Computerization of clinical practice in Hong Kong: a study of Chinese medicine practitioners

Computerization of clinical practice in Hong Kong: a study ofChinese medicine practitioners

MOON FAI CHAN*, SONNY H. M. TSE, MARY C. DAY,

T. F. TONG and LORNA SUEN

School of Nursing, The Hong Kong Polytechnic University

Abstract. Primary objectives: To explore the current level of computerization in clinicalpractice in the Hong Kong Special Administrative Region through a population-based,Chinese medicine practitioner (CMP).Methods and procedures: A self-completed, one-page two-sided, questionnaire were sent tothe sample via mail, and a second mailing was sent to those who had not replied after 14days. The sample consisted of 3335 listed CMPs registered with the Chinese MedicineCouncil of Hong Kong in 2002.Main outcomes and results: We received 1036 questionnaires from this mailed survey. Afterdeducting those who had moved (n=60), we calculated a response rate of 31.6%. Malerespondents accounted for 81.8% (n=847) of replies, and 279 respondents (26.9%) hadused computer in their practices. The present analyses provide evidence that CMPs’current overall level of knowledge and use of computers in clinical practice is far fromoptimal. At best, only about 6.5% and 8.4% of CMPs in the study sample hadcomputerized 4 – 8 clinical and 3 – 6 administrative functions, respectively.Conclusions: In Hong Kong primary health care systems place much emphasis on qualityoutcomes and cost reduction. In order to achieve these goals, apparatus that allows greateraccountability represents a means by which healthcare providers and policy makers canexercise greater control over healthcare services. Thus, implementation of computersystems in clinical practice can be seen as a prominent part of this overall philosophy.The present study has systematically documented the extent of clinical computer use inHK, identified areas for improvement, as well as specific groups of CMPs who mightbenefit from targeted efforts to promote computerization in practice for CMPs.

Keywords: Chinese medicine practitioner; Hong Kong; Traditional Chinese medicine

1. Introduction

Within the practice of Western medicine, a medical information system is an

important tool in the efficient management of information for healthcare services

and many potential computer applications can facilitate and improve the delivery

of healthcare services. This help can operate at several levels, via both routine

administrative tasks as well as more advanced clinical tasks. Examples including

patient registration [1], billing and payment system [2], access to scientific publi-

cations [3], provision of guidelines and protocols [4], electronic medical record

systems (e.g. preparing referral letter, writing patient summaries and consultation

notes and writing patient prescriptions) [5], prompting for recalls and regular

follow-ups [6], and structured knowledge-based clinical decision support systems

[7]. Studies also show that computer use in Western medical practice has been

examined in many contexts. For example, a study in UK reported that about 90%

of UK physicians were using a computer [8]. Corresponding figures were 84% in

New Zealand [9], 57% in three European countries [10], and 31% in Australia [11].

*Author for correspondence; The Hong Kong Polytechnic University, School of Nursing, Hung Hom,Kowloon, Hong Kong. E-mail: [email protected]

MED. INFORM. (MARCH 2003) VOL. 28, NO. 1, 43–57

Medical Informatics & The Internet in Medicine ISSN 1463-9238 print/ISSN 1464-5238 online # 2003 Taylor and Francis Ltdhttp://www.tandf.co.uk/journals

DOI: 10.1080/1463923031000124029

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However, there has been little research on the extent of computerization in

alternative medical practices such as Chinese medicine, although in certain

contexts such as Hong Kong, Chinese medicine also plays a significant role in

the health care system. Of course practitioners of Western medicine are the main

health care providers in Hong Kong, Chinese medicine practitioners (CMP) are

becoming increasingly popular as more and more people acknowledge the strength

of Chinese medicine in contributing to the health of the community and provide

the drive for its development [12].

Given the recognized importance of computer applications in the patient-care

environment [13], it is surprising that there has been little research on the nature

of computerization in clinical practice of Chinese medicine practitioner (CMP) in

Hong Kong. A thorough search of the literature, through MEDLINE as well as

bibliographic references of published articles since 1966, yielded fewer than 10

papers on a search based on two keywords: Computer and Chinese medicine.

But none of the studies were related to the study reported in this paper that aimed

at examining the extent of computerization in the field of Chinese medicine. The

literature seems to be dominated by Western medicine and this study attempts

to redress the balance by examining how CMPs in Hong Kong make use of

computer applications for the efficient management of healthcare information

and in doing so break new ground. Our objective is to explore the current level

of computerization in clinical practice in the Hong Kong Special Administrative

Region (SAR) through a population-based, Chinese medicine practitioner

(CMP) self-completed mailed survey.

