title: Impact of Implementing a Wiki to Develop Structured Electronic Order Sets on Physicians' Intention to Use Wiki-Based Order Sets.
abstract: BACKGROUND
  Wikis have the potential to promote best practices in health systems by sharing order sets with a broad community of stakeholders. However, little is known about the impact of using a wiki on clinicians' intention to use wiki-based order sets.
  
  
  OBJECTIVE
  The aims of this study were: (1) to describe the use of a wiki to create structured order sets for a single emergency department; (2) to evaluate whether the use of this wiki changed emergency physicians' future intention to use wiki-based order sets; and (3) to understand the impact of using the wiki on the behavioral determinants for using wiki-based order sets.
  
  
  METHODS
  This was a pre/post-intervention mixed-methods study conducted in one hospital in Lévis, Quebec. The intervention was comprised of receiving access to and being motivated by the department head to use a wiki for 6 months to create electronic order sets designed to be used in a computer physician order entry system. Before and after our intervention, we asked participants to complete a previously validated questionnaire based on the Theory of Planned Behavior. Our primary outcome was the intention to use wiki-based order sets in clinical practice. We also assessed participants' attitude, perceived behavioral control, and subjective norm to use wiki-based order sets. Paired pre- and post-Likert scores were compared using Wilcoxon signed-rank tests. The post-questionnaire also included open-ended questions concerning participants' comments about the wiki, which were then classified into themes using an existing taxonomy.
  
  
  RESULTS
  Twenty-eight emergency physicians were enrolled in the study (response rate: 100%). Physicians' mean intention to use a wiki-based reminder was 5.42 (SD 1.04) before the intervention, and increased to 5.81 (SD 1.25) on a 7-point Likert scale (P =.03) after the intervention. Participants' attitude towards using a wiki-based order set also increased from 5.07 (SD 0.90) to 5.57 (SD 0.88) (P =.003). Perceived behavioral control and subjective norm did not change. Easier information sharing was the most frequently positive impact raised. In order of frequency, the three most important facilitators reported were: ease of use, support from colleagues, and promotion by the departmental head. Although participants did not mention any perceived negative impacts, they raised the following barriers in order of frequency: poor organization of information, slow computers, and difficult wiki access.
  
  
  CONCLUSIONS
  Emergency physicians' intention and attitude to use wiki-based order sets increased after having access to and being motivated to use a wiki for 6 months. Future studies need to explore if this increased intention will translate into sustained actual use and improve patient care. Certain barriers need to be addressed before implementing a wiki for use on a larger scale.
authors.affiliation: Centre intégré de santé et services sociaux de Chaudière-Appalaches, Lévis, QC, Canada. patrick.m.archambault@gmail.com.
authors.forename: Patrick Michel
authors.identifier: http://orcid.org/0000-0002-5090-6439
authors.initials: PM
authors.lastname: Archambault
authors.forename: Pierre
authors.identifier: http://orcid.org/0000-0001-9087-9888
authors.initials: P
authors.lastname: Beaupré
authors.forename: Laura
authors.identifier: http://orcid.org/0000-0002-5819-5117
authors.initials: L
authors.lastname: Bégin
authors.forename: Audrey
authors.identifier: http://orcid.org/0000-0002-5525-1777
authors.initials: A
authors.lastname: Dupuis
authors.forename: Mario
authors.identifier: http://orcid.org/0000-0002-9425-396X
authors.initials: M
authors.lastname: Côté
authors.forename: France
authors.identifier: http://orcid.org/0000-0002-2296-6696
authors.initials: F
authors.lastname: Légaré
keywords: Theory of Planned Behavior; collaborative writing applications; computer physician order entry; decision support tools; emergency medicine; health informatics; knowledge translation; wiki