The Literature of Medicine
1 January 1990

Online Access to MEDLINE in Clinical Settings: A Study of Use and Usefulness

Publication: Annals of Internal Medicine
Volume 112, Number 1


Study Objective: We introduced self-service access to the medical literature database, MEDLINE, into clinical settings to assess the frequency, patterns, purposes, and success of use.
Design: Longitudinal descriptive study.
Setting: Inpatient and outpatient services of a university medical center.
Participants: All trainees and attending staff working at the service sites were invited to participate; 158 (84%) did so.
Interventions: Free online access was provided to MEDLINE through GRATEFUL MED software. Participants were offered a 2-hour introduction to online searching and 2 hours of free search time.
Measurements and Main Results: For each search, a computer program requested identification of the user and the question to be addressed. Search transactions were recorded automatically. Interviews were conducted after a random sample of searches, and search questions were given to more expert searchers to run for comparison with the original. Eighty-one percent of participants did searches oh study computers, at a mean rate of 2.7 searches per month. On comparison searches, participants retrieved 55% of the number of relevant articles retrieved by reference librarians (P = 0.024) and 50% more irrelevant articles (P < 0.001). Forty-seven percent of searches on patient problems affected clinical decisions, but often on scanty information.
Conclusions: MEDLINE searching from clinical settings is feasible with brief training and affects clinical decisions. However, inexperienced searchers miss many relevant citations and search inefficiently. Further studies are needed to assess the impact of searching on physician performance and patient care.

Get full access to this article

View all available purchase options and get full access to this article.


Stross J and Harlan W. The dissemination of new medical information. JAMA. 1979;241:2662-4.
Evans CHaynes RGilbert JTaylor DSackett D, and Johnston M. Educational package on hypertension for primary care physicians. Can Med Assoc J. 1984;130:719-22.
Williamson JGerman PWeiss RSkinner E, and Bowes F. Health science information management and continuing education of physicians. Ann Intern Med. 1989;110:151-60.
Covell DUman G, and Manning P. Information needs in practice: are they being met? Ann Intern Med. 1985;103:596-9.
Haynes RMcKibbon KFitzgerald DGuyatt GWalker C, and Sackett D. How to keep up with the medical literature. IV. Using the literature to solve clinical problems. Ann Intern Med. 1986;105:636-40.
Haynes RMcKibbon KFitzgerald DGuyatt GWalker C, and Sackett D. How to keep up with the medical literature. V. Access by personal computer to the medical literature. Ann Intern Med. 1986;105:810-6.
Horowitz G and Bleich H. PaperChase, a computer program to search the medical literature. N Engl J Med. 1981;305;924-30.
Collen M and Flagle C. Full-text medical literature retrieval by computer. A pilot test. JAMA. 1985;254:2768-74.
Haynes R and McKibbon K. Grateful Med. MD Computing. 1987;4:47-9, 57.
McKibbon KWalker CRyan NFitzgerald D, and Haynes R. A study of MEDLINE in clinical settings: design and preliminary results. In: Greenes RA, ed. Proceedings of the Twelfth Annual Symposium on Computer Applications in Medical Care. New York: Institute of Electrical and Electronics Engineers; 1988:526-9.
Collen M and Flagle C. Full-text medical literature retrieval by computer: a pilot test. JAMA. 1985;254:2768-74.
Horowitz GJackson J, and Bleich H. PaperChase: self-service bibliographic retrieval. JAMA. 1983;250:2494-9.
Sewell W and Teitelbaum S. Observations of end-user online searching behavior over eleven years. J Am Soc Information Sci. 1986;37:234-45.
Kirby M and Miller N. MEDLINE searching on Colleague: reasons for failure or success of untrained end users. Medical Reference Services Q. 1986;5:17-34.
White H. Putting users to work. Library J. 1988;113:40-1.
Dickersin KHewitt PMutch LChalmers I, and Chalmers T. Perusing the literature: comparison of MEDLINE searching with a perinatal trials database. Controlled Clin Trials. 1985;6:306-17.
Kirpalani HSchmidt BMcKibbon KHaynes R, and Sinclair J. Searching MEDLINE for randomized clinical trials involving care of the newborn. Pediatrics. 1989;83:543-6.
Ad hoc working group for critical appraisal of the medical literature. A proposal for more informative abstracts of clinical articles. Ann Intern Med. 1987;106:598-604.
Davies N and DeVierno A. Reimbursement for computer-assisted literature searches for patient care [Letter]. N Engl J Med. 1988;319:1021.

Information & Authors


Published In

cover image Annals of Internal Medicine
Annals of Internal Medicine
Volume 112Number 11 January 1990
Pages: 78 - 84


Published in issue: 1 January 1990
Published online: 1 December 2008




R. Brian Haynes, MD, PhD
Cynthia J. Walker, MLS
Dorothy Fitzgerald, MLS
Michael F. Ramsden, MD
From McMaster University, Hamilton, Ontario. For current author addresses, see end of text.

Metrics & Citations



If you have the appropriate software installed, you can download article citation data to the citation manager of your choice. For an editable text file, please select Medlars format which will download as a .txt file. Simply select your manager software from the list below and click Download.

For more information or tips please see 'Downloading to a citation manager' in the Help menu.


Download article citation data for:
R. Brian Haynes, K. Ann McKibbon, Cynthia J. Walker, et al. Online Access to MEDLINE in Clinical Settings: A Study of Use and Usefulness. Ann Intern Med.1990;112:78-84. doi:10.7326/0003-4819-112-1-78

View More

Get Access

Login Options:

You will be redirected to to sign-in to Annals to complete your purchase.

Access to EPUBs and PDFs for FREE Annals content requires users to be registered and logged in. A subscription is not required. You can create a free account below or from the following link. You will be redirected to to create an account that will provide access to Annals. If you are accessing the Free Annals content via your institution's access, registration is not required.

Create your Free Account

You will be redirected to to create an account that will provide access to Annals.

View options


View PDF/ePub

Related in ACP Journals







Copy the content Link

Share on social media