2. Methods

2.1. Selection of subjects

The sample frame consisted of all listed CMPs (n=7677) registered with the

Chinese Medicine Council of Hong Kong (CMCHK) as of April 30, 2002. There

are three main streams of practice in Hong Kong: herbalists (general practice),

bone-setters, and acupuncturists. Our target was to include all listed CMPs in

our study, due to the Personal Data (Privacy) Ordinance in Hong Kong, it was

not possible to access information (e.g. contact address, and name) for all of them.

Only 3335 CMPs were willing to release their information via the CMCHKs’

website [14], and were included in the main study. We mailed a one-page, two-

sided questionnaire to the sample as this is the format suggested by some studies

[15]. A second mailing was sent to those who had not replied after 14 days.

Returned questionnaires with address corrections were mailed to the updated

address, otherwise, we excluded from the analysis mail returned due to unknown

or incorrect addresses and discounted these from the denominator when calcu-

lating the response rate. Retirees who indicated on the returned questionnaire that

they were no longer involved in clinical practice were similarly excluded, as were

deceased individuals. In total, from the initial mailing and follow-up reminder

mailing, we received 1036 completed questionnaires, yielding a response rate of

31.6%.

2.2. Survey instrument

The questionnaire contained three parts. In the first part, there was a list

of 14 specific functions (eight clinical and six administrative). For each func-

44 M. F. Chan et al.

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tion, the CMP was asked to indicate (a) their opinion (yes or no) as to

whether the function should be computerized, (b) whether it actually was

computerized in their practice, and (c) if it was not already computerized,

whether they intended to (yes or no) computerize the function. Part two

recorded their self-perceived level of skills/knowledge and current use of

computer in their clinical practice. Questions included computer currently

using (yes or no), how frequently (hours per week), experience in using a

computer (number of years). Questions were also asked about their perceived

difficulty in doing six specific tasks using a 4-point scale (1= very difficult,

2 = difficult, 3 = easy, 4 = very easy). The average total scores were used for

comparison, the lower the scores, the more difficulty practitioners had in using

a computer. The last part requested personal information such as professional

qualifications, and demographic details such as age and gender. We composed

and compiled the questionnaire after the second mailing (54 days). The design

and conduct of the study received approval from the Research Ethics

Committee of the Hong Kong Polytechnic University.

2.3. Statistical analysis

We generated frequency tables and descriptive statistics for the data

collected. Bivariate associations and between-group differences were analysed

using one-way ANOVA for continuous variables, and the post-hoc tukey test

was used to compare each pair group. Pearson’s w2 test was used for categorical

items, Mann–Whitney U-test and Kruskal-Wallis test was used for ordinal

items, and factor analysis was used to test the instrument on computer use

skills. All analyses were carried out using SPSS [16], with a significance level

at p5 0.05.

3. Results

3.1. CMP characteristics

We received 1036 questionnaires from this mailed survey. After deducting

those who had moved (n=60), we calculated a response rate of 31.6%. Male

respondents accounted for 81.8% (n=847) of replies, and 279 respondents

(26.9%) had used computer in their practices. Twenty-one per cent of participants

(n = 221) had obtained additional professional qualifications, while 41.2% (n=91)

were trained in Western medicine and 19.9% (n=44) were pharmacists. Table 1

presents the demographics of the study sample by sex and by current computer

use (yes or no). In general, significant differences were found in age between sex

(Mann–Whitney U=55151, p5 0.001), and also by current computer use

(Mann–Whitney U=82332, p5 0.001). Most respondents worked in the private

sector (n=807, 85.9%), followed by the corporate (n=100, 10.6%), and academic

sectors (n=14, 1.5%). The largest age group was composed of practitioners aged

50 – 59 years old (n=338, 33.5%), followed by those aged 60 – 69 years (n=263,

26.1%) and those aged 40 – 49 years (n=249, 24.7%). Fifty-seven per cent of

respondents had experiences practice in mainland China, and 56% of respondents

had 16 years of experience practising in Hong Kong since their registration with

the CMCHK. As a proportion, more of the respondents were herbalists (n=630,

72.2%) than bone-setters (n=189, 21.7%), followed by acupuncturists (n=53,

6.1%).

45Computerization of clinical practice in Hong Kong

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Tab

le1.

Characteristicsofthestudysample

Sex

Curren

tcomputeruse

Chi-squaretest

Total(n

=1036)

Fem

ale(n

=189)

Male(n

=847)

No(n

=722)

Yes

(n=279)

Sex

Curren

tcomputeruse

Characteristics

n(%

)n

(%)

n(%

)n

(%)

n(%

)w2

Sign.

w2Sign.

