Medical Informatics Needs Survey

Below is a copy of the Medical Informatics Needs Assessment, given to our Faculty, Residents and Staff at the beginning of our curriculum development.  Data from this survey and followup surveys was used to track self-reported competencies and attitudes as we developed our curriculum.  You can download a copy of the survey as well.  To facilitate data collection and analysis, we converted the original paper survey to an Access database questionnaire, which could be done "on-line".  This is also available for download in Access MDE form.  If you use any of these tools, please contact Dr. Zelnick, who would be interested in helping you use them as well as discussing results and experiences.

 

 

Medical Informatics Needs Assessment

I. Name___________________________________________ Date_________________________

I. Demographics

a. Your age:_________

b. Your gender:

Female p

Male p

c. Training level:

R1

R2

R3

MD Faculty

Other Faculty

FPC Staff

FHC Staff

  1. Please list the most recent formal school you attended (highest level, e.g. Washington HS, Kirkwood Community College, Iowa State, Harvard Medical School, etc.)

_______________________________________

II. Computer Experiences

a. How frequently do you use a computer (choose one)?

Daily

Weekly

Monthly

Rarely

Never

b. What training or experience with computers have you had? (check all that apply)

p Formal course(s) in computer science or related field

p Formal medical school training in computers

p Formal residency or fellowship training in computers

p Formal workshops or conferences on computers for which I received CME credit

p Workshops or conferences on computers for which I did not receive CME credit

p Self-guided learning about computers

p None

c. On the whole, how sophisticated a computer user do you consider yourself? (choose only one)

p Very sophisticated

p Sophisticated

p Neither sophisticated nor unsophisticated

p Unsophisticated

p Very unsophisticated

d. On the whole, how interested are you in learning more about computers? (choose only one)

p Eager to learn more

p I’d like to learn more

p I’ll learn more it I have to, to do my job

p I’d just as soon avoid the subject.

p I feel hostile when I hear the word "computer".

e. On the whole, how interested are you in learning more about the noncomputer aspects of medical informatics (e.g. evidence based medicine, Problem oriented medical record, etc.) (choose only one)

p Eager to learn more

p I’d like to learn more

p I’ll learn more it I have to, to do my job

p I’d just as soon avoid the subject.

p I feel hostile when I hear the words "medical informatics".

f. Please complete the following table.

 

1. Where do you have access to a computer or terminal? Complete all rows that apply

What type of machine?

Other features does this computer have? Check all that apply: (AMOS is the FPC billing system. Meditech is Mercy’s system, PHAMIS is St. Lukes’.

How often do you use this computer, and how comfortable you are using it?

__No access anywhere

 

 

 

 

 

__At work,on my desk

 

__PC, WINDOWS

__PC, DOS only

__Mac

__PC or Terminal connected to a mainframe

_Other, which?_______

__CD-ROM

__Sound

__Printer

__Modem, speed?______

__AMOS

__Meditech

__Phamis

__Local Area Network

__Internet connection

__Medline search

Frequency

__Never

__Rarely

__Monthly

__Weekly

__Daily

 

Comfort Level

__Very comfortable

__Somewhat

comfortable

__Neutral

__Somewhat

uncomfortable

__Very

uncomfortable

__At work,NOT on my desk

 

__PC, WINDOWS

__PC, DOS only

__Mac

__PC or Terminal connected to a mainframe

_Other, which?_______

__CD-ROM

__Sound

__Printer

__Modem, speed?______

__AMOS

__Meditech

__Phamis

__Local Area Network

__Internet connection

__Medline search

Frequency

__Never

__Rarely

__Monthly

__Weekly

__Daily

 

Comfort Level

__Very comfortable

__Somewhat

comfortable

__Neutral

__Somewhat

uncomfortable

__Very

uncomfortable

__Laptop computer

__PC, WINDOWS

__PC, DOS only

__Mac

__PC or Terminal connected to a mainframe

_Other, which?_______

__CD-ROM

__Sound

__Printer

__Modem, speed?______

__AMOS

__Meditech

__Phamis

__Local Area Network

__Internet connection

__Medline search

Frequency

__Never

__Rarely

__Monthly

__Weekly

__Daily

 

