Duties and responsibilities
Managing information to deliver safer care
Originally published December 2013
Physicians need accurate and up-to-date information to provide effective and safe patient care, but too much information — commonly called information overload — can create distraction and inefficiencies, rather than improve knowledge.
The term "information overload" was popularized by Alvin Toffler in his 1970 book, Future Shock. It refers to the difficulty a person can have understanding an issue and making decisions in the presence of too much information.
Indeed, gathering much-needed information from multiple sources can create a dilemma. This quandary exists when there is too much information, just as when there is too little. Either situation can increase risk rather than reduce it. The key for doctors is to prevent information overload by leveraging strategies and solutions that help manage and control large amounts of information.
Today's physicians contend with multiple sources of information, a large number of users and contributors to the system of care (particularly when working in collaborative care models), as well as complex regional information systems. Doctors must also manage enormous amounts of new and updated clinical information. Trying to keep current on the latest scientific evidence, new medications, and medical devices and technologies is a huge challenge. When combined with increasing patient expectations and patient involvement in healthcare, the challenges may leave doctors feeling overwhelmed.
Strategies to manage information
While most doctors are skilled at multi-tasking and prioritizing urgent matters, it can be equally important to devote complete attention to one task at a time. Scheduling and setting a deadline for each task is helpful.
Effective delegation of administrative tasks can also help doctors to focus on clinical issues. Physicians do not have to be experts in all aspects of office management or business processes. Office staff may be better suited to identify and implement good practices for patient scheduling, billing, and clerical functions. The delegation of non-clinical tasks can help to enhance office management, as well as develop and deepen employee skills and abilities.
The Alberta Medical Association has developed guidelines and a podcast on effective delegation.1 While the delegation of clinical tasks may not directly assist with information overload, it may enable doctors to focus on essential activities. Physicians should be familiar with their medical regulatory authority (College) guidelines on the delegation of medical acts. This delegation does not absolve the doctor of responsibility for patient care. However, it widens the circle of responsibility for the safe execution of procedures.2
An increasing number of doctors are experiencing the advantages of electronic health records. Some of the benefits include easier access to patient information, quicker retrieval of test results, and instant alert notification systems — all of which can support clinical decision-making. On the other hand, electronic health records can result in more information being available to physicians. In addition to the relative sophistication of electronic records as compared to paper records, there have been reports that excessive electronic alerts or notifications can actually contribute to information overload.3
Physicians working with electronic health records are urged to develop a solid understanding of the system to maximize efficiency and effectiveness. It is important for doctors to remain sensitive and be responsive to system alerts and notifications, and to take time to process these notifications. Physicians should also follow or develop workflow processes that allow them to attend to alerts and electronic health record system messages.
While some physicians find the use of computer-based systems time consuming, these systems can assist doctors with care-related decisions, such as making a diagnosis. These systems, known as clinical decision support systems (DSS), can help physicians manage information overload by providing clinical advice based on patient data. Courts have found that physicians must be aware of significant developments in the areas in which they practise, even if it is not their primary area of specialization. There is general agreement that DSS can speed the transmission of medical knowledge as physicians attempt to cope with information overload.4 These systems can help with the management of information since they enable clinical information to be better organized and linked to relevant knowledge in a way that serves the needs of doctors and the choices they make about patient care.5
Arbitrarily dismissing the suggestions of decision support systems without reasonable clinical justification can also expose the physician to risk. If the decision support system suggests a possible diagnosis, for example, the physician will likely need to be prepared in the context of a legal action or College investigation to justify why and how the suggested diagnosis was eliminated as a possibility.
There are more than 25,000 journals in science, technology, and medicine. The number is increasing by 3.5% a year. These journals publish more than 1.5 million articles every year. PubMed now cites more than 20 million papers.6
Clinical pathways, which are also known as care maps or collaborative care pathways, can also support effective decision-making. These pathways outline the decisions to be made and the steps and care to be followed for a given patient or patient group with a particular condition. Physicians should be familiar with and respect the clinical pathways implemented in their organizations. These pathways or care maps may also help physicians support clinical effectiveness, reduce variations in patient care, manage clinical risk, and support continuity and coordination of care across healthcare disciplines and sectors. Doctors using clinical pathways should remember that these are best suited to standard clinical conditions rather than unusual or unpredictable ones, and should ensure that variance and outcomes are properly recorded, audited, and acted upon.7
New and emerging technologies
Information and communication technologies can assist doctors to be more efficient at handling the wealth of information before them. For example, physicians can leverage internet-based tools to seek out clinical experts and information, search a medical specialty, or link to a medical group or topic of interest.
To help avoid clogging up their email inboxes with journal titles that may never be read, physicians can set up "readers" that push desired information directly to them. By subscribing to preferred feeds, the information can be accessed in a selected location such as on a home or work computer, or a mobile device. These readers or aggregators can also store and categorize information to be read later. Filters may be used to identify the most valuable and relevant information. Filters can include medical journal summaries and evidence-based scientific resources.
The use of reliable medical apps can also assist physicians in managing clinical information. It is best to select apps that have been created or endorsed by a professional or recognized association or medical society, such as the mobile apps developed by the Canadian Cardiovascular Society.8 The Canadian Medical Association also provides apps and mobile versions of some of their most popular resources, including current evidence-based point-of-care tools, journal articles, and medical textbooks. The Canadian Medical Association Journal app has a "favourites" function, as well as index searching, for quick access to preferred articles and topics.
Planning to avoid information overload
The vast amount of new scientific information undoubtedly adds to physicians' concerns about remaining current. However, given human limits and 24-hour days, physicians must take a measured approach to remain current and up-to-date. Doctors are encouraged to identify and use information management strategies that work for them, and to share effective strategies with colleagues.
- Alberta Medical Association, "How to delegate without having to ask: "Why didn't they do that right?," Alberta Doctors' Digest (2013) Vol 38, no 3 p.14-15. Retrieved on August 15 2013 from: https://www.albertadoctors.org/Publications%20-%20ADD/pub_add_mayjun13_bkmks.pdf
- College of Physicians and Surgeons of British Columbia, "Delegation of a Medical Act," 2009. Retrieved on August 15 2013 from: https://www.cpsbc.ca/files/pdf/PSG-Delegation-of-a-Medical-Act.pdf
- Rice, Chelsea, "87% of physicians say quantity of EHR alerts ‘excessive'," 2013. Retrieved on May 3 2013 from: http://www.healthleadersmedia.com/print/TEC-289789/87
- Rebitzer, James, Rege, Mari, Shepard, Christopher, "Influence, information overload, and information technology in health care," The National Bureau of Economic Research Working Paper No. 14159 (2008). Retrieved on June 26 2013: from http://www.nber.org/papers/w14159.pdf
- Hayward, Robert, "Clinical decision support tools: Do they support clinicians?," Future Practice (2004) p.66-68.
- Fraser, Alan G., Dunstan, Frank D., "On the impossibility of being expert," British Medical Journal (2010) Vol. 341, p 6815. Retrieved on July 2 2013 from: http://www.bmj.com/content/341/bmj.c6815
- Open Clinical, "Clinical pathways." Retrieved on June 17 2013 from: www.openclinical.org/clinicalpathways.html
- Canadian Cardiovascular Society, CCS apps. For more information, see http://www.ccsguidelineprograms.ca/index.php?option=com_content&view=article&id=98&Itemid=68