Sex M

ale

822

(82.1)

602

(67.0)

220

(26.8)

2.81

p=0.094

Fem

ale

179

(17.9)

120

(73.2)

59

(33.0)

Origin

China

897

(96.2)

161

(94.2)

736

(96.7)

645

(98.2)

234

(91.8)

2.54

p=0.111

21.64

p5

0.001

Others

35

(3.8)

10

(5.8)

25

(3.3)

12

(1.8)

21

(8.2)

Age(years)f*

39orbelow

80

(7.9)

18

(9.9)

62

(7.5)

40

(5.6)

40

(14.5)

18.89

p5

0.001

53.45

p5

0.001

40–49

249

(24.7)

62

(33.3)

187

(22.7)

169

(23.7)

78

(28.3)

50–59

338

(33.5)

64

(34.4)

274

(33.3)

223

(31.3)

109

(39.5)

60–69

263

(26.1)

37

(19.9)

226

(27.5)

215

(30.2)

41

(14.9)

70+

79

(7.8)

5(2.7)

74

(9.0)

65

(9.1)

8(2.9)

Mean(SD)

4.0

(1.1)

3.9

(1.1)

4.2

(1.0)

4.2

(1.0)

3.9

(1.0)

62312.50e

p5

0.001

72981.00e

p5

0.001

Higher

educationlevel

b

Master/PhD

56

(5.9)

9(5.1)

47

(6.1)

21

(3.2)

34

(13.1)

17.95

p5

0.001

45.66

p5

0.001

Degree

366

(38.7)

86

(48.6)

280

(36.5)

246

(37.0)

114

(43.8)

Diploma/

Certificate

376

(39.8)

71

(40.1)

305

(39.7)

277

(41.6)

88

(33.9)

Others

147

(15.6)

11

(6.2)

136

(17.7)

121

(18.2)

24

(9.2)

Qualificationsaccep

tedbyCM

CHK

No

22

(2.7)

2(1.4)

20

(3.0)

14

(2.4)

7(3.0)

0.66

p=0.415a

0.24

p=0.626

Yes

803

(97.3)

146

(98.6)

657

(97.0)

563

(97.6)

224

(97.0)

(continued

overleaf)

(continued

opposite)


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Tab

le1.

(continued

)

Sex

Curren

tcomputeruse

Chi-squaretest

Total(n

=1036)

Fem

ale(n

=189)

Male(n

=847)

No(n

=722)

Yes

(n=279)

Sex

Curren

tcomputeruse

Characteristics

n(%

)n

(%)

n(%

)n

(%)

n(%

)w2

Sign.

w2Sign.

Mainstudyfrom

d

Academic

376

(60.4)

98

(79.0)

278

(55.6)

232

(72.1)

137

(85.2)

25.98

p5

0.001

28.81

p5

0.001

Paren

ts128

(20.5)

9(7.3)

119

(23.8)

105

(14.7)

19

(6.9)

Master

86

(13.8)

10

(8.1)

76

(15.2)

69

(9.7)

15

(5.4)

Others

33

(5.3)

7(5.6)

26

(5.2)

25

(3.5)

7(2.5)

Main

workingsectord

Academic

14

(1.5)

3(1.7)

11

(1.4)

9(1.3)

5(1.8)

6.635

p=0.085

4.53

p=0.210

Corporate

100

(10.6)

26

(14.9)

74

(9.7)

63

(12.8)

36

(18.6)

Private

807

(85.9)

140

(80.0)

667

(87.2)

579

(84.0)

212

(77.4)

Others

19

(2.0)

6(3.4)

13

(1.7)

13

(1.9)

6(2.2)

Main

stream

inpractised

Herbalistc

630

(72.2)

113

(71.5)

517

(72.4)

447

(73.3)

174

(71.0)

20.28

p5

0.001

2.28

p=0.320

Bone-setter

189

(21.7)

23

(15.2)

165

(23.1)

130

(21.3)

51

(20.8)

Acu

puncturist

53

(6.1)

21

(13.3)

32

(4.5)

33

(5.4)

20

(8.2)

Yearsofpractisein

HK

asat

Jan01.2000g

0–4

83

(8.3)

36

(19.9)

47

(5.8)

53

(7.5)

29

(10.8)

48.66

p5

0.001

14.68

p=0.002

5–9

98

(9.8)

22

(12.2)

76

(9.3)

59

(8.3)

39

(14.6)

10–15

258

(25.9)

52

(28.7)

206

(25.2)

181

(25.6)

73

(27.2)

16+

559

(56.0)

71

(39.2)

488

(59.7)

415

(58.6)

127

(47.4)

Mean(SD)

3.3

(1.0)

2.8

(1.1)

3.4

(0.8)

3.4

(0.9)

3.2

(1.0)

55151.00e

p5

0.001

82332.00e

p5

0.001

Practise

inmainlandChina

No

308

(42.7)

61

(42.7)

247

(42.7)

195

(37.9)

99

(53.8)

0.01

p=0.938

13.99

p5

0.001

Yes

414

(57.3)

82

(57.3)

331

(57.3)

319

(62.1)

85

(46.2)

(continued

overleaf)


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Tab

le1.