Comfort Level

__Very comfortable

__Somewhat

comfortable

__Neutral

__Somewhat

uncomfortable

__Very

uncomfortable

__In a hospital teaching area, which hospital? ________________

__PC, WINDOWS

__PC, DOS only

__Mac

__PC or Terminal connected to a mainframe

_Other, which?_______

__CD-ROM

__Sound

__Printer

__Modem, speed?______

__AMOS

__Meditech

__Phamis

__Local Area Network

__Internet connection

__Medline search

Frequency

__Never

__Rarely

__Monthly

__Weekly

__Daily

 

Comfort Level

__Very comfortable

__Somewhat

comfortable

__Neutral

__Somewhat

uncomfortable

__Very

uncomfortable

__In my ambulatory clinical teaching area

__PC, WINDOWS

__PC, DOS only

__Mac

__PC or Terminal connected to a mainframe

_Other, which?_______

__CD-ROM

__Sound

__Printer

__Modem, speed?______

__AMOS

__Meditech

__Phamis

__Local Area Network

__Internet connection

__Medline search

Frequency

__Never

__Rarely

__Monthly

__Weekly

__Daily

 

Comfort Level

__Very comfortable

__Somewhat

comfortable

__Neutral

__Somewhat

uncomfortable

__Very

uncomfortable

__At home

__PC, WINDOWS

__PC, DOS only

__Mac

__PC or Terminal connected to a mainframe

_Other, which?_______

__CD-ROM

__Sound

__Printer

__Modem, speed?______

__AMOS

__Meditech

__Phamis

__Local Area Network

__Internet connection

__Medline search

Frequency

__Never

__Rarely

__Monthly

__Weekly

__Daily

 

Comfort Level

__Very comfortable

__Somewhat

comfortable

__Neutral

__Somewhat

uncomfortable

__Very

uncomfortable

 

g. Where do you have access for conducting MEDLINE searches? (Check all that apply)

How do you connect to the information? (Check one)

NLM = National Library of Medicine

__ No access

 

 

__ At work

__ Grateful Med to NLM __ Modem to library, which?________

__ CD-ROM on site __ Other, how?

__ Physicians On Line

__ In my clinic

__ Grateful Med to NLM __ Modem to library, which?_________

__ CD-ROM on site __ Other, how?

__ Physicians On Line

__ In thehospital library, which hospital? ________

__ Grateful Med to NLM __ I search

__ CD-ROM on site __ Someone else searches for me

__ At home

__ Grateful Med to NLM __ Modem to library, which? _________

__ CD-ROM on site __ Other, how?

__ Physicians On LIne

h. To what extent do you personally use a computer for each of the following professional tasks? Please circle your answer.

1. Never perform this task

| 2. Perform this task but never use a computer

| | 3. Sometimes use a computer

l | | 4. Often use a computer

l | | | 5. Always use a computer

v v v v v

 

Documenting patient information (e.g., history & physicals, progress notes)

1

2

3

4

5

Accessing clinical data (e.g., laboratory data, EKGs, radiology reports)

1

2

3

4

5

Communicating with colleagues

1

2

3

4

5

Obtaining advice on a specific patient's diagnosis or therapy

1

2

3

4

5

Scheduling patient appointments

1

2

3

4

5

Writing (e.g., grants, research papers, teaching material)

1

2

3

4

5

Prepping presentation slides or overheads

1

2

3

4

5

Performing statistical analysis on clinical or research data

1

2

3

4

5

Searching the medical literature (e.g., MEDLINE)

1

2

3

4

5

Teaching students and residents

1

2

3

4

5

Financial tools: accounting and analysis

1

2

3

4

5

Internet search and research on topic

1

2

3

4

5

E-mail

1

2

3

4

5

Generating reports from a database

1

2

3

4

5

Patient education

1

2

3

4

5

i. Does your current hardware access meet your work needs? _Yes _No If no, why not?

 

j. Does your current software meet your work needs? _Yes _No If no, why not?

 

k. Rate the quality of computer/informatics training provided to residents in your program?

__Excellent __Very good __Good __Fair __Poor __None

la. (Faculty only) Rate the quality of computer/informatics training provided to faculty in your program?

__Excellent __Very good __Good __Fair __Poor __None

lb. Rate the quality of computer/informatics training provided to staff in your program?

__Excellent __Very good __Good __Fair __Poor __None

m. For each skill below, we want you to enter ONE code number which reflects both (a) whether or not you can perform the skill, and (b) your attitude about learning the skill. Example: Enter "4" if you can’t do the skill right now, but are excited about learning to do it.

