MEDICAL INFORMATICS AND MILITARY DEPLOYMENT

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					MEDICAL
INFORMATICS AND
MILITARY
DEPLOYMENT:
WHAT SOURCES OF MEDICAL
INFORMATION DO PHYSICIANS
TURN TO WHILE ON DEPLOYMENT

                                 Mark B. Stephens, MD
                 Associate Professor of Family Medicine
                         Uniformed Services University
Traditional Sources of
Medical Information



Textbooks
Medical Journals
Personal Communication
Modern Sources of Medical
Information
Internet
     Primary sources
     Secondary (filtered) sources
Personal Digital Assistants (PDA)
Electronic Databases
Smart Phones
At least one question
related to individual
patient care is
generated during each
visit

         Davies, 2007
Physicians pursue
an answer to these
clinical questions
only 50% of the time
         Ely, 1999
Lack of time
Lack of resources
Lack of training
   The most common reasons physicians “give up”

           Cogdill, 2000
When searching for answers,
physicians want:

Reliability
Validity
Speed!

             Wyatt, 2005
For most physicians, if a
search takes more than


   60 seconds
The search is abandoned and
the question not answered

                Ely, 1999
Fort Detrick 2002

  Biomedical Informatics
    Roadmap Meeting

“Computational tools should be
provided to facilitate the clinical
capabilities of deployed physicians”
With this in mind, our
collaboration set out to:

Determine common sources
 of medical information
 used by military
 physicians
   – In Garrison
   – On Deployment
Determine to what
extent surgical and
primary care physicians
employ different
sources of medical
information
METHODOLOGY

USU IRB M081-CA

Survey of USU Students and Alumni
Deployment Experience
Use of medical resources

PHP® Surveyor
De-identified responses

Basic descriptive statistics
Chi-square; students t-test
RESULTS

•1351 of 4208 responded (31%
response rate)
•Cohort of interest = 632 staff
physicians with deployment
experience
•411 of 632 gave data
regarding specialty
Age
 20-30                   14    (2%)
 31-40                   259   (41%)
 41 and over             358   (57%)

Gender
 Male                    527   (84%)
 Female                  105   (16%)

Branch of Service
 Army                    292   (46%)
 Navy                    150   (24%)
 Air Force               174   (27%)
 Public Health Service   16    (3%)

Prior informatics training
 Yes                   576     (91%)
 No                    56      (9%)
GARRISON SOURCES OF
INFORMATION

1. On-line resources       (98%)
2. Medical journals        (95%)
3. Colleagues              (94%)
4. Medical textbooks       (80%)

^94% of garrison physicians access the
  Internet daily
GARRISON INTERNET SOURCES

1.Google®          (93%)
2.MEDLINE ®        (84%)
3.PubMed ®         (83%)
4.MDConsult ®      (78%)
5.UptoDate ®       (69%)
DEPLOYMENT SOURCES OF
INFORMATION

1.Textbook                 (91%)*
2.Colleague                (87%)*
3.On-line reference        (81%)*
4.Journal                  (74%)*


        *varies from garrison (p < 0.05)
DEPLOYMENT ELECTRONIC
RESOURCES

1.Google ®                            (56%)
2.MDConsult ®                         (45%)
3.UptoDate ®                          (42%)
4.PubMed ®                            (37%)
5.Medline ®                           (35%)

^19% of deployed physicians accessed Internet daily
MISCELLANEOUS

•No difference based on gender
•No difference based on service
•No differences in frequency of
internet usage or types of sources
by specialty

•Significant differences in
preferences for electronic
resources by specialty
SPECIALTY DIFFERENCES

PRIMARY CARE
1.Google®
2.UptoDate ®
3.MDConsult ®

SURGERY
1.PubMed ®
2.Google ®
3.MEDLINE ®
SO WHAT?

1.Internet is now a routine part of
  practice, particularly in garrison
2.Google® is most common search
  engine
SO WHAT?

3.Relatively few military
  physicians use ‘boutique’ fee-for-
  service’ filtered medical
  information sources (ACP
  Journal Club®, InfoRetriever ®,
  etc.)
4.One size does not fit all for the
  medical informatics needs of
  deployed military physicians
LIMITATIONS

•Response bias
     Electronically ‘savvy’?
•Don’t’ know absolute
physician response rate
•Differences in operational
electronic infrastructure
CONCLUSIONS

•Internet Access
•Generic search
engine
•Open-domain
sources
   1. MEDLINE ®
   2. PubMed ®
•Filtered sources
   1. MDConsult ®
   2. UptoDate®
ACKNOWLEDGEMENTS

CDR Annette von Thun, MC USN
Dr. Donna Waechter, USU
Ms. Dana Davila, USU
Questions?

mstephens@usuhs.mil