Integrating personal computers into family practice: a comparison of practicing physicians and residents*t

Transcription

1 Integrating personal computers into family practice: a comparison of practicing physicians and residents*t By Martha C. Cook, M.L.S., AHIPt Technical Services/Systems Librarian Health Sciences Library Julia A. Hartman, M.A. Research Associate Department of Behavioral and Community Medicine Lisa Rains Russell, M.L.S., AHIP Chief Medical Librarian Health Sciences Library University of Alabama School of Medicine Tuscaloosa Program Box Tuscaloosa, Alabama A survey was used to assess levels of experience with personal computers and interest in learning personal computer applications among Alabama family practice physicians and residents in The study compared responses of 272 physicians and 77 residents as well as responses of physicians and residents in a sample of respondents thirtyeight years old or younger, including 77 physicians and 73 residents. Almost 25% of physicians reported never having used a computer, compared to 7.9% of residents. Respondents had learned computer skills through various combinations of methods, with over half of each group claiming to be self-taught through reading and hands-on experience. More than 86% of both groups expressed interest in learning more; interest increased in the population thirty-eight years or younger. Respondents, especially physicians, reported using professional applications less often than personal applications. Overall, there was a high level of interest in learning various practice-related applications; however, a significantly larger proportion of residents reported interest in each type of application than did physicians. INTRODUCTION The impetus for this study was the perceived lack of interest in computer use, poor attendance at training sessions, and low Grateful Med usage among practicing physicians in Alabama. A survey was conducted * This article is based in part on a paper presented at the 46th Annual Meeting of the Southern Chapter/ Medical Library Association, Memphis, Tennessee, October 13, t This research was supported by a grant from the College of Community Health Sciences Research Committee, University of Alabama. t Please send all correspondence to Martha C. Cook, Health Sciences Library, University of Alabama, Box , Tuscaloosa, AL Phone: (205) Fax: (205) mcook@cchs.ua.edu. in 1994 to assess the use of personal computers among a group of practicing physicians and a group of residents. Both groups were in the family practice area. BACKGROUND The information needs of physicians have been categorized as related to clinical practice, continuing medical education, or research [1]. Although computerized retrieval of information was already an option in the early 1990s, studies showed that physicians rarely used computers to answer case-specific clinical questions [2-4]. According to Fox, family physicians, whose information needs should be greater than those of specialists because of the depth and breadth of their prac- 316

2 Integrating personal computers tices, were not utilizing computer technology to meet these needs [5]. McCarthy described computer use among physicians as "established and growing," but noted that measures may indicate potential rather than actual use and that nonprofessional computer activities may represent a substantial proportion of use among physicians who own personal computers [6]. The failure to integrate computer applications into undergraduate, graduate, and postgraduate curricula, as well as into clinical settings, has also been studied [7]. Review of the literature related to computer technology in undergraduate medical curricula reveals varying degrees of interest and action in incorporating such training. By 1986 only a few medical schools had followed the recommendation of the 1984 Panel on the General Professional Education of the Physician that information science and computer technology be integrated into the professional education of physicians [8]. In 1989 Barnett reported that medical educators were falling short in teaching their students how to utilize personal computers in the practice of medicine [9]. As recognition of the value of information technology in medical education became more widespread, some medical schools began to incorporate a variety of applications into their curricula: access to the knowledge base, computer-based simulations, computer-assisted instruction, medical informatics applications, patient information systems, computerized medical records, and electronic mail and bulletin boards [10]. Haynes et al. supported the theory that computer applications that are integrated into clinical practice are more effective than computer-aided instruction presented in a laboratory setting. They stated that "exposing students to computer applications in the settings in which they can improve