Describing the use of an internet-based computerized clinic order entry (CCOE) tool in rural medical practice

BACKGROUND: Many believe that internet-based technologies offer a solution to the unique (and often formidable) challenges of rural medical practice. We introduced a novel internet-based prescription writer and decision-support tool to rural medical clinics and quantified its impact on clinical practice, patient safety, provider productivity, and office efficiency. PURPOSE: The objectives of this study were to characterize current use of a computerized clinic order entry (CCOE) tool among healthcare providers and to describe possible implications of current use on selection of technology in outpatient settings. DESIGN: Observational study performed as part of a cluster-randomized trial in sixteen rural communities in Utah, Idaho, and Wyoming. Data were collected electronically from computers, laptops and personal digital assistants (PDAs). RESULTS: Providers logged a total of 176,098 prescriptions using the CCOE, the majority of which (98%) were from family practitioners. CCOE use among healthcare providers was significantly related to “medium” practice size (p<0.05, Kruskal-Wallis test), previously owning a PDA (p< 0.05, Mann-Whitney U test), and type of practitioner (p< 0.05, Mann-Whitney U test). Slightly more than half (55%) of the CCOE use took place on devices other than the wireless PDA we supplied for the providers. CONCLUSIONS: Family practitioners were much more likely to adopt CCOE into regular use than were pediatricians, and medical clinics with 3–4 providers were more likely to adopt the CCOE than were practices with 2 or 5–6 providers. Providers who had used a PDA previous to CCOE introduction logged 58% more prescriptions than no previous PDA users. Data confirms information gathered in field observations: providers have strong preferences for the hardware associated with CCOE use. Rather than forcing providers into using specific hardware, adapting CCOE software to hardware preferences (and not vice versa) will more likely result in successful adoption of internet-based technologies in rural medical practice.