Use of Mobile Clinical Decision Support Software by Junior Doctors at a UK Teaching Hospital: Identification and Evaluation of Barriers to Engagement
Clinical Decision Support (CDS) Tools are intended to improve patient care. Their purpose is to reduce medical error and increase accuracy of clinicians and medical staff. The development of CDS tools coincides with the increasing technical advancements. This is particularly evident in the mobile market. As many of the new tools are specifically developed for cellular phones and tablets. The increase in mobility for the patients’ records also has prompted patients concerns about the security of their information.
The study attempted to answer three questions. The first being what is the total amount that the junior doctors actually use a CDS on a mobile device (tablet or phone). The next objective was to observe the perceptions of the junior doctors while using the mobile CDS. The final objective was to observe and gather information on the patients’ perspective on the junior doctors using the mobile CDS. Though these are outlined the specific objective however appeared to be the collection of influences that lead to the use of a mobile CDS while simultaneously attempting to quantify the usage and then compare those with what the patient perceived were the reasons for a junior doctor to use a mobile CDS.
The study was conducted at the University Hospitals of Leicester NHS Trusts, United Kingdom. The study included 4 in-patient wards in a tertiary center renal unit totaling 59 beds. All patients and junior doctors provided their consent to be included in the study. Although junior doctors had other CDS at this particular hospital most items where manually written. The junior doctors were instructed not to discontinue the use of their CDSs to focus on the newly acquired study CDS (for the sake of patient safety). A total of sixteen junior doctors participated in the 4-month study.
142 mobile CDS interactions where recorded from the 16 junior doctors over the course of the study. Out of the junior doctors seven did not use the mobile CDS. Thus separate conclusions where needed for this group:
- Consider those who used the software
- Consider those who did not use the software compared to the total
Typically each junior doctor used the software 4 times a month. Another key result was where the usage took place. 14 of the junior doctors provided data on whether they were on shift or off when using the mobile CDS. Out of a total of 113 interactions, 86weere completed off-shift of the junior doctor. In the group only 4 patients were interviewed. They were all current members of the Kidney Patient Association. The patients’ perceptions were positive. Citing that the mobility of the CDS allows the doctors to stay constantly informed and up-to-date not only on their medical history but the illness itself.
Patients were positive towards the mobile CDS as they all focused on it assisting their healing. Although the items where present there will be those clinicians that are hesitant to use the technology. As well, those that did use the technology did so at times where they could spend ample time learning. The mobile CDS learning curve was notably difficult while the MDs were also completing other duties with minimal adminstrative support.
I strongly feel that this study shows the overall consensus of CDS not only in the US but internationally. Many physicians are slow to adapt or adjust to the new technology and therefore miss the positive impact it brings. Or with their lack of willingness to adopt or be taught they negatively impact the technology which further presents CDS in a negative fashion.
Patel, R., Green, W., Waseem Shahzad, M., & Larkin, C. (2015). Use of Mobile Clinical Decision Support Software by Junior Doctors at a UK Teaching Hospital: Identification and Evaluation of Barriers to Engagement . JMIR Publications, 3(3). Retrieved from http://mhealth.jmir.org/2015/3/e80/