clinical effectiveness and efficiency... will be likely to give students all the impetus they require to become knowledgeable about these new tools" [11]. Whatever the approach, the Association of American Medical Colleges noted that medical students need a strong foundation in computer technology to meet their needs in information management, patient care decision-making, and development as lifelong learners [12]. Residency training curricula also often failed to address computer education. More than ten years ago, Manning noted that computers would "undoubtedly make practice-based continuing medical education more efficient" [13]. At that time many computer applications were already available for research, diagnosis, communication, clinical management, and medical education, but physicians lacked the computer knowledge to utilize them effectively. Robie noted that a computer curriculum component in residency training was uncommon and suggested that advances in computer hardware and software signaled that it was time to extend computer teaching into housestaff education [14]. A lack of formal computer education in medical school and residency programs despite adequate access for both residents and faculty was noted by Debehnke and Valley [15]. In 1995 Rowe et al. reported that most residents they surveyed felt that computer instruction "should be a mandatory component of family medicine training programs" and that assistance in the form of time and funding should be provided to aid in the process. The residents expressed interest in learning word processing, database searching, office billing, and office management software, although many were already using a variety of computer applications (including word processing, games, educational applications, spreadsheets, graphics, and database searching) in spite of the lack of formal instruction [16]. METHODS The present study was developed to assess the levels of experience with personal computers (PCs) and interest in learning PC applications among family practice physicians and residents in Alabama. In November 1994, a 48-item survey (Appendix A) was mailed to all 627 members of the Alabama Academy of Family Physicians; a stamped return envelope was provided. Items on the survey addressed personal and practice demographics and computer experience, access, and attitudes. A total of 272 physicians returned the survey for a response rate of 44.7%. A similar 37-item survey (Appendix B) was distributed by residency program staff to the 144 residents in the seven family practice residency programs in Alabama. Of these, 77 residents returned the survey for a response rate of 53.8%. RESULTS In the discussion of the results of this study, the term "physicians" is used to refer to practicing physicians as they are compared to residents. The term "residents" refers to respondents from one of the seven family practice residencies in Alabama. Of the physicians responding, 87.3% (n = 233) were male and 12.7% (n = 34) were female; these figures were 72.7% (n = 56) and 27.3% (n = 21), respectively, for the residents who responded. With a mean age of 45.9 years (SD = 10.8), physicians were significantly older than the residents (mean = 30.1 years, SD = 4.9; t = 18.28, df = , P < 0.001). This difference in mean age prompted the data to be analyzed in two ways. In addition to comparing the responses of all residents to those of all the physicians, responses of residents and physicians were also compared in a sample comprised of only those respondents 38 years of age or younger. The age of 38 was selected as a cutoff because the resulting groups of residents and physicians, referred to as the "younger" group, were approximately the same 317

3 Cook et al. Table 1 Locations of personal computer use Overall Younger Physicians Residents Physicians Residents (n = 265) (n = 76) (n = 76) (n = 72) % (n) % (n) % (n) % (n) Never used PC 23.8 (63) 7.9 (6)** 17.1 (13) 8.3 (6) Used at home 48.5 (132) 62.3 (48)* 54.5 (42) 60.3 (44) Used at college 10.3 (28) 46.8 (36)** 19.5 (15) 47.9 (35)* Used at medical school 9.6 (26) 53.2 (41)** 13.0 (10) 54.8 (40)** Used in residency 12.9 (35) 46.8 (36)** 26.0 (20) 49.3 (36)* P < P < size (n = 73 and n = 77, respectively). Although the mean age of the physicians in the younger group (mean = 34.9 years, SD = 2.5) was significantly higher than that of the younger residents (mean = 29.1 years, SD = 2.7; t = 13.56, df = 148, P < 0.001), the variances were not significantly different. As shown in Table 1, almost one-fourth of the physicians reported never having used a PC, compared to a significantly lower percentage (7.9%) of residents. In the younger group, these figures were 17.1% and 8.3%, respectively, and the difference was not significant. Significantly larger proportions of residents reported having used a PC in college, medical school, and residency than did the