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Archambault PM, Beaupré P, Bégin L, et al. Impact of Implementing a Wiki to Develop Structured Electronic Order Sets on Physicians' Intention to Use Wiki-Based Order Sets. JMIR Med Inform. 2016;4(2):e18doi: 10.2196/medinform.4852.
Archambault, P. M., Beaupré, P., Bégin, L., Dupuis, A., Côté, M., & Légaré, F. (2016). Impact of Implementing a Wiki to Develop Structured Electronic Order Sets on Physicians' Intention to Use Wiki-Based Order Sets. JMIR medical informatics, 4(2), e18. https://doi.org/10.2196/medinform.4852
Archambault, Patrick Michel, et al. "Impact of Implementing a Wiki to Develop Structured Electronic Order Sets on Physicians' Intention to Use Wiki-Based Order Sets." JMIR medical informatics vol. 4,2 (2016): e18. doi: https://doi.org/10.2196/medinform.4852
Archambault PM, Beaupré P, Bégin L, Dupuis A, Côté M, Légaré F. Impact of Implementing a Wiki to Develop Structured Electronic Order Sets on Physicians' Intention to Use Wiki-Based Order Sets. JMIR Med Inform. 2016 May 17;4(2):e18. doi: 10.2196/medinform.4852. PMID: 27189046; PMCID: PMC4909394.
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JMIR Med Inform. 2016 May 17;4(2):e18. doi: 10.2196/medinform.4852.

Impact of Implementing a Wiki to Develop Structured Electronic Order Sets on Physicians' Intention to Use Wiki-Based Order Sets.

JMIR medical informatics

Patrick Michel Archambault, Pierre Beaupré, Laura Bégin, Audrey Dupuis, Mario Côté, France Légaré

Affiliations

  1. Centre intégré de santé et services sociaux de Chaudière-Appalaches, Lévis, QC, Canada. [email protected].

PMID: 27189046 PMCID: PMC4909394 DOI: 10.2196/medinform.4852

Abstract

BACKGROUND: Wikis have the potential to promote best practices in health systems by sharing order sets with a broad community of stakeholders. However, little is known about the impact of using a wiki on clinicians' intention to use wiki-based order sets.

OBJECTIVE: The aims of this study were: (1) to describe the use of a wiki to create structured order sets for a single emergency department; (2) to evaluate whether the use of this wiki changed emergency physicians' future intention to use wiki-based order sets; and (3) to understand the impact of using the wiki on the behavioral determinants for using wiki-based order sets.

METHODS: This was a pre/post-intervention mixed-methods study conducted in one hospital in Lévis, Quebec. The intervention was comprised of receiving access to and being motivated by the department head to use a wiki for 6 months to create electronic order sets designed to be used in a computer physician order entry system. Before and after our intervention, we asked participants to complete a previously validated questionnaire based on the Theory of Planned Behavior. Our primary outcome was the intention to use wiki-based order sets in clinical practice. We also assessed participants' attitude, perceived behavioral control, and subjective norm to use wiki-based order sets. Paired pre- and post-Likert scores were compared using Wilcoxon signed-rank tests. The post-questionnaire also included open-ended questions concerning participants' comments about the wiki, which were then classified into themes using an existing taxonomy.

RESULTS: Twenty-eight emergency physicians were enrolled in the study (response rate: 100%). Physicians' mean intention to use a wiki-based reminder was 5.42 (SD 1.04) before the intervention, and increased to 5.81 (SD 1.25) on a 7-point Likert scale (P =.03) after the intervention. Participants' attitude towards using a wiki-based order set also increased from 5.07 (SD 0.90) to 5.57 (SD 0.88) (P =.003). Perceived behavioral control and subjective norm did not change. Easier information sharing was the most frequently positive impact raised. In order of frequency, the three most important facilitators reported were: ease of use, support from colleagues, and promotion by the departmental head. Although participants did not mention any perceived negative impacts, they raised the following barriers in order of frequency: poor organization of information, slow computers, and difficult wiki access.

CONCLUSIONS: Emergency physicians' intention and attitude to use wiki-based order sets increased after having access to and being motivated to use a wiki for 6 months. Future studies need to explore if this increased intention will translate into sustained actual use and improve patient care. Certain barriers need to be addressed before implementing a wiki for use on a larger scale.

Keywords: Theory of Planned Behavior; collaborative writing applications; computer physician order entry; decision support tools; emergency medicine; health informatics; knowledge translation; wiki

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