(continued

)

Sex

Curren

tcomputeruse

Chi-squaretest

Total(n

=1036)

Fem

ale(n

=189)

Male(n

=847)

No(n

=722)

Yes

(n=279)

Sex

Curren

tcomputeruse

Characteristics

n(%

)n

(%)

n(%

)n

(%)

n(%

)w2

Sign.

w2Sign.

Years

ofpractisein

other

placesh

0–4

183

(37.5)

26

(28.3)

157

(39.6)

141

(37.7)

40

(38.5)

13.39

p5

0.004

6.66

p=0.084

5–9

86

(17.6)

10

(10.9)

76

(19.2)

60

(16.0)

24

(23.1)

10–15

100

(20.5)

29

(31.5)

71

(17.9)

85

(22.7)

13

(12.5)

16+

119

(24.4)

27

(29.3)

92

(23.2)

88

(23.5)

27

(26.0)

Mean(SD)

2.3

(1.2)

2.7

(1.2)

2.2

(1.2)

2.3

(1.2)

2.3

(1.2)

15204.50e

p5

0.01

18999.50e

p=0.707

aYates’continuitycorrectiontest.

bQualificationin

MainlandChinaorHongKong.

cChineseherbalmed

icines.

dM

ultiple

answ

erswere

notconsidered

.eM

ann–W

hitney

U-test.

f Years

(age)

wereranged

from

(1)to

(7),(1)=less

than

29,(2)=30–39,an

d(7)=80years

old

ormore.

gYears

ofpractisein

HK

asatJan0.1,2000wereranged

from

(1)to

(4),(1)=0–4years,an

d(4)=16years

ormore.

hYears

ofpractisein

other

placeswereranged

from

(1)to

(4),(1)=0–4years,an

d(4)=16years

ormore.

*,figuresmay

notequal

tototalnumber

ofresponden

ts(n)dueto

missingvalue.


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3.2. Computerization of clinical and administrative functions

Table 2 lists specific clinical and administrative functions, giving the prop-

ortions of respondents who (a) yes, had already computerized and/or (b) no, but

intended to computerize particular functions. Taking into account that the practice

setting might significantly influence the extent of computerization, we also tabu-

lated the results by categorizing the respondents into three groups (herbalists,

bone-setters, and acupuncturists) based on the main stream of their practice.

For clinical functions in the overall sample, about 12% of CMPs already

recorded consultation notes (n=109, 12.5%) and patient summaries (n=104,

11.9%); 9.4% (n=82) wrote prescriptions, 5.2% (n=45) clinical decision support

tools, 4.1% (n=36) prepared referral notes electronically, and 3.9% (n=34)

processed laboratory results or specialist reports. Of note, however, very few

CMPs utilized a computer to access educational materials/health for patients

(n=28, 3.2%), although 48.4% (n=422) reported their intention to computerize

that function later. In general, no significant differences were found between the

three groups in (a) yes, had already computerized and/or (b) no, but intended to

computerize particular clinical functions.

For administrative functions such as patient registration (n=101, 11.6%),

billing and payment systems (n=75, 8.6%), managing practice finance (n=64,

7.3%), and stock and stores control (n=62, 7.1%) were the top four functions

to be computerized. Among CMPs who had yet to computerize specific clinical

functions, 44.5% to 60.1% of respondents confirmed their intention to compu-

terize the functions later, while from 34.3% to 60.3% acknowledged the same

intentions for various administrative functions. In general, no significant differ-

ences were found between the three groups in (a) yes, had already computer-

ized and/or (b) no, but intended to computerize particular administrative

functions.

Table 3 shows the extent of computerization by the number of clinical and

administrative functions already processed by CMPs. Of note, 83.1% of herbalists,

84.8% of bone-setters, and 83.0% of acupuncturists had not yet computerized any

clinical functions. The patterns for administrative functions were similar with clin-

ical functions, with approximately 82.4% of herbalists, 82.1% of bone-setters and

85.7% of acupuncturists had not yet computerized any function. At the other

end of the spectrum, in total, 6.5% of CMPs had computerized most or all of clin-

ical functions (4 – 8) and 8.4% had computerized most or all of administrative func-

tions (3 – 6) listed in the survey. There were no significant differences when

comparing type of practice to the number of computerized functions either clinical

or administrative, except for those who had computerized 4 – 8 clinical functions

(w2 = 6.44, p=0.40).