physicians overall or the younger physicians. Almost half of all residents had used a PC at college; exactly the same percentage had used one during residency; and slightly more than half had used a PC during medical school, as compared to only 10-13% of all physicians and 13-26% of younger physicians during any of the three. When compared to all physicians a significantly larger proportion (62.3% vs. 48.5%) of the residents had used a PC at home, but among the younger physicians, the difference was much smaller (54.5% of physicians, 60.3% of residents). Residents were significantly more likely to have acquired some ability to use a PC than were physicians overall (X2 = 6.82, df = 1, P < 0.01), but the difference in the younger group was not significant. When asked to assess their PC skills, 17.1% (n = 13) of the residents and 32.6% (n = 85) of the physicians said they could do no more than turn on a PC; these figures were 17.8% (n = 13) and 26.3% (n = 20) among the younger residents and physicians, respectively. More than half (61.8%, n = 47 overall; 61.6%, n = 45 younger) of the residents indicated that they could run programs from menus or by using a mouse, and an additional 21% (n = 16 overall, n = 15 younger) indicated that they could accomplish more complex tasks. Among the physicians, 37.2% (n = 97) overall and 42.1% (n = 32) of the younger said they could handle the basic skills, while 30.3% (n = 79) overall and 31.6% (n = 24) of the younger could also complete the more difficult tasks. Overall almost half (48.9%, n = 129) of the physicians reported using a PC at least once a week; overall the remainder was split relatively equally between those never using a PC (24.2%, n = 64) and those whose use was less frequent than weekly (26.9%, n = 71). Slightly fewer of the younger physicians (46.8%, n = 36) reported weekly or more frequent use; 36.4% (n = 28) reported less frequent use, and only 16.9% (n = 13) reported never using a PC. Both of these distributions were significantly different from the frequency of use among the residents (X2 = 48.7, df = 2, P < overall; X2 = 15.67, df = 2, P < younger). The overwhelming majority (70.1%, n = 54 overall; 68.5%, n = 50 younger) of residents reported less than weekly use, and relatively few (n = 5) for both groupings reported never using a PC; approximately a quarter (24.7%, n = 18 both groups) reported using a PC at least once a week. The residents and physicians responding to the survey had learned computer skills through various combinations of methods. Over half of both groups (54.5%, n = 42 of residents and 56.3%, n = 153 of all physicians) reported teaching themselves through reading and hands-on experience; 63.6% (n = 49) of the younger physicians and 54.8% (n = 40) of the younger residents had learned computer skills on their own. Informal instruction from friends or colleagues was a source of learning for 45% of the residents (n = 35 overall, n = 33 younger), and for 33.5% (n = 91) of all physicians and 36.4% (n = 28) of the younger ones. Overall, a significantly greater proportion of residents had taken computer classes in high school or college than had physicians (20.8%, n = 16 and 5.1%, n = 14, respectively; X2 = 18.76, df = 1, P < 0.001), but there was no significant difference when the younger groups were compared (14.3%, n = 11 physicians; 20.5%, n = 15 residents). An interest in learning more about PCs was expressed by 87.0% (n = 228) of the physicians and 88.2% (n = 67) of the residents. These figures increased to 89.3% (n = 67) and 90.3% (n = 65), respectively, when only the younger respondents were compared. Well over three-fourths (84.1%, n = 286) of all respondents expressed an interest in workshops or courses to help them integrate PCs into their practices; this included 89.8% (n = 132) of the younger group. The proportion of all residents who indicated no interest (5.3%, n = 4) was significantly smaller than that of all physicians (18.9%, n = 50, X2 = 8.01, df = 1, P < 0.005), but the difference was not significant among in the younger group (5.6%, n = 4 residents; 14.5%, n = 11 physicians). Both similarities and significant differences were found between residents and physicians when personal use of various applications was compared. As 318

