ABSTRACT
BACKGROUND: In Belgium, the construction of a national electronic point-of-care information service, EBMPracticeNet, was initiated in 2011 to optimize quality of care by promoting evidence-based decision-making. The collaboration of the government, health care providers, evidence-based medicine (EBM) partners, and vendors of electronic health records (EHR) is unique to this project. All Belgian health care professionals get free access to an up-to-date database of validated Belgian and nearly 1000 international guidelines, incorporated in a portal that also provides EBM information from other sources than guidelines, including computerized clinical decision support that is integrated in the EHRs. OBJECTIVE: The objective of this paper was to describe the development strategy, the overall content, and the management of EBMPracticeNet which may be of relevance to other health organizations creating national or regional electronic point-of-care information services. METHODS: Several candidate providers of comprehensive guideline solutions were evaluated and one database was selected. Translation of the guidelines to Dutch and French was done with translation software, post-editing by translators and medical proofreading. A strategy is determined to adapt the guideline content to the Belgian context. Acceptance of the computerized clinical decision support tool has been tested and a randomized controlled trial is planned to evaluate the effect on process and patient outcomes. RESULTS: Currently, EBMPracticeNet is in "work in progress" state. Reference is made to the results of a pilot study and to further planned research including a randomized controlled trial. CONCLUSIONS: The collaboration of government, health care providers, EBM partners, and vendors of EHRs is unique. The potential value of the project is great. The link between all the EHRs from different vendors and a national database held on a single platform that is controlled by all EBM organizations in Belgium are the strengths of EBMPracticeNet.
ABSTRACT
An electronic decision support system (the EBMeDS system) was integrated in one of the Electronic Medical Records (EMR) of Belgian family physicians (Feb 2010). User acceptance of the system is considered as a necessary condition for the effective implementation of any IT project. Facilitators, barriers and issues of non-acceptance need to be understood in view of a successful implementation and to minimize unexpected adoption behavior. Objectives of the study were the assessment of users' perceptions towards the recently implemented EBMeDS system, the investigation of user-interactions with the system and possible relationships between perceptions and use. A mixed evaluation approach was performed consisting of a qualitative and a quantitative analysis. The technology acceptance model of UTAUT was used as a structural model for the development of our questionnaire to identify factors that may account for acceptance and use of the EBMeDS system (seven-point Likert scales). A quantitative analysis of computer-recorded user interactions with the system was performed for an evaluation period of 3 months to assess the actual use of the system. Qualitative and quantitative analysis were linked to each other. Thirty-nine family physicians (12 %) completed the survey. The majority of respondents (66 %) had a positive attitude towards the system in general. Mean intention to keep using the system was high (5,91 ± 1,33). Their perception of the ease of use of the system (mean 5,04 ± 1,41), usefulness (mean 4,69 ± 1,35) and facilitating conditions (4,43 ± 1,13) was in general positive. Only 0,35 % of reminders were requested on demand, the other 99,62 % of reminders displayed automatically. Detailed guidelines (long) were requested for 0,47 % of reminders automatically shown versus 16,17 % of reminders on request. The script behind the reminders was requested for 8,4 % of reminders automatically shown versus 13,6 % of reminders on request. The majority of respondents demonstrated a relatively high degree of acceptance towards the EBMeDS system. Although the majority of respondents was in general positive towards the ease of use of the system, usefulness and facilitating conditions, part of the statements gave rather mixed results and could be identified as important points of interest for future implementation initiatives and system improvements. It has to be stressed that our population consisted of a convenience sample of early adopters, willing to answer a questionnaire. The willingness to adopt the system depends on the willingness to use ICPC coding. As such, the quality of reminding partly depends on the quality of coding. There is a need to reach a larger population of physicians (including physicians who never used the system or stopped using the system) to validate the results of this survey.
