Implementation of a Wiki to Develop Structured Electronic Order Sets in a Computer Physician Order Entry System
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Abstract
Background: Wikis have a great potential to promote best practices in health systems by sharing decision support tools with a broad community of stakeholders. However, we do not know if clinicians are willing to use collaboratively created wiki decision support tools. Before testing the use of a wiki to share decision support tools across hospitals and across jurisdictions, more knowledge about the feasibility and impact of using a wiki within a small group of collaborators is needed. In response to this need, we developed a Google Sites wiki to create structured electronic order sets (i.e., predefined groupings of standard medical orders for a condition, disease, or procedure) for a computer physician order entry system in the Emergency Department (ED) at the Centre de santé et services sociaux Alphonse-Desjardins (CSSS AD) in Lévis, Quebec, Canada.
Objectives: We aimed to assess whether the implementation of our wiki would change emergency physicians’ intention to use a wiki promoting best practices.
Methods: We conducted a pre/post evaluation of the implementation of the wiki. All eligible EPs in the ED at CSSS AD were invited to respond to a validated questionnaire before using the wiki, and after 6 months of wiki use. Based on the Theory of Planned Behavior (TPB), the questionnaire measured the intention to use a wiki to promote best practices and the other TPB determinants (perceived behavioral control, attitude and subjective norm) on a 7-point Likert scale. SurveyMonkey and Google Analytics were used to collect usage data. Results were then imported in an Excel spreadsheet and analysed with SAS. P values were calculated using the Wilcoxon signed rank sum test for continuous variables and Fischer's exact test for categorical variables.
Results: During the 6-month study, 28 EPs used the wiki to create 68 orders sets for a variety of conditions seen in the ED. All eligible survey participants (100%; n=28) answered the survey. Among these EPs, 75% (n=21) were male; the median age was 40 years (25-75% IQR: 35-47); 75% (n=21) were certified by the Canadian College of Family Physicians and 25% (n=7) were certified by the Royal College of Physicians and Surgeons of Canada; 25% (n=7) had used a wiki for professional reasons in the past; 68% (n=19) had used a wiki for personal reasons; and only 1 EP had edited a wiki in the past. The wiki was accessed on average 1.9 times per day by 54% (15/28) of the participants. Although there was a trend for non-users to be older, male, specialized EPs, there were no statistically significant differences between wiki users and non-users. Overall, the intention to use a wiki increased from an average (SD) 5.42 (1.04) to 5.81 (1.25) (P=.03). All the other direct TPB construct measures increased compared to baseline, however only the attitude towards using a wiki (i.e., degree to which using the wiki was positively or negatively valued) increased significantly from 5.07 (0.9) to 5.57 (0.88) (P=.003).
Conslusions: EPs' intention and attitude towards using a wiki promoting best practices increased after using a wiki for 6 months in a small local project. Although the clinical significance of this increase needs to be determined, the use of a wiki to promote best practices across a larger health system seems feasible and needs to be explored.
Objectives: We aimed to assess whether the implementation of our wiki would change emergency physicians’ intention to use a wiki promoting best practices.
Methods: We conducted a pre/post evaluation of the implementation of the wiki. All eligible EPs in the ED at CSSS AD were invited to respond to a validated questionnaire before using the wiki, and after 6 months of wiki use. Based on the Theory of Planned Behavior (TPB), the questionnaire measured the intention to use a wiki to promote best practices and the other TPB determinants (perceived behavioral control, attitude and subjective norm) on a 7-point Likert scale. SurveyMonkey and Google Analytics were used to collect usage data. Results were then imported in an Excel spreadsheet and analysed with SAS. P values were calculated using the Wilcoxon signed rank sum test for continuous variables and Fischer's exact test for categorical variables.
Results: During the 6-month study, 28 EPs used the wiki to create 68 orders sets for a variety of conditions seen in the ED. All eligible survey participants (100%; n=28) answered the survey. Among these EPs, 75% (n=21) were male; the median age was 40 years (25-75% IQR: 35-47); 75% (n=21) were certified by the Canadian College of Family Physicians and 25% (n=7) were certified by the Royal College of Physicians and Surgeons of Canada; 25% (n=7) had used a wiki for professional reasons in the past; 68% (n=19) had used a wiki for personal reasons; and only 1 EP had edited a wiki in the past. The wiki was accessed on average 1.9 times per day by 54% (15/28) of the participants. Although there was a trend for non-users to be older, male, specialized EPs, there were no statistically significant differences between wiki users and non-users. Overall, the intention to use a wiki increased from an average (SD) 5.42 (1.04) to 5.81 (1.25) (P=.03). All the other direct TPB construct measures increased compared to baseline, however only the attitude towards using a wiki (i.e., degree to which using the wiki was positively or negatively valued) increased significantly from 5.07 (0.9) to 5.57 (0.88) (P=.003).
Conslusions: EPs' intention and attitude towards using a wiki promoting best practices increased after using a wiki for 6 months in a small local project. Although the clinical significance of this increase needs to be determined, the use of a wiki to promote best practices across a larger health system seems feasible and needs to be explored.
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