4 Integrating personal computers Table 2 Computer application use Overall Younger Physicians (n = 272) Residents (n = 77) Physicians (n = 77) Residents (n = 73) % (n) % (n) % (n) % (n) Personal use Any personal application 64.7 (176) 79.2 (61)* 68.8 (53) 79.5 (58) Finances 34.6 (94) 16.9 (13)** 37.7 (29) 15.1 (11)** E-communication 25.7 (70) 7.8 (6)** 24.7 (19) 6.8 (5)** Investments 15.4 (42) 2.6 (2)** 16.9 (13) 2.7 (2)** Work processing 51.1 (139) 61.0 (47) 53.2 (41) 61.6 (45) Scheduling 15.1 (41) 16.9 (13) 16.9 (13) 17.8 (13) Information management 27.6 (75) 20.8 (16) 31.2 (24) 20.5 (15) Personal education 36.8 (100) 37.7 (29) 35.1 (27) 37.0 (27) Games 43.0 (117) 46.8 (36) 48.1 (37) 47.9 (35) Professional use Any professional application 36.4 (99) 58.4 (45)** 39.0 (30) 58.9 (43)* Information mgmt./research 12.1 (33) 28.6 (22)** 10.4 (8) 30.1 (22)** Database access 16.5 (45) 28.6 (22)* 13.0 (10) 30.1 (22)* Expert programs 12.1 (33) 3.9 (3)* 13.0 (10) 4.1 (3)* Clinical practice mgmt (30) 11.7 (9) 11.7 (9) 11.0 (8) Patient education 10.7 (29) 10.4 (8) 11.7 (9) 11.0 (8) CME 15.8 (43) 7.8 (6) 11.7 (9) 6.8 (5) E-communication 14.3 (39) 6.5 (5) 15.6 (12) 5.5 (4)* P < P < shown in Table 2, 79.2% of residents and 64.7% of physicians reported using a PC for personal applications. Word processing applications were used most widely by both groups and over 40% of both groups used the PC for games. Use of PCs for personal education was reported by approximately 35% of both groups. Overall and in the younger groups, a significantly greater proportion of physicians than of residents used applications for personal finances, electronic communication, and personal investments. Respondents, especially physicians, reported using professional applications less often than personal applications; only 36.4% (n = 99) of al physicians (39.0%, n = 30 of younger) and 58.4% (n = 45) of residents (58.9%, n = 43 of younger) reported using any professional application. Less than 20% of physicians reported using any specific type of professional application. The 28.6% each of residents who reported use of applications for information management or research and for database applications was significantly larger than that of physicians, but no other specific application was reported by more than 12% of residents. Significantly larger proportions of physicians than of residents reported using expert diagnostic programs and electronic communication among younger physicians. Overall, there was a high level of interest in learning a variety of practice-related applications, ranging from a low of 70.7% (n = 222) respondents interested in learning information management applications to a high of 89.2% (n = 280) respondents interested in learning patient management applications. However, a significantly larger proportion of residents reported an interest in each type of application than did physicians, as represented in Table 3. Learning communications applications was the lowest interest level among the residents, with 75.3% expressing an interest. In contrast, the highest level of interest reported by the physicians was 76.8% in patient management applications. In the younger groups, the proportions expressing an interest were higher in every category, especially among the physicians. DISCUSSION Physicians' recognition of the value of technology in the delivery of quality health care is evidenced by their use of state-of-the-art equipment for diagnosis and treatment, but many fail to take advantage of the benefits of computer technology available to them for patient management, expert consultation, patient education, information management and research, and continuing medical education. Our study shows a high level of interest in developing computer knowledge among residents, who not only have had more exposure to computers, but who are also at a point in their medical training where they see so many needs and have so little time. Residency programs could provide the opportunity to help physicians learn how to use computer technology to cope with the demands of a medical practice. Computer literacy curricula such as that at Bowman Gray School of Medicine, Wake Forest University, are a good starting point. This program offers three levels 319

5 Cook et al. Table 3 Interest in learning personal computer applications Overall Younger Physicians (n = 272) Residents (n = 77) Physicians (n = 77) Residents (n = 73) % (n) % (n) % (n) % (n) Business 73.2 (199) 92.2 (71)** 76.6 (59) 94.5 (69)' Patient management 76.8 (209) 92.2 (71)** 87.0 (67) 94.5 (69) Patient education 57.0 (155) 90.9 (70)** 71.4 (55) 93.2 (68)" CME 75.7 (206) 90.9 (70)** 88.3 (68) 91.8 (67) Expert consultation 69.1 (188) 85.7 (66)** 79.2 (61) 89.0 (65) Bibliographic info./databases 65.8 (179) 87.0 (67)** 71.4 (55) 87.7 (64)' Communication 62.5 (170) 75.3 (58)* 68.8 (53) 76.7 (56) Information management 59.9 (163) 76.6 (59)* 68.8 (53) 79.5 (58) P < P < of instruction, based on the residents' experience when entering the program. The first level introduces basic computer concepts, hardware, and operating systems; the second level includes instruction in word processing, bibliographic retrieval, and use of drug interaction software; and the third level focuses on differential diagnosis programs. Residents may enter the curriculum at the level appropriate for their own degree of computer sophistication [17]. In addition to these computer applications, a computer literacy curriculum in a residency program could also