Background

Increasingly, information about healthcare is readily available to healthcare workers in electronic formats. Electronic healthcare information (EHI) refers to information that is accessed on a computer, either on a local server or Intranet or online, using the Internet. In 2004, The WHO commissioned a discussion paper arguing for increased global access to health information, on the premise that limited or no access to information was the major barrier to evidence-based healthcare in developing countries. Although it is easy to assume that if EHI is accessible to practitioners they will use it to inform best practice in patient care, this is not always the case; despite the proliferating technology to support access to EHI, the actual implementation of healthcare evidence in patient care remains suboptimal. Research has identified that practitioners who are able to identify and access EHI may still not be able to integrate information into practice at an individual or organizational level.

There is a widespread availability of EHI in high-income countries and, increasingly, in low-to-middle income countries there are better opportunities to for accessing EHI; indeed EHI is becoming a global norm. Given that nurses make up the largest proportion of healthcare workers around the world, it is important to understand how nurses use EHI and how best to integrate such information to positively influence professional practice and improve patient outcomes.

Objectives

The aim of the study was to assess the effects of interventions aimed at improving or increasing healthcare practitioners' use of electronic health information (EHI) on professional practice and patient outcomes.

Intervention/methods

This review included all types of randomized and non-randomized controlled studies, controlled pre-post studies and interrupted time series studies that met the criteria established by the Cochrane Effective Practice and Organisations of Care Group (EPOC). The population included nurses, physicians and allied health practitioners who were involved in patient care. Any type of intervention was included in which it aimed to improve or increase the use of EHI by practitioners to inform clinical practice. No restrictions were placed on language or date. The comparators in the included studies were as follows: electronic versus printed health information; EHI on different devices (e.g. desktop, laptop or tablet computer, mobile phones); EHI via different user interfaces; EHI with or without education and training and EHI compared to no other source or type of information. The primary outcomes included the following: changes to professional behaviour, both clinical practice and use of EHI, and measures of changes to patient outcomes, such as improved symptoms or decreased length of hospital stay.

A large variety of electronic databases were searched, and the reference lists of relevant studies or reviews were searched. The process of data collection and analysis was undertaken according to the established methodology of the Cochrane Collaboration. The EPOC risk of bias tool was used to grade the quality of each study.

Results

There were two randomized controlled trials and four cluster randomized controlled trials involving 352 physicians, 48 resident medical doctors and 135 allied health practitioners. Overall risk of bias was low, as was quality of the evidence. One comparison was supported by three studies and three comparisons were supported by a single study. Outcomes across all studies were highly heterogeneous. There were no studies to support EHI versus alternatives. Given these factors, it was not possible to determine the relative effectiveness of interventions. All studies reported practitioner use of EHI, two reported on compliance with electronic practice guidelines and none reported on patient outcomes.

One trial measured guideline adherence for electronic versus printed guidelines, but reported no difference between groups. One small cross-over trial reported increased use of clinical guidelines when provided with a mobile laptop versus stationary desktop computer [mean use per shift 3.6 (SD 1.7) intervention group versus 2.0 (SD 1.9) control group; P = 0.03]. Another cross-over trial reported that using a customized versus generic interface had little impact on practitioners' use of EHI. Three trials included education or training and reported increased use of EHI by practitioners following training.

Conclusion

There is evidence to support that education and training increase the use of EHI, but there is no evidence that the use of EHI translates into improved clinical practice or patient outcomes. Whereas use of EHI may be considered an important part of evidence-based medicine, use of EHI alone is insufficient to improve patient care or clinical practice. More research is required to understand why practitioners do not access or do not apply acquired EHI to clinical practice.

Implications for practice

This review highlights the complexity of translating evidence into practice. As nurses, the importance of evidence-based healthcare is often promoted, but nurses are not always certain of where or how to access information. With the availability of EHI at our fingertips, we should be able to access and apply information to provide high-quality healthcare, resulting in improved patient outcomes. However, the evidence demonstrates that access to EHI alone is not enough. We need to understand what information influences our practice and what changes in management process are required at an organizational level to implement knowledge into clinical practice.

Reference