3.3. Skills and use of computer in their daily work

In table 4, a total of 245 (28.7%) CMPs used computers in their clinical prac-

tices. By group, 174 (28%) subjects were herbalists, 51 (28.2%) subjects were

bone-setters, and 20 (37.7%) subjects were acupuncturists. There were no signifi-

cant differences between groups (w2 = 2.28, p=0.320). Among subjects who used

computers, the time spent using the computer varied, 21 (8.8%), 88 (36.7%), 58

(24.2%), and 73 (30.3%) respondents reported spending less than an hour, 1 –

5 h, 6 – 10 h, and 11 or more than 11 h per week on use computer, respectively.

There were no significant differences between groups (w2 = 3.20, p=0.783).


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Tab

le2.

Curren

tstatusan

dfuture

intentionsofcomputerizationin

clinicalpractice

bygroup

Groupa

Total(n

=872)

Functionalread

ycomputerized

Herbalist(n

=630)

Functionalread

ycomputerized

Bone-setter

(n=189)

Functionalread

ycomputerized

Acu

puncturist

(n=53)

Functionalready

computerized

Chi-squaretest

Yes

No,but

intended

tocomputerize

Yes

No,but

intended

tocomputerize

Yes

No,but

intended

tocomputerize

Yes

No,but

intended

tocomputerize

Yes

No,but

intended

tocomputerize

Functions

n(%

)n

(%)

n(%

)n

(%)

n(%

)n

(%)

n(%

)n

(%)

w2Sign

w2Sign.

Clinical

133

(3.8)

392

(45.0)

27

(4.3)

287

(45.6)

2(1.1)

76

(40.2)

4(7.5)

29

(54.7)

6.35

p=0.042

3.85

p=0.146

282

(9.4)

388

(44.5)

65

(10.3)

276

(43.8)

11

(5.8)

82

(43.4)

6(11.3)

30

(56.6)

3.70

p=0.158

3.36

p=0.186

334

(3.9)

491

(56.3)

25

(4.0)

354

(56.2)

5(2.6)

102

(54.0)

4(7.5)

35

(66.0)

2.68

p=0.261

2.46

p=0.292

436

(4.1)

397

(45.5)

25

(4.0)

300

(47.6)

4(2.1)

70

(37.0)

7(13.2)

27

(50.9)

13.01

p=0.002

7.23

p=0.027

528

(3.2)

422

(48.4)

18

(2.9)

312

(49.5)

5(2.6)

82

(43.4)

5(9.4)

28

(52.8)

7.05

p=0.029

2.64

p=0.268

6109

(12.5)

523

(60.0)

79

(12.5)

376

(59.7)

23

(12.2)

111

(58.7)

7(13.2)

36

(67.9)

0.04

p=0.978

1.54

p=0.463

7104

(11.9)

524

(60.1)

76

(12.1)

379

(60.2)

22

(11.6)

108

(57.1)

6(11.3)

37

(69.8)

0.05

p=0.978

2.77

p=0.250

845

(5.2)

459

(52.6)

37

(5.9)

332

(52.7)

4(21.2)

98

(51.9)

4(7.5)

29

(54.7)

4.85

p=0.089

0.14

p=0.933

Administrative

975

(8.6)

358

(41.1)

58

(9.2)

249

(39.5)

13

(6.9)

85

(45.0)

4(7.5)

24

(45.3)

1.08

p=0.582

2.20

p=0.333

10

62

(7.1)

386

(44.3)

46

(7.3)

283

(44.9)

13

(6.9)

79

(41.8)

3(5.7)

24

(45.3)

0.22

p=0.896

0.60

p=0.742

11

64

(7.3)

327

(37.5)

47

(7.5)

239

(37.9)

15

(7.9)

65

(34.4)

2(3.8)

23

(43.4)

1.10

p=0.576

1.62

p=0.446

12

36

(4.1)

299

(34.3)

30

(4.8)

222

(35.2)

3(1.6)

59

(31.2)

3(5.7)

18

(34.0)

4.04

p=0.133

1.05

p=0.593

13

36

(4.1)

475

(54.5)

26

(4.1)

347

(55.1)

6(3.2)

97

(51.3)

4(7.5)

31

(58.5)

2.00

p=0.368

1.20

p=0.550

14

101

(11.6)

526

(60.3)

72

(11.4)

378

(60.0)

23

(12.2)

114

(60.3)

6(11.3)

34

(64.2)

