A taxonomy of generic clinical questions: classification study.

OBJECTIVE: To develop a taxonomy of doctors' questions about patient care that could be used to help answer such questions. DESIGN: Use of 295 questions asked by Oregon primary care doctors to modify previously developed taxonomy of 1101 clinical questions asked by Iowa family doctors. SETTING: Primary care practices in Iowa and Oregon. PARTICIPANTS: Random samples of 103 Iowa family doctors and 49 Oregon primary care doctors. MAIN OUTCOME MEASURES: Consensus among seven investigators on a meaningful taxonomy of generic questions; interrater reliability among 11 individuals who used the taxonomy to classify a random sample of 100 questions: 50 from Iowa and 50 from Oregon. RESULTS: The revised taxonomy, which comprised 64 generic question types, was used to classify 1396 clinical questions. The three commonest generic types were "What is the drug of choice for condition x?" (150 questions, 11%); "What is the cause of symptom x?" (115 questions, 8%); and "What test is indicated in situation x?" (112 questions, 8%). The mean interrater reliability among 11 coders was moderate (kappa=0.53, agreement 55%). CONCLUSIONS: Clinical questions in primary care can be categorised into a limited number of generic types. A moderate degree of interrater reliability was achieved with the taxonomy developed in this study. The taxonomy may enhance our understanding of doctors' information needs and improve our ability to meet those needs.

Analysis of questions asked by family physicians regarding patient care.

Objectives To characterize the information needs of family physicians by collecting the questions they asked about patient care during consultations and to classify these in ways that would be useful to developers of knowledge bases. Design An observational study in which investigators visited physicians for two half-days and collected their questions. Taxonomies were developed to characterize the clinical topic and generic type of information sought for each question. Setting Eastern Iowa. Participants Random sample of 103 family physicians. Main outcome measures Number of questions posed, pursued, and answered; topic and generic type of information sought for each question; time spent pursuing answers; and information resources used. Results Participants asked a total of 1,101 questions. Questions about drug prescribing, obstetrics and gynecology, and adult infectious disease were most common, comprising 36% of the total. The taxonomy of generic questions included 69 categories; the three most common types, comprising 24% of all questions, were "What is the cause of symptom X?" "What is the dose of drug X?" and "How should I manage disease or finding X?" Answers to most questions (n = 702 [64%]) were not immediately pursued, but of those pursued, most (n = 318 [80%]) were answered. Physicians spent an average of less than 2 minutes pursuing an answer, and they used readily available print and human resources. Only two questions led to a formal literature search. Conclusions Family physicians in this study did not pursue answers to most of their questions. Questions about patient care can be organized into a limited number of generic types, which could help guide the efforts of knowledge-base developers.

Analysis of questions asked by family doctors regarding patient care.

OBJECTIVES: To characterise the information needs of family doctors by collecting the questions they asked about patient care during consultations and to classify these in ways that would be useful to developers of knowledge bases. DESIGN: Observational study in which investigators visited doctors for two half days and collected their questions. Taxonomies were developed to characterise the clinical topic and generic type of information sought for each question. SETTING: Eastern Iowa. PARTICIPANTS: Random sample of 103 family doctors. MAIN OUTCOME MEASURES: Number of questions posed, pursued, and answered; topic and generic type of information sought for each question; time spent pursuing answers; information resources used. RESULTS: Participants asked a total of 1101 questions. Questions about drug prescribing, obstetrics and gynaecology, and adult infectious disease were most common and comprised 36% of all questions. The taxonomy of generic questions included 69 categories; the three most common types, comprising 24% of all questions, were "What is the cause of symptom X?" "What is the dose of drug X?" and "How should I manage disease or finding X?" Answers to most questions (702, 64%) were not immediately pursued, but, of those pursued, most (318, 80%) were answered. Doctors spent an average of less than 2 minutes pursuing an answer, and they used readily available print and human resources. Only two questions led to a formal literature search. CONCLUSIONS: Family doctors in this study did not pursue answers to most of their questions. Questions about patient care can be organised into a limited number of generic types, which could help guide the efforts of knowledge base developers.

Lifelong self-directed learning using a computer database of clinical questions.