CODE

Can you do this skill?

How do you feel about learning this skill?

1

NO

-- I really don’t want to learn this skill

2

NO

- I’d just as soon not learn this skill, but will if I need to for the job

3

NO

= Neutral about learning this skill

4

NO

++ I’m eager to learn this skill

5

YES

- No, I know more than I want to already

6

YES

+ Yes,I’d like to learn more about it

7

YES

++ Yes, I’m feeling a real need to learn a lot more about it.

 

Basic Electronic Mail (Email) Skills

 ___Log in to the system

 ___Send messages

 ___Read messages

 ___Reply to messages

 ___Forward messages

 ___Delete messages

 ___Print messages

 ___Use a lookup or address book feature

 ___Save messages into appropriate folders

 ___Create folders or mail boxes

 ___Change password

 ___Attach files for shipment

 ___Read or save attachments

 ___Use online help

 ___Log out or shut down

Advanced Email Skills:

 ___Create personal mail groups

 ___Create/use a signature

 ___Use/customize button bars

 ___Create/use rules

 ___Handle trash (undelete messages, empty trash)

Basic Word Processing Skills

 ___Create a new document

 ___Open an existing document

 ___Save a document

 ___Save a document to a floppy disk

 ___Print a document

 ___Spell check a document

 ___Simple formatting (bold, underline, center,

margins, fonts)

 ___Cut, copy, or paste text

 ___Use online help

Advanced Word Processing Skills

 ___Use page numbers

 ___Use headers/footers

 ___Use the thesaurus

 ___Create a table

 ___Use hanging indent and user-defined tabs

 ___Save a file in a different format (ASCII, other

format)

Operating System Skills

 ___Format or initialize floppies

 ___Copy/move files to other locations

 ___Create directories/folders

 ___Delete files

 ___Switch among open applications

 ___Cut, copy, or paste text

 ___Log in to a network

 ___Log out of a network

 ___Change passwords

 ___Access files on a shared network

 ___Use the public folders to share network files

 ___Remove/delete folders/directories

 ___Back up files

 ___Find files

 ___Undelete erased files

 ___Customize the desktop

Calendar/Scheduling

 ___Read calendar information

 ___Add/delete items in personal calendar

 ___Print calendars

 ___Accept/decline appointment requests

 ___Schedule appointments

 ___Schedule resources (rooms, department car)

 ___View other calendars (with permission)

Medline Searches

 ___Log into the Medline computer

 ___Select a bibliographic database

 ___Select the type of search (keyword, author, etc.)

 ___Perform a search

 ___Review search results on screen

 ___Print search results

 ___Download results onto to a disk

 ___Disconnect from the system

Clinical Computing Skills

 ___Use a clinical business billing system

 ___Use electronic medical records

 ___Access patient information in a clinical information

system

 ___Use a decision-support program (eg, QMR)

 ___Use a CD-ROM (such as Stat-Ref or SAM) to

access information

 ___Use a drug interaction program (eg, AskRx)

 ___Use Problem Knowledge Couplers

 ___Use Clinical Reference Systems (CRSWin handouts on disk)

 ___Use Instant Medical History

 ___Use PATIENTED ® (patient education templates)

Analysis Skills

 ___Use a spreadsheet (like Excel) for financial analysis

 ___Use a spreadsheet for statistical analysis

 ___Generate reports from a database (AMOS, Access, etc.)

Programming Skills

 ___Write or record a Macro

 ___Write a simple program, in _____________language(s)

 ___Write a complex program in ____________language(s)

 ___Build a Web Page

Other Skills

 ___Use presentation software (eg, PowerPoint) for

transparencies, slides, etc.

 ___Use a web browser (Netscape or MIE) to

access the World Wide Web (WWW)

 ___Use a browser to search for information on WWW

 ___Use a WWW search engine (Yahoo, Altavista, Excite, etc.)

 ___Access Usenet discussion groups (NEWS://)

 ___Use an Internet Gopher

 ___Telnet into a remote computer

 ___Subscribe to and unsubscribe from a Listserv

(email discussion group)

 ___Use File Transfer Protocol (FTP) to download files

 ___Use a personal data base (eg, article file,

document procedures)

 ___Participate in distance education by phone, TV, etc

 

 

k. What computer training would you most like to receive?___________________________________________ ______________________________________________________________________________________________________________________________________________________ ____________________________________________________________________________________________________

 

n. What software program(s) do you use for:

email?____________________________________

word processing?___________________________

data base?_________________________________

communications (modem)?____________________

spreadsheet?_______________________________

statistics?__________________________________

presentation graphics?________________________

medical information?_________________________

III. Computer Knowledge

Below are a set of paired terms that relate to computers in medicine. Please score your knowledge of the distinction between

the terms in each pair, using the following scale:

 

1

I don't understand the distinction at all.

