TITLE: UTILIZATION OF AN INTRANET-ENABLED PREOPERATIVE EVALUATION: BUILD IT AND COAX THEM TO COME

AUTHORS: Joseph F. Foss, MD
AFFILIATION: University of Chicago, Chicago, IL.

INTRODUCTION: In December 1996, our institution opened a new anesthesia perioperative medicine clinic (APMC) and initiated an electronic record for all preoperative evaluations (preops). Although the evaluations are available as printouts, one of the most requested features was electronic display of them via the Internet. A test system to view records with any Web browser was initiated in December 1998, and on March 1, 1999, 42 faculty and 21 residents were given instructions for viewing the preops on the Internet. All access to patient records is logged for pattern of use.
METHODS: Logs of access to the APMC records from March through August 20, 1999, were tabulated by number of visits per user.
RESULTS: Average new preops/month was 550. In March, 282 preops were viewed by 8 residents and 16 faculty; 5 residents and 5 faculty had >10 logins each. In April, 7 residents and 9 faculty viewed 179 preops and by June, 7 residents and 6 faculty viewed 132 preops. Only 5 users retrieved >10 patient records. In July 1999, 12 new residents were given passwords for the system. There were 354 logins in July and 388 in August (through the 20th), with the entire CA1 class using the system actively (>20 per resident). From the CA2-4 class there were 4-6 residents who logged in; among faculty, 6-7.
DISCUSSION: After introduction of electronically available preops because of multiple requests for this feature, utilization was low. When presented to a new class with no special instruc- tion or encouragement, the system was widely used. Contributing factors to this pattern might include a greater familiarity with Internet resources, more usefulness of preops to newer residents, and different expectations by the new residents. Most faculty have computers at home or in their offices, and none of the CA1 class has access to the system from home, suggesting that equipment availability is not a limiting factor. The low utilization by faculty and senior residents in the face of previously expressed interest suggests that additional research into the needs and expectations of these groups be initiated to get the maximum benefit from an online preoperative assessment system.