0.08

p=0.960

0.35

p=0.839

Function1.Runningarecallsystem

toremindpatientsto

return

forroutinetests;Function2.W

ritingprescriptions;Function3.Receivingorstoringinform

ationsuch

aslaboratory

resultsorspecialist

report;Function4.Preparingreferral

letters;Function5.Accessinged

ucational

materials/healthforpatients;Function6.Recordingcon-

sultationnotes;Function7.Recordingpatientsummaries;Function8.Usingdecisionsupport

functionsto

solvediagnostic

problemsormakedecisionsab

outdispen

sing

ortreatm

ent;Function9.Billingan

dpaymen

tsystem

;Function10.Stock

andstorescontrol;Function11.M

anagingpracticefinan

ce;Function12.Payroll;Function13.

Sch

edulingappointm

ent;Function14.Registerationofpatientdetails.

a,multiple

answ

ers

werenoconsidered.


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Tab

le3.

Extentofcomputerizationofclinical

andad

ministrativefunctionsbygroup

Groupa

No.offunctions

Total(n

=872)

Herbalist(n

=630)

Bone-setter

(n=189)

Acu

puncturist

(n=53)

Chi-squaretest

computerized

n(%

)n

(%)

n(%

)n

(%)

w2Sign.

Clinical

0695

(83.4)

500

(83.1)

151

(84.8)

44

(83.0)

0.32

p=0.852

123

(3.0)

19

(3.2)

5(2.8)

1(1.9)

0.30

p=0.861

224

(2.9)

14

(2.3)

9(5.1)

1(1.9)

3.86

p=0.145

335

(4.2)

26

(4.3)

8(4.5)

1(1.9)

0.76

p=0.683

4–8

54

(6.5)

43

(7.1)

5(2.8)

6(11.3)

6.44

p=0.040

Mean(SD)

0.54

(1.4)

0.6

(1.5)

0.5

(1.2)

0.7

(1.9)

0.63b

p=0.728

Administrative

0652

(82.5)

472

(82.4)

138

(82.1)

42

(85.7)

0.37

p=0.830

144

(5.6)

31

(5.4)

10

(6.0)

3(6.1)

0.10

p=0.950

228

(3.5)

19

(3.3)

9(5.4)

0(0.0)

3.50

p=0.174

3–6

66

(8.4)

51

(8.9)

11

(6.6)

4(8.2)

0.94

p=0.624

Mean(SD)

0.047

(1.2)

0.5

(1.2)

0.4

(1.1)

0.5

(1.4)

0.32b

p=0.852

aM

ultiple

answ

ers

werenotconsidered

.bKruskal-W

allistest.


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Tab

le4.

Characteristicsofstudysample

whohad

computerin

clinical

practicebygroup

Groupa

Total

Herbalist

Bone-setter

Acupuncturist

Chi-squaretest

Characteristics

n(%

)n

(%)

n(%

)n

(%)

w2Sign.

Use

computer

No

610

71.3)

447

(72.0)

130

(71.8)

33

(62.3)

2.28

p=0.320

Yes

245

(28.7)

174

(28.0)

51

(28.2)

20

(37.7)

Hours

perweek

c

51

21

(8.8)

16

(9.4)

4(8.0)

1(5.0)

3.20

p=0.783

1–5

88

(36.7)

60

(35.3)

20

(40.0)

8(40.0)

6–10

58

(24.2)

38

(22.4)

15

(30.0)

5(25.0)

11+

73

(30.3)

56

(32.9)

11

(22.0)

6(30.0)

Mean(SD)

2.8

(1.0)

2.8

(1.0)

2.7

(0.9)

2.8

(1.0)

0.70b

p=0.703

Years

ofexperience

d

51

33

(13.6)

22

(12.7)

10

(20.0)

1(5.0)

5.98

p=0.426

1–2

49

(20.2)

39

(22.5)

7(14.0)

3(15.0)

3–4

52

(21.3)

34

(19.7)

13

(26.0)

5(25.0)

5+

109

(44.9)

78

(45.1)

20

(40.0)

11

(55.0)

Mean(SD)

3.0

(1.1)

3.0

(1.1)

2.9

(1.2)

3.3

(0.9)

2.09b

p=0.352

aM

ultiple

answ

ers

were

notconsidered

.bKruskal-W

allistest.

cHours

perweekswere

ranged

from

(1)to

(4),(1)=less

than

1hour,

and(4)=11ormore

hours.

dYearsofexperience

were

ranged

from

(1)to

(4),(1)=less

than

1year,

and(4)5ormore

than

5years.


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Although, 44.9% (n=109) had 5 or more than 5 years of computer experience, no

significant differences were found between groups (w2 = 5.98, p=0.426).