 

 

|

2

I have a general appreciation of the distinction but I couldn't define it.

 

|

|

3

I can define the distinction precisely

 

|

|

|

 

V

V

V

Hardware Û Software

1

2

3

Images Û Graphics

1

2

3

Forward chaining Û Backward chaining  

1

2

3

Free textÛ Coded data  

1

2

3

Field Û Record  

1

2

3

Relational database Û Flat-file database  

1

2

3

Data in memory Û Data on disk  

1

2

3

Sensitivity Û Positive predictive value  

1

2

3

ICD9-CM Û SNOMED  

1

2

3

Entities Û Relationships  

1

2

3

Floppy diskÛ Hard disk  

1

2

3

Full-text database Û Bibliographic database  

1

2

3

Interpreter Û Compiler  

1

2

3

Mainframe computer Û Personal computer  

1

2

3

Electronic mail Û Electronic bulletin board  

1

2

3

Client Û Server  

1

2

3

Digital Û Analog  

1

2

3

Database Û Knowledge base  

1

2

3

 

Don’t Understand distinction

General understanding, can’t define

Could define distinction precisely

RAM Û ROM

1

2

3

Data Û Information

1

2

3

Privacy Û Confidentiality

1

2

3

Identification Û Authentication

1

2

3

Algorithm Û Flowchart

1

2

3

Problem Oriented Record Û SOAP Charting

1

2

3

Internet Û World Wide Web

1

2

3

Java Û HTML

1

2

3

Backup Û Archive

1

2

3

Rule Based System Û Neural Network

1

2

3

In Statistics: Type 1 Error Û Type 2 Error

1

2

3

Standard Deviation Û Standard Error

1

2

3

Evidence Based Medicine(EBM) Û Your unsubtantiated clinical knowledge (YUCK)

1

2

3

Disease Oriented Evidence(DOE) Û Patient Oriented Evidence that Matters (POEM)

1

2

3

Recall based systems Û "Just-in-time" systems

1

2

3

Patient instructions Û Patient education

1

2

3

Computer Literacy Û Punishment

1

2

3

IV. Applications of Computers in Medicine

A. Priorities for future development. Listed below are 18 potential functions of computers in medicine. First, circle six functions that you consider to be of highest priority for future development. Then, circle six functions you consider to be of lowest priority for future development.

Priority for future development

 

Highest

(Choose 6)

Lowest

(Choose 6)

Creating electronic medical record systems to replace the paper record

Highest

Lowest

Taking a medical history from a patient

Highest

Lowest

Entering physician orders such as laboratory tests or prescriptions

Highest

Lowest

Controlling of machine tools that assist in surgical procedures

Highest

Lowest

Performing automated interpretations of diagnostic tests (e.g., X-rays, EKGs, and pulmonary function tests)

Highest

Lowest

Assisting in the development of treatment plans for patients with complex problems

Highest

Lowest

Computer assisted patient education

Highest

Lowest

Providing reminders to patients and clinicians of overdue visits, tests, or preventive care

Highest

Lowest

Collecting directly from patients information that is useful for screening or triage

Highest

Lowest

Augmenting medical care in geographic areas where trained personnel are not readily available

Highest

Lowest

Monitoring and adjusting life support systems in intensive-care units

Highest

Lowest

Offering advice in the diagnosis of the patient with an unknown illness

Highest

Lowest

Substituting for cadavers in the teaching of anatomy

Highest

Lowest

Simulating patient encounters to teach clinical skills

Highest

Lowest

Administering a medical licensure examination using simulations

Highest

Lowest

Identifying patients eligible for clinical trials

Highest

Lowest

Assisting in collecting and reporting clinical trials data

Highest

Lowest

Auditing the quality of care provided by hospitals and physicians

Highest

Lowest

Reviewing the utilization of medical resources

Highest

Lowest

B. Capabilities of future computer systems. If you were considering the use of a computer-based system in medical care, how necessary would the following capabilities be? Circle your response using the scale below.

