A descriptive feast but an evaluative famine: systematic review of published articles on primary care computing during 1980-97

Mitchell and Sullivan’s comprehensive review on primary care
computing1 raised the issue that practitioners perceived their training in
computer use as being poor. They also noted that computer literacy should
be made a component of ongoing medical education.

While agreeing with this statement, however we feel that there is
more to this issue than just being comfortable using a computer. There is
little doubt that most practitioners have some basic knowledge of
computing, but are they information literate, can they search Medline
efficiently, negotiate the Cochrane database, navigate a reliable health
portal and evaluate useful content on behalf of their patients?

A study by Young and Ward2 on general practitioners’ use of evidence
databases showed that 22% were aware of the Cochrane database, 6% had
access to it and only 4% had ever used it. Another study by Ely, Levy and
Hartz3 shows that only 26% of family physicians had computers in their
offices and that the majority turned to books when faced with questions
about patient care. Hence, research suggests that general practitioners
may be reluctant to embrace information technology. Perhaps one of the
reasons to this reluctance is due to technical issues rather than issue of
skill.

The best method for information retrieval from the web is not
currently known. In a study by Graber, Bergus and York4 it was found that
medicine-specific search engines on the web fare poorly in answering
clinical questions when compared with general search engines. Furthermore,
a review by Hersh and Hickam5 suggests that current information retrieval
systems are too slow to allow busy clinicians to address the myriad
questions that arise in clinical practice. Hence how can one integrate
computers into clinical practice if the tools we use are worn and dated?

The younger generation of medical practitioners and medical students
seem to have more confidence and skill in computer and medical informatic
use6. Combined with advances in user-friendly technology perhaps the
problem of information illiteracy will no longer be an issue for future
generations.

References:
1. Mitchell E, Sullivan F. A descriptive feast but an evaluative famine:
systematic review of published articles on primary care computing during
1980-97. BMJ 2001; 322: 279-82.
2. Young JM, Ward JE. General practitioners’ use of evidence databases.
MJA 1999; 170: 56-58.
3. Ely JW, Levy BT, Hartz A. What clinical information resources are
available in family physicians’ offices?. Journal of family practice 1999;
48(2): 135-139.
4. Graber MA, Bergus GR, York C. Using the World Wide Web to answer
clinical questions: how efficient are different methods of information
retrieval?. Journal of family practice 1999; 48(7): 520-524.
5. Hersh WR, Hickman DH. How well do physicians use electronic information
retrieval systems? A framework for investigation and systematic review.
JAMA 1998; 280(15): 1347-1352.
6. Jerant AF, Lloyd AJ. Applied medical informatics and computing skills
of students, residents, and faculty. Family medicine 2000; 32(4): 267-272.