Clinicians’ perceptions about use of computerized protocols: A multicenter study

Phansalkar, Shobha; Weir, Charlene R.; Morris, Alan H.; Warner, Homer R.

doi:10.1016/j.ijmedinf.2007.02.002

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Volume 77, Issue 3 , Pages 184-193, March 2008

Clinicians’ perceptions about use of computerized protocols: A multicenter study

Shobha Phansalkar
- Department of Biomedical Informatics, School of Medicine, University of Utah, Salt Lake City, UT 84112-5750, USA
- Geriatrics Research, Education, and Clinical Center (GRECC), Veterans Administration Salt Lake City Health Care System, Salt Lake City, UT, USA
- Corresponding author at: Department of Biomedical Informatics, School of Medicine, University of Utah, 26 South 2000 East, Suite 5700 HSEB Salt Lake City, UT 84112-5750, USA. Tel.: +1 801 582 1565x2221; fax: +1 801 584 5640.
Charlene R. Weir
- Geriatrics Research, Education, and Clinical Center (GRECC), Veterans Administration Salt Lake City Health Care System, Salt Lake City, UT, USA
- Department of Biomedical Informatics, School of Medicine, University of Utah, Salt Lake City, UT 84112-5750, USA
Alan H. Morris
- Department of Biomedical Informatics, School of Medicine, University of Utah, Salt Lake City, UT 84112-5750, USA
- Pulmonary Division, Department of Medicine, LDS Hospital and University of Utah, Salt Lake City, UT, USA
Homer R. Warner
- Department of Biomedical Informatics, School of Medicine, University of Utah, Salt Lake City, UT 84112-5750, USA

Received 5 September 2006; received in revised form 26 January 2007; accepted 5 February 2007.

Abstract

Purpose

Implementation of evidence-based techniques, such as explicit computerized protocols, has achieved limited success among clinicians. In this study, we describe the development and validation of an instrument for assessing clinicians’ perceptions about use of explicit computerized protocols.

Methods

Qualitative assessment of semi-structured interviews with clinicians gave rise to a cognitive model evaluating the factors that motivate clinicians to use explicit computerized protocols. Using these constructs we developed a 35-item instrument which was administered to 240 clinicians (132 nurses, 53 physicians and 55 respiratory therapists), in three health-care institutions.

Results

Factor analysis identified nine factors that accounted for 66% of the total variance cumulatively. Factors identified were: Beliefs regarding Self-Efficacy, Environmental Support, Role Relevance, Work Importance, Beliefs regarding Control, Attitude towards Information Quality, Social Pressure, Culture, and Behavioral Intention. The strongest predictor was Beliefs regarding Self-Efficacy, which accounted for 26% of the total variance of intention to use explicit computerized protocols. Results supported the reliability and construct validity of the instrument.

Conclusions

Clinicians’ perceptions play a critical role in determining their intention to use explicit computerized protocols in routine clinical practice. Behavioral theories will help us understand factors predicting clinicians’ intention to use explicit computerized protocols and recognize the implications of these factors in the design and implementation of these protocols.

Keywords: Computerized protocols, Clinician perceptions, Implementation, Clinical protocols [MeSH], Decision making [MeSH], Factor analysis [MeSH]