Developing a Taxonomy of Online Medical Calculators for Assessing Automatability and Clinical Efficiency Improvements.

Medical calculators play an important role as a component of specific clinical decision support systems that synthesize measurable evidence and can introduce new medical guidelines and standards. Understanding the features of calculators is important for calculator adoption and clinical acceptance. This paper presents a novel classification system for medical calculators. Metadata on 766 medical calculators implemented online were collected, analyzed, and categorized by their input types, method of presenting results, and advisory nature of those results. Reference rate, publication year, and availability of references were collected. We found the majority of calculators are likely not automatable. 16% of medical calculators present advisory results to clinicians. 83% of medical calculators provide references. We show a 9-year lag from publication to implementation of calculators. New medical calculators should be developed with EHR integration and the advisory nature of results in mind so that calculators may become integral to clinical workflow.

Medical calculators: Prevalence, and barriers to use.

BACKGROUND AND OBJECTIVES: Medical calculators synthesize measurable evidence and help introduce new medical guidelines and standards. Some medical calculators can fulfill the role of CDS for Meaningful Use purposes. However, there are barriers for clinicians to use medical calculators in practice. Objectives of this study were to determine whether lack of EHR integration would be a barrier to use of medical calculators, and understand factors that may limit use and perceived usefulness of calculators METHODS: A survey about medical calculators as they relate to clinical efficiency, perceived usefulness, and barriers to effective use was conducted at a medium-sized academic medical center. 819 physicians were invited to participate in an online survey with a 13% response rate. Results were statistically analyzed to highlight factors related to use or non-use of medical calculators. RESULTS: We found a negative correlation between use of medical calculators and years of experience (p < 0.001), with decreasing calculator use as experience goes up. Barriers to using medical calculators by non-users and users of medical calculators show that necessity and integration are significantly different with p < 0.001 and p = 0.037, respectively. 46.7% of non-users reported necessity as a barrier compared to 7.7% of users. Integration was reported as a barrier for 43.6% of users, but only 13.3% of non-users. 61% of users indicated that calculators made them more efficient, and 70% reported that unavailability of normally used calculators make them less efficient. 60% of users indicated that they are somewhat or very likely to use newly published medical calculators. CONCLUSION: The results highlight that medical calculators are important for care delivery by both users and non-users. For non-users, they are seen as having a potentially positive impact on patient care, but unnecessary as part of clinical practice. For medical calculator users, calculators are an important part of regular workflow for efficiency improvement. Clinicians with fewer years of experience show an eagerness to consume newly published calculators, making these kinds of CDS a potentially useful way to disseminate new medical evidence. The survey results suggest that when medical calculators can be automated and integrated into the EHR as part of everyday workflow then efficiency and adoption may increase.