Medical Calculators: Prevalence, and Barriers to Use

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

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.

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.

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.