J Am Med Inform Assoc 11:113-120 doi:10.1197/jamia.M1385
  • Perspectives on CPOE and Patient Care Information Systems
  • Research Paper

Do clinicians use online evidence to support patient care? a study of 55,000 clinicians

  1. Johanna I Westbrook,
  2. A Sophie Gosling,
  3. Enrico Coiera
  1. Affiliation of the authors: Centre for Health Informatics, University of New South Wales, Kensington, NSW, Australia
  1. Correspondence and reprints: Johanna I. Westbrook, PhD, Centre for Health Informatics, Level 2, Samuels Building, University of New South Wales, Kensington, 2052, Australia; e-mail: j.westbrook{at}
  • Received 23 April 2003
  • Accepted 2 October 2003


Objectives To determine clinicians' (doctors', nurses', and allied health professionals') “actual” and “reported” use of a point-of-care online information retrieval system; and to make an assessment of the extent to which use is related to direct patient care by testing two hypotheses: hypothesis 1: clinicians use online evidence primarily to support clinical decisions relating to direct patient care; and hypothesis 2: clinicians use online evidence predominantly for research and continuing education.

Design Web-log analysis of the Clinical Information Access Program (CIAP), an online, 24-hour, point-of-care information retrieval system available to 55,000 clinicians in public hospitals in New South Wales, Australia. A statewide mail survey of 5,511 clinicians.

Measurements Rates of online evidence searching per 100 clinicians for the state and for the 81 individual hospitals studied; reported use of CIAP by clinicians through a self-administered questionnaire; and correlations between evidence searches and patient admissions.

Results Monthly rates of 48.5 “search sessions” per 100 clinicians and 231.6 text hits to single-source databases per 100 clinicians (n = 619,545); 63% of clinicians reported that they were aware of CIAP and 75% of those had used it. Eighty-eight percent of users reported CIAP had the potential to improve patient care and 41% reported direct experience of this. Clinicians' use of CIAP on each day of the week was highly positively correlated with patient admissions (r = 0.99, p < 0.001). This was also true for all ten randomly selected hospitals.

Conclusion Clinicians' online evidence use increases with patient admissions, supporting the hypothesis that clinicians' use of evidence is related to direct patient care. Patterns of evidence use and clinicians' self-reports also support this hypothesis.


  • This research was funded by the New South Wales Health Department.

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