include electronic mail, computerized medical records, computerized history-taking, patient education, practice management, expert systems, and continuing medical education. Integrating computer instruction into the medical training program would increase the residents' comfort level with computers and provide a practical setting in which to learn applications through hands-on experience. CONCLUSIONS Computers certainly will not replace physicians in the foreseeable future, but they have great potential value in terms of increased efficiency, productivity, and the informed practice of medicine. They can serve as an invaluable link to libraries, colleagues, consultants, bibliographic databases, patient education information, and Internet resources-especially for rural physicians and others practicing in isolated locations. As John D. Rootenberg of Tulane University School of Medicine writes, "Like the stethoscope, the scalpel, and the textbook, the computer is a tool that becomes effective in the hands of skilled users. Rather than fault ourselves for the inability to overcome our limitations, we should take advantage of the help computers can provide" [18]. A component of the residency curriculum focusing on the use of technology as it relates to patient and practice management, to diagnosis and research, and to the development of lifelong learning skills is vital to a well-rounded program, and our study indicates that such a component would be wellreceived by residents. Barry Weiss, M.D., editor of Family Medicine, sums it up well: If we are to effectively prepare our trainees for the medicine they will practice in the future, we must stop focusing our teaching efforts on today's (or tomorrow's) medical system. Instead, we must consider the span of our students' and residents' future careers and anticipate the tools they will need to work in those careers. We should introduce our trainees to cutting edge technologies, even if those technologies are not yet fully developed. Then Weiss takes it one step further by adding that "family medicine academicians are not taking advantage of the leadership role they could play in the computer revolution that will ultimately change primary care medicine" [19]. With each new class of residents changes in their attitudes toward computers and increases in their levels of computer knowledge have been noticed. There is more interest, more expertise, and more demand for computer literacy training and for computer facilities. A repeat of this study would likely produce somewhat different results-higher levels of competency among residents and greater expectations for a computer education component within the residency program. Computer literacy among the practicing physicians will, of course, increase more slowly, but will definitely increase as the new generation of physicians replaces the old. REFERENCES 1. ELY JW, BURCH RJ VINSON DC. The information needs of family physicians: case-specific clinical questions. J Fam Pract 1992 Sept;35(3): IBID., CONNELLY DP, RICH EC, CURLEY SP, KELLY JT Knowledge 320

6 resource preferences of family physicians. J Fam Pract 1990 Mar;30(3): VINCENT C, SCHNEEWEIss R. How family physicians choose an office computer system. J Am Board Fam Pract 1992 May-June;5(3): Fox GN. Computer literature searching-will docs byte? Fam Pract Res J 1991 Mar;11(1): MCCARTHY JT. Estimating the number of physicians using computers [Letter]. MD Comput 1993 Feb;10(2): MULLER S, Chairman. Physicians for the twenty-first century: report of the Project Panel on the General Professional Education of the Physician and College Preparation for Medicine. J Med Educ 1984 Nov;59(11),Part 2: BRESNITZ EA, STETTIN GD, GABRIELSON IW A survey of computer literacy among medical students. J Med Educ 1986 May;61(5): BARNETT 0. Information technology and undergraduate medical education. Acad Med 1989 Apr;64(4): JENNETT PA, EDWORTHY SM, ROSENAL TW, MAES WR ET AL. Preparing doctors for tomorrow: information management as a theme in undergraduate medical education. Med Educ 1991 Mar;25(2): HAYNES RB, RAMSDEN M, McKIBBON KA, WALKER CJ ET AL. A review of medical education and medical informatics. Acad Med 1989 Apr;64(4): APPENDIX A Use of Personal Computers in Family Practice I. DEMOGRAPHIC INFORMATION Sex Female Male Year of birth: Year graduated from medical school: Year graduated from residency: Board Certification Yes No Population of Practice Location Less than 5,000 30,001-50,000 5,000-15,000 50, ,000 15,001-30,000 More than 100,000 II. USE OF PERSONAL COMPUTERS What is your experience with personal computers? (Check all that apply.) I have never used a personal computer. I use or have used a personal computer in someone's (including your own) home. I use or have used a personal computer in my practice. I use or have used a personal computer elsewhere. College Residency Medical School (Where? Which