Physicians often have self-perceived knowledge gaps when they are seeing patients. Traditional continuing medical education is designed to meet the knowledge gaps of groups rather than individual physicians with specific patient problems. Physicians with clinical information needs are advised to critically evaluate high-quality original research in order to practice "evidence-based medicine." But this advice may be unrealistic for busy clinicians. We propose a system for documenting self-perceived information needs using a computer database. Concise answers to these needs are included in the database along with reference citations supporting the answers. The system tracks continuing education efforts, directs patient care decisions, and focuses lifelong learning on relevant topics. We emphasize the importance of being sensitive to personal information needs and the benefits of maintaining a record of these needs.

American College of Physicians (ACP) medical informatics and telemedicine.

The American College of Physicians (ACP) is the largest speciality society in the United States with over 83,000 Internal Medicine physician members. ACP seeks to be the foremost comprehensive education and information resource for all internists in support of its mission "to enhance the quality and effectiveness of health care." Medical Informatics and telemedicine is an integral part of the American College of Physicians' strategy to achieve its goals. ACP Medical Informatics Subcommittee and staff develop ACP policies and programs to improve clinical care and medical education through the use of Information Systems and new technologies for managing and integrating medical information and knowledge. This paper describes present and planned ACP informatics and telemedicine programs and projects focussing particularly on strategies to meet physicians' information needs incident to their patient care activities.

Physicians' use of computer software in answering clinical questions.

Descriptive data about the use of medical information software were gathered from physicians who were early users of these resources. Eight clinically active internists and medical subspecialists were lent a microcomputer loaded with six commercially available medical information software products. Participants used the software for two weeks to answer questions arising in their practice and completed written questionnaires. They recorded a total of 50 questions (between 3 and 11 per participant per two-week study period). Using the workstation, participants answered 20 questions (40% of the total), partially answered 16 questions (32%), and did not obtain useful information for 14 questions (28%). Participants found answers outside the workstation to 8 of the 14 questions (57%) not answered by using the software. The most common question topic was drug information (16 questions, or 32% of the total). The most common problems encountered using the workstation were retrieval of incomplete information (20 questions, or 40% of the total) and difficulty navigating the software (16 questions, or 32%). Other problems included difficulty translating clinical problems into questions, inappropriate resource selection, inadequate training for using the software, and excessive time required to access information. The study highlights several opportunities for medical librarians and others involved in clinical information management to facilitate the use of computer software for solving clinical problems.

Expanding the concept of medical information: an observational study of physicians' information needs.

Obtaining and managing clinically relevant information constitutes a major problem for physicians, for which the development of automated tools is often proposed as a solution. However, designing and implementing appropriate automated solutions presumes knowledge of physicians' information needs. We describe an empirical study of information needs in four clinical settings in internal medicine in a university teaching hospital. In contrast to the retrospective data often used in previous studies, this research used ethnographic techniques to facilitate direct observation of communication about information needs. On the basis of this experience, we address two main issues: how to identify and interpret expressions of information needs in medicine and how to broaden our conception of "information needs" to account for the empirical data.

Physicians' information needs: analysis of questions posed during clinical teaching.

OBJECTIVE: To describe information requests expressed during clinical teaching. SETTING: Residents' work rounds, attending rounds, morning report, and interns' clinic in a university-based general medicine service. SUBJECTS: Attending physicians, medical house staff, and medical students in a general medicine training program. METHODS: An anthropologist observed communication among study subjects and recorded in field notes expressions of a need for information. We developed a coding scheme for describing information requests and applied the coding scheme to the data recorded. Based on assigned codes, we created a subset of strictly clinical requests. MEASUREMENTS: Five hundred nineteen information requests recorded during 17 hours of observed clinical activity were selected for detailed analysis. These requests related to the care of approximately 90 patients by 24 physicians and medical students. Sixty-five requests were excluded because they were not strictly clinical, leaving a subset of 454 clinical questions for analysis. MAIN RESULTS: On average, five clinical questions were raised for each patient discussed. Three hundred thirty-seven requests (74%) concerned patient care. Of these 337 questions, 175 (52%) requested a fact that could have been found in a medical record. Seventy-seven (23%) of these questions, motivated by the needs of patient care, were potentially answerable by a library, a textbook, a journal, or MEDLINE. Eighty-eight (26%) of the questions asked for patient care required synthesis of patient information and medical knowledge. CONCLUSIONS: Clinicians in the study settings requested information frequently. Many of these information needs required the synthesis of patient information and medical knowledge and thus were potentially difficult to satisfy. A typology is proposed that characterizes information needs as consciously recognized, unrecognized, and currently satisfied.