Practicing clinicians have an obvious imperative to manage and apply information effectively. However, physicians attempting to identify research relevant to their clinical practice are faced with a number of potential roadblocks. These issues may be contributing to the large proportion of questions encountered during clinical practice that go unpursued [1
]. In addition, lack of time is a clear concern for the busy practicing clinician and is one of the most often cited barriers to the effective practice of evidence-based medicine (EBM) [1
]. Given the time constraints of clinical practice, it is not surprising that clinicians are not generally able to consider the multiple sources of evidence that an answer to a complex question may necessitate.
A growing number of information resources provide ready access to evidence-based syntheses of the clinical research literature (e.g., UpToDate, MDConsult, Cochrane Database of Systematic Reviews). These resources attempt to assist clinicians with quick access to readily available answers. However, these resources are less useful in addressing more complex queries, such as the conflicting reports in the literature regarding the relative merit of multiple diagnostic or therapeutic strategies [18
]. Numerous investigations continue to demonstrate significant gaps between research evidence and the clinical care actually provided in a broad range of clinical specialties [25
], underscoring the need for additional, systematic ways to integrate evidence into clinical practice.
Given these challenges, considerable attention is being devoted to developing technical and human systems that incorporate the best evidence into clinical practice. Recent interest has focused on the potential role of expert information professionals who can work with clinicians to address unanswered information needs. These papers describe efforts to train “clinical informationists,” professional members of the health care team who inhabit the intersection between information and clinical care and act as expert information providers to identify and fulfill the complex information needs of the team [33
]. This emerging professional is skilled in identifying, assessing, and synthesizing research relevant to specific clinical contexts.
At the Vanderbilt University Medical Center (VUMC), the Eskind Biomedical Library (EBL) developed a service providing clinical information, called the Clinical Informatics Consult Service (CICS), as a local strategy to address clinician needs for evidence to support patient care [38
]. The main goal of the library's evidence-based services has been to provide clinicians with the highest-quality and most relevant research evidence to support effective clinical decision making and evidence-based practice.
While the service initially focused primarily on librarian consultations with clinicians during in-patient morning rounds, library staff also recognized a need to adapt this model to provide service to VUMC's outpatient clinics, where attending physicians and housestaff care for patients in individual examination rooms rather than through the group “bedside rounds” of the inpatient setting. In late 2003, the library began using VUMC's electronic medical record (EMR) system, StarPanel [40
], as an entry point into the outpatient arena [42
]. The StarPanel EMR system includes a secure messaging feature that has been successfully integrated throughout the outpatient clinics at VUMC and is heavily used in the clinic workflow. The library's EBM Literature Request service permits clinicians to use this messaging feature to consult with EBL librarians to request evidence summaries that address complex patient care questions. As with the consultation services provided to clinicians during in-patient rounds, each out-patient clinical area has one librarian designated as its primary liaison, with additional members of the library team substituting as needed.
In response to a clinical question received through the StarPanel system message basket, the librarian searches the literature, selects the “best” evidence based on methodological rigor and relevance to the question at hand, and summarizes the evidence in a written synthesis that is delivered to the clinician through the StarPanel system. (An example of a question and librarian response is provided in Appendix A online). The librarian is also able to access the record of the patient prompting the question, when appropriate, to facilitate tailoring the literature to the clinical context, which is also a key characteristic of the service provided to in-patient clinicians. These clinical questions have required from three to more than ten hours of librarian time to complete, depending on the complexity and volume of the literature published on each topic.
Because this service is integrated into the EMR, it directly links evidence expertise into the clinical workflow using the StarPanel message system to facilitate easy and direct communication between clinicians and the librarian. The current study combines service usage statistics, a focus group, and a clinician survey to evaluate the strategies used to market the service to clinicians and to assess clinicians' perceptions about the utility of the EBM Literature Request service. The specific research questions addressed by the current work are:
- Did newly implemented marketing and communication strategies increase physicians' use of the EBM Literature Request function in StarPanel?
- How did clinicians rate the relevance of the information provided through the EBM Literature Request Service?
- How was the information provided to the clinicians used and shared?