one of the following best describes your ability to use a personal computer? _ I do not know how to do anything. I can turn it on. I can run programs from a menu or using a mouse. I can run programs, manage files and directories, and customize program settings. I can troubleshoot problems and make my system operate to my specifications. Integrating personal computers 12. AssoCIATION OF AMERICAN MEDICAL COLLEGES. Educating medical students: assessing change in medical education-the road to implementation. Washington, D.C.: The Association, MANNING PR. The computer and the future of continuing medical education. In: Medical Informatics [Special issue]. West J Med 1986 Dec;145(6): ROBIE PW, KENDRICK SB, RICHARDS BR. Developing a computer literacy curriculum for residents. Acad Med 1992 Oct;67(10): DEBEHNKE DJ, VALLEY VT. Assessment of the current computer literacy and future needs of emergency medicine residents and faculty. Am J Emerg Med 1993 Jul;11(4): ROWE BH, RYAN DT, THERRIEN S, MULLOY JV. First-year family medicine residents' use of computers: knowledge, skills and attitudes. Can Med Assoc J 1995 Aug;153(3): ROBIE, op. cit., ROOTENBERG JD. Physicians and computers: future allies? JAMA 1990 Apr 4;263(13): WEIss BD. Computer applications in family medicine: too little, too late? Fam Med 1994 July-Aug;26(7): Received September 1997; accepted February 1998 Practice Type Solo Small group (2 to 4) Medium group (5 to 10) Large single specialty group (more than 10) Large multi-specialty group (more than 10) than physicians, how many people are employed by your practice? More than 10 Not applicable Size of Local Hospital Less than 50 beds beds beds beds More than 500 beds 321

7 Cook et al. Approximately how often do you use a personal computer? Never Rarely, less than once a month Occasionally, at least once a month Regularly, at least once a week Often, daily or almost every day How do you feel about your own ability to use personal computers? I do not feel the need to learn more about using personal computers. I would like to learn more about using personal computers. How did you learn to use a personal computer? (Check all that apply.) Do not know how to use a personal computer Primarily self-taught through reading and hands-on experience Informal instruction from friends, colleagues, family, etc. Classes in high school or college Continuing Education course(s) offered through university, junior college, etc. workshops or courses (How? For which of the following personal applications do you use a computer? (Check all that apply.) Do not use Information management (personal filing systems) Personal finances Investment tracking and trading Personal word processing Education Personal/ private scheduling Games Electronic communications (What? Indicate who in your practice uses a personal computerfor each of the following applications. USED BY USED BY YOU OTHERS APPLICATION Business practice management (accounting, billing, scheduling, etc.) Clinical practice management (medical records, patient histories, etc.) Patient education Diagnostic programs CME Databases and bibliographic information Electronic bulletin boards and /or Information management/research (patient demographics, epidemiology, etc.) (What? III. ACCESS TO PERSONAL COMPUTERS How many personal computers are available for your use at your office? How many personal computers are located in your home? Do you have a modem available for your use at your office? yes no donf t know Do you have a modem for a personal computer at your home? yes no don't know Do you belong to a national online service (Prodigy, Compuserve, etc.)? yes no don't know IV. INTEREST IN PERSONAL COMPUTERS Would you be interested in workshops or courses that would help you integrate personal computers into your practice? yes maybe no If you are interested in computer workshops or courses, where (how) do you think they should be held? (Check all that apply.) Workshops at Alabama AFP meeting Week-end workshops on the campus of The University of Alabama Evening courses on the campus of The University of Alabama On-line workshops or correspondence courses using modem Distance-learning using satellite and modem Week-end or evening workshop at (Where? 322