Scores for relevant computer skills have been aggregated into two categories:

very difficult/difficult (5=2), and easy/very easy (4=3). The results are

shown in table 5 by the subjects’ main stream of practice. The instrument

consists of six tasks. The principal component method was used in the factor

analysis, and the scree plot supported a one-factor solution explaining 84.7%

of the total variance (figure 1). All six tasks displayed factor loadings ranging

from 0.88 to 0.95. This factor reflected concerns about CMPs’ perceived

computer skills (table 5). In general, for four out of six tasks, half of subjects

reported finding them very difficult/difficult. These tasks were document

formatting (n=455, 59.6%), copying information from one document to another

(n=431, 56.2%), installing new software onto a personal computer (n=521,

69.1%), and copying and moving files between directories (n=495, 64.9%).

Conversely, saving documents (n=417, 54.1%) and printing documents

(n=396, 51.8%) were tasks that more than half of subjects reported finding

easy/very easy to perform. The average sum of scores of the overall sample

was 13.7 (SD=4.83). For each group of practitioners the scores were 13.6

(SD=4.75), 13.6 (SD=4.9), and 15.1 (SD=5.14) for general practice, bone-

setting, and acupuncture, respectively, and no significant differences were found

among the three groups (F= 2.29, p=0.102).

4. Discussions

The present analyses provide evidence that CMPs’ current overall level of

knowledge and use of computers in clinical practice is far from optimal. At

best, only about 6.5% and 8.4% of CMPs in the study sample had computer-

ized 4 – 8 clinical and 3 – 6 administrative functions, respectively. On exam-

ining responses related to computerization, we observe at least four issues.

First, variations between different practices are immediately apparent for all

clinical and administrative functions. Second, for those who had computer-

ized (table 1), the majority were private (n=212), an alarming paucity of

CMPs used a computer patient recall system, prepared referral letters or used

computer-assisted clinical decision software, which of the eight functions

listed in table 2 are arguably the ones most likely to improve patient care.

Third, the disparities between tasks respondents intended to computerize

and tasks that were actually computerized helped to identify functions with

the greatest potential for computerization. This presents a distinct opportu-

nity for medical associations, governments and industry to foster and promote

the rapid implementation of these intentions. Lastly, the very low levels of

computerization in clinical practices leave a wide area where progressive

improvement is possible. This suggests that any efforts to encourage indivi-

dual CMPs to computerize will probably realize some degree of benefit.

Again as mentioned above, the Hong Kong government has paid scant atten-

tion to CMPs. Not surprisingly, only a small proportion of CMPs in the

three main categories had computerized their work practices. In fact, most

CMPs in Hong Kong do not have the financial resources to invest in

computer hardware and software until they are fairly well-established in

the community.


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Tab

le5.

SkillsofCM

Pto

computeruse

ingen

eral

practicebymainstream

ofpractices

Groupc

Total

Herbalist

Bone-setter

Acupuncturist

Factor

load

ing

VD/D

E/V

EVD/D

E/V

EVD/D

E/V

EVD/D

E/V

EChi-squaretest

compontent

184.7%

Task*

n(%

)n

(%)

n(%

)n

(%)

n(%

)n

(%)

n(%

)n

(%)

w2Sign.

variance

1384

(49.2)

396

(51.8)

286

(50.6)

279

(49.4)

79

(48.2)

85

(51.8)

19

(37.3)

32

(62.7)

3.44

p=0.179

0.91

2455

(59.6)

309

(41.4)

346

(62.5)

208

(37.5)

91

(56.9)

69

(43.1)

18

(36.0)

32

(64.0)

13.93

p=0.001

0.93

3431

(56.2)

336

(43.8)

326

(58.6)

230

(41.4)

86

(53.1)

76

(46.9)

19

(38.8)

30

(61.2)

8.02

p=0.018

0.95

4354

(45.9)

417

(54.1)

267

(47.8)

291

(52.2)

71

(43.3)

93

(56.7)

16

(32.7)

33

(67.3)

4.77

p=0.092

0.94

5521

(69.1)

233

(30.9)

381

(69.7)

166

(30.3)

114

(71.3)

46

(28.8)

26

(55.3)

21

(44.7)

4.61

p=0.100

0.88

6495

(64.9)

268

(35.1)

364

(65.9)

188

(34.1)

109

(67.3)

53

(32.7)

22

(44.9)

27

(35.1)

9.27

p=0.010

0.92

Overall*

13.7

(4.83)

13.6

(4.75)

13.6

(4.96)

15.1

(5.14)

2.29b

p=0.102

*,Scoresforeachtask

rangefrom

(1)to

(4),VD

=verydifficu

lt(1),D

=difficu

lt(2),E=easy

(3),VE=veryeasy

(4).

