HOW WELL DO PHYSICIANS USE ELECTRONIC INFORMATION-RETRIEVAL SYSTEMS -A FRAMEWORK FOR INVESTIGATION AND SYSTEMATIC REVIEW

Objective.-Despite the proliferation of electronic information retriev al (IR) systems for physicians, their effectiveness has not been well assessed. The purpose of this review is to provide a conceptual framew ork and to apply the results of previous studies to this framework. Da ta Sources.-All sources of medical informatics and information science literature, including MEDLINE, along with bibliographies of textbooks in these areas, were searched from 1966 to January 1998. Study Select ion.-All articles presenting either classifications of evaluation stud ies or their results, with an emphasis on those studying use by physic ians. Data Extraction.-A framework for evaluation was developed, consi sting of frequency of use, purpose of use, user satisfaction, searchin g utility, search failure, and outcomes. All studies were then assesse d based on the framework. Data Synthesis.-Due to the heterogeneity and simplistic study designs, no meta-analysis of studies could be done. General conclusions were drawn from data where appropriate. A total of 47 articles were found to include an evaluation component and were us ed to develop the framework. Of these, 21 articles met the inclusion c riteria for 1 or more of the categories in the framework. Most use of IR systems by physicians still occurs with bibliographic rather than f ull-text databases. Overall use of IR systems occurs just 0.3 to 9 tim es per physician per month, whereas physicians have 2 unanswered quest ions for every 3 patients. Conclusions.-Studies comparing IR systems w ith different searching features have not shown that advanced searchin g methods are significantly more effective than simple text word metho ds. Most searches retrieve only one fourth to one half of the relevant articles on a given topic and, once retrieved, little is known about how these articles are interpreted or applied. These studies imply tha t further research and development are needed to improve system utilit y and performance.