8 APPLICATION Business Practice Management Accounting Filing insurance claims Patient accounts and billing Patient scheduling Physician scheduling Word processing Clinical Management Computerized medical records Computerized patient history Patient education Patient management CME Journals on disk or CD-ROM Medical education software "Expert" Programs "Expert Consultant in the Box" (e.g., diagnostic software) "Expert Consultant on the Wire" Integrating personal computers Indicate your level of interest in learning about each of the following applications of personal computers by checking the appropriate box. LEVEL OF INTEREST NOT SOMEWHAT VERY INTERESTED INTERESTED INTERESTED (e.g., on-line consultation) Communications software to access electronic bulletin boards and electronic mail (CompuServe, Internet, etc.) Information management/ research (patient demographics, epidemiology, etc.) Software to access databases and bibliographic information (e.g., Grateful Med) APPENDIX B Use of Personal Computers by Family Practice Residents I. DEMOGRAPHIC INFORMATION Sex Residency Program Female Carraway Male Medical Center East Program Year of birth: Selma/Dallas County Program Year graduated from medical school: Tuscaloosa Program Current Status University of Alabama at Birmingham PG1 University of Alabama-Huntsville PG2 University of South Alabama PG3 In what size community do you plan to establish your practice Less than 5,000 50, ,000 5,000-15,000 More than 100,000 15,001-30,000 Undecided 30,001-50,000 II. USE OF PERSONAL COMPUTERS What is your experience with personal computers? (Check all that apply.) I have never used a personal computer. I use or have used a personal computer in someone's (including your own) home. I use or have used a personal computer elsewhere. Where? College Residency Medical School (Where? -) 323

9 Cook et al. Which one of the following best describes your ability to use a personal computer? I do not know how to do anything. I can tum it on. I can run programs from a menu or using a mouse. I can run programs, manage files and directories, and customize program settings. I can troubleshoot problems and make my system operate to my specifications. Approximately how often do you use a personal computer? Never Rarely, less than once a month Occasionally, at least once a month Regularly, at least once a week Often, daily or almost every day How do you feel about your own ability to use personal computers? I do not feel the need to learn more about using personal computers. I would like to leam more about using personal computers. How did you learn to use a personal computer? (Check all that apply.) Do not know how to use a personal computer Primarily self-taught through reading and hands-on experience Informal instruction from friends, colleagues, family, etc. Classes in high school or college Continuing Education course(s) offered through university, junior college, etc. workshops or courses (How? For which of the following personal applications do you use a computer? (Check all that apply.) Do not use Information management (personal filing systems) Education Investment tracking and trading Personal finances Games Personal word processing Personal/private scheduling (What? Electronic communications For which of the following professional applications do you use a computer? (Check all that apply.) Clinical practice management "Expert" programs CME Information management/ research Databases/bibliographic information Patient education Electronic communications (What? III. ACCESS TO PERSONAL COMPUTERS How many personal computers are available for your use in your residency program? How many personal computers are located in your home? Do you have a modem available for your use in your residency program? yes no don't know Do you have a modem for a personal computer at your home? yes no don't know Do you belong to a national online service (Prodigy, Compuserve, etc.)? yes no _ don't know IV. INTEREST IN PERSONAL COMPUTERS Would you be interested in workshops or courses designed to help you integrate personal computers into your practice? yes maybe no If you are interested in computer workshops or courses, where (how) to you think they should be held? (Check all that apply.) Course in residency curriculum Workshops at Alabama AFP meeting Week-end workshop on the campus of The University of Alabama Evening courses on the campus of The University of Alabama On-line workshop or correspondence course using modem Distance-learning using satellite and modem Week-end or evening workshop at (Where? 324

10 Integrating personal computers Indicate your level of interest in learning about each of the following applications of personal computers by checking the appropriate box. LEVEL OF INTEREST APPLICATION NOT INTERESTED SOMEWHAT INTERESTED VERY INTERESTED Business Practice Management Accounting Filing insurance claims Patient accounts and billing Patient scheduling Physician scheduling Word processing Clinical Management Computerized medical records Computerized patient history Patient education Patient management CME Journals on disk or CD-ROM Medical education software "Expert" Programs "Expert Consultant in the Box" (e.g., diagnostic software) "Expert Consultant on the Wire" (e.g., on-line consultation) Communications software to access electronic bulletin boards and electronic mail (CompuServe, Internet, etc.) Information management/research (patient demographics, epidemiology, etc.) Software to access databases and bibliographic information (e.g., Grateful Med) 325