Task

1.Printingdocu

men

ts;Task2.Form

attingdocu

men

ts;Task3.Copyinginform

ationfrom

onedocu

men

tto

another;Task

4.Savingdocu

men

ts;Task5.In

stalling

new

softwareonto

apersonal

computer;

Task6.Copyingan

dmovingfilesbetweendirectories.

aM

eanofthetotalscore

rangefrom

6to

24,M

ean(SD);

bANOVA;cM

ultiple

answ

erswerenotconsidered

.


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In Hong Kong, as elsewhere, today’s primary health care systems place

much emphasis on quality outcomes and cost reduction. In order to achieve

these goals, apparatus that allows greater accountability represents a means by

which healthcare providers and policy makers can exercise greater control over

healthcare services. Thus, implementation of computer systems in clinical prac-

tice can be seen as a prominent part of this overall philosophy. The present

study has systematically documented the extent of clinical computer use in

HK, identified areas for improvement, as well as specific groups of CMPs

who might benefit from targeted efforts to promote computerization in practice

for CMPs.

5. Limitation

Though this study, as reported, has a population-based design, our sample

only represented 43% of the total population (n=7677). Therefore, a comparison

between our respondents and the CMCHK latest statistics for CMPs based on

sex, age, and the main streams of their practices were appropriate [16]. Results

showed that while no significant differences were found for the main practice

streams, but significant differences were found in age (p5 0.001) and sex

(p5 0.001) (see table 6). Second, the study cannot explain why there is such

a low level of computerization in private practices in the community. Questions

emerged concerning the barriers that may limit CMPs computer use in the clin-

ical practice. What are the gaps between their expectations and reality? The

current study cannot address these issues, which will need further study. In

addition, a certain number of CMPs reported that they may consider computer-

izing some clinical/administrative functions in their clinical practices in future.

Figure 1. Computer skills (6 tasks) Factor analysis –Scree plot


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The question is how much money are CMPs willing to pay to computerize their

clinics? Further study to explore this issue is also suggested.

Acknowledgements

We thank Dr Angela Chan, Dr Loretta Chung, and Miss Grace Yuen for their

expert opinions, Miss Portia Yam and all student helpers for their assistance in the

preparation of this study. We thank Dr G. M. Leung, and Dr J. M. Johnston and

their research team can approved us to use and translate their instrument for this

survey. This study was funded through a research grant (G-T508) from the Hong

Kong Polytechnic University.

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of a medical information system: evaluation of adaptation.Health Care Management Reveiew, 8, 25 –33.

2. FRIEDMAN, R.B. and GUSTAFSON, D. H., 1977, Computers in clinical medicine, a critical review.Computing Biomedical Review, 10, 199 – 204.

3. YOUNG, D. W., 1984, What makes doctors use computers? Journal of the Royal Society of Medicine,77, 663 – 667.

4. JOHNSON, P., 1991, Flexible protocols at the touch of a keyboard. Practical Computing, 6, 47 – 49.5. BARNETT, G. O., 1984, The application of computer-based medical record systems in ambulatory

practice. New England Journal of Medicine, 310, 1643 – 1650.6. MOIDU, K. and WIGERTZ, O., 1989, Computers and physicians – an appraisal study. Medical Infor-

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patient care? A systematic review of published reports. British Medical Journal 311, 848 – 852.9. THAKURDAS, P., COSTER, G., CURR, E. and ARROLL, B., 1996, New Zealand general practice com-

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Table 6. Listed CMP characteristics in study sample vs. population from CMCHK

Study sample CMCHK Chi-square test

Characteristics n (%) n (%) w2 Sign.

SexMale 847 (81.8) 5824 (75.9) 17.34 p5 0.001Female 189 (18.2) 1853 (24.1)

Age (years)39 or below 80 (7.9) 958 (12.5) 22.37 p5 0.00140 – 59 587 (58.2) 4485 (58.4)60 or above 342 (33.9) 2234 (29.1)

Main stream in practisea

Herbalist 630 (72.2) 5374 (70.0) 4.30 p=0.117Bone-setter 189 (21.7) 1689 (22.0)Acupuncturist 53 (6.1) 614 (8.0)

aMultiple answers were not considered


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rate, response time, and cost in a questionnaire study among nurses. CJIM, 1, 72 – 74.16. SPSS. SPSS Base 9.0 Applications Guide. 1999, SPSS Inc., Chicago, IL., USA.


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Documents

Computerization of clinical practice in Hong Kong: a study of Chinese medicine practitioners