习生和47%的专科资格肿瘤学家在2012年的最后三个月访问了eviQ。该队列在2012年产生了44,5492次网页点击量。平均而言，高级实习生使用eviQ的频率比其他医生高出五倍（每月42.次网页点击量相比专科资格医生的22.8次和实习医生/住院医生的7.4次）。在52名调查受访者中，89% 在调查前一个月每天或每周访问eviQ的化疗方案。79%的受访者至少每周使用eviQ来启动治疗并支持监测（29%）、调整（35%）或停止治疗（19%）。与日志文件分析一致，高级肿瘤学实习生报告使用eviQ的频率高于医学培训其他阶段的医生。
澳大利亚大多数肿瘤学工作人员都在eviQ上注册。使用频率直接反映了医生的临床角色以及对eviQ在决策中效用的态度。此类评估为系统开发者和医学教育工作者提供了重要数据，以推动电子决策支持的改进，更好地满足临床医生的需求。这种以最终用户为中心的方式将优化系统的采用，从而转化为护理流程和患者结局的改善。
