Answering family physicians' clinical questions using electronic medical databases

OBJECTIVE We studied the ability of electronic medical databases to provide adequate answers to the clinical questions of family physicians. STUDY DESIGN Two family physicians attempted to answer 20 questions with each of the databases evaluated. The adequacy of the answers was determined by the 2 physician searchers, and an arbitration panel of 3 family physicians was used if there was disagreement. DATA SOURCE We identified 38 databases through nominations from national groups of family physicians, medical informaticians, and medical librarians; 14 of these databases met predetermined eligibility criteria. OUTCOME MEASURED The primary outcome was the proportion of questions adequately answered by each database and by combinations of databases. We also measured mean and median times to obtain adequate answers for individual databases. RESULTS The agreement between fan-lily physician searchers regarding the adequacy of answers was excellent (kappa =0.94). Five individual databases (STAT!Ref, MDConsult, DynaMed, MAXX, and MDChoice.com) answered at least half of the clinical questions. Some combinations of databases answered 75% or more. The average time to obtain an adequate answer ranged from 2.4 to 6.5 minutes. CONCLUSIONS Several current electronic medical databases could answer most of a group of 20 clinical questions derived from family physicians during office practice. However, point-of-care searching is not yet fast enough to address most clinical questions identified during routine clinical practice.