1. Vitally necessary: Any system I would use must have this capability. I would not use a system that lacked it.

2. Generally necessary: I would be much more likely to use a system having this capability, but I might use a system that lacked it.

3. Somewhat necessary: I would be somewhat more likely to use a system because it had this capability.

4. Not necessary: My decision to use a system would be unaffected by the presence of this capability.

5. Unable to respond: The meaning or implications of this capability are not clear to me.

 

Vitally Necessary

Generally Necessary

Somewhat necessary

Not necessary

Unable to respond

I can enter information in my own words and not need to know any special codes

1

2

3

4

5

I can learn to use the system in less than two hours.

1

2

3

4

5

I can access the system at any place in the clinical setting

1

2

3

4

5

The system always responds to my queries in less than five seconds

1

2

3

4

5

The system always displays X-rays and other images in less than 30 seconds

1

2

3

4

5

I can interact with the computer without using a keyboard

1

2

3

4

5

The system is always functioning. There is never any "down time."

1

2

3

4

5

The system can be implemented with no changes whatsoever to existing clinic routines

1

2

3

4

5

When a system provides medical advice on the care of specific patients, it always provides multiple alternative recommendations

1

2

3

4

5

When a system provides medical advice on the care of specific patients, it can quantify the level of certainty inherent in its recommendations

1

2

3

4

5

The system takes a patient's own preferences into account when giving advice to clinicians

1

2

3

4

5

The system can clearly explain the rationale for advice it gives on the care of patients

1

2

3

4

5

Users can browse the information in a system as well as asking it to provide advice about care of specific patients

1

2

3

4

5

The system has been demonstrated in research studies to make diagnoses at least as accurate as human consultants

1

2

3

4

5

The system has been demonstrated in research studies to provide treatment recommendations at least as accurate as human consultants

1

2

3

4

5

Help on how to use the program is available on-line

1

2

3

4

5

Level of confidentiality and security must be better than the paper record

1

2

3

4

5

 

1

2

3

4

5

 

C. Potential effects of computers. Given below are some effects that computers may have on medicine and health care. For each, indicate whether you believe the effect will be beneficial or detrimental using the scale below:

Effect of computers on:

Highly detrimental

Detrimental on the whole

Neither detrimental nor beneficial

Beneficial on the whole

Highly beneficial

Costs of health care

1

2

3

4

5

Clinician autonomy

1

2

3

4

5

Quality of health care

1

2

3

4

5

Interactions within the health care team

1

2

3

4

5

Role of the government in health care

1

2

3

4

5

Access to health care in remote or rural areas

1

2

3

4

5

Management of medical/ethical dilemmas

1

2

3

4

5

Enjoyment of the practice of medicine

1

2

3

4

5

Status of medicine as a profession

1

2

3

4

5

Continuing medical education

1

2

3

4

5

Physicians’ stress levels

1

2

3

4

5

The self-image of clinicians

1

2

3

4

5

Humaneness of the practice of medicine

1

2

3

4

5

The rapport between clinicians and patients

1

2

3

4

5

Personal and professional privacy

1

2

3

4

5

Clinicians' access to up-to-date-knowledge

1

2

3

4

5

Patients' satisfaction with the quality of care they receive

1

2

3

4

5

Generalists' ability to manage more complex problems

1

2

3

4

5

V. Open Response Area (Use back of page if necessary)

1. Regarding medical information in general, is there anything you might like to do or be able to do that you can’t do right now.

 

2. What barriers or problems do you see us encountering and needing to overcome. What can we do to better address these barriers.

3. What anxieties or worries do you in relation to changes in the way we deal with medical information?

 

4. What else do you think we should know?

 

Page 9 Acknowledgments: This survey was adapted and modified from the work of Craig Gjerde, Univ. of Wisconsin who provided the sections on computer access and computer skills. The sections on computer use, knowledge, priorities, capabilites and effects are derived from the Computers in Medical Care Survey, ã 1993 William Detmer M.D., MSc and Charles Friedman, Ph.D.. (http://www.med.virginia.edu/~wmd4n/medsurvey.html, or email: bdetmer@virginia.edu.) Synthesis and expansion of this work accomplished by Charles Zelnick M.D. Many thanks to the above authors.