Wikis: Game-changing tech for health IT communication?

Wikis, collaborative websites where content can be edited by anyone who has access to it, could be transformational tools in health IT. For radiology residents at Indiana University Health (IUH), that transformation is already under way. Researchers at IUH's department of radiology and imaging sciences in Indianapolis found that radiology residents at IUH reported visiting IUH’s wiki on average more than five times per week, with one resident reportedly visiting the site 20 times per week.

Using open-source dokuwiki software, IUH implemented the wiki as an educational/communications tool about four years ago to house key pieces of content such as call/rotation schedules and dictation templates. “Educating radiology residents is a complex procedure that requires hours of self-study, an enriching didactic environment and extensive clinical experience,” wrote Marc D. Kohli, MD, and John K. Bradshaw, MD, from IUH’s department of radiology and imaging services in the February edition of the Journal of Digital Imaging.

IUH is home to the second largest radiology resident program in the country, with 60 residents alongside 100 radiologists, said Kohli, an associate professor in IUH's radiology department, in an interview. Providing reliable communication among at least 160 people in a timely fashion with IUH's previous tools--static webpages updated by administrative assistants who might not understand the content, and e-mails where information might not be easily attainable--wasn't possible, Kohli said.

IUH developed the wiki to maintain the highest quality of information in the most relevant format to be easily accessible by residents, he said. Residents are dispersed among seven hospitals, so these hospitals' policies and schedules need to be coordinated in an efficient, understandable manner. “We tried to address pain points,” said Kohli. In addition, IUH’s program coordinator uses the wiki to make sure the vacation policy is clear and available to residents.

The wiki is accessed through a log-in password, yet the wiki is tied into IUH’s existing log-in structure so a user doesn’t need to remember an extra password.

Technology like wikis could cut down on potentially long-winded e-mails because users could treat the webpage as a known reference point among staff members for wider dissemination of information.

To gauge wiki use, IUH surveyed 51 radiology residents. Most residents (78 percent) reported knowing how to edit an existing page; however, far fewer reported knowing how to add a new page (38 percent). “Despite such a large percentage of residents reporting how to edit, only 35 (69 percent) had edited content,” wrote the authors.

“The human and hardware costs associated with implementing the wiki have been low, including 18 hours of server setup and use of inexpensive server hardware,” wrote Kohli and Bradshaw. In fact, the wiki was first set up on a repurposed desktop, Kohli said. “If you already have an existing web server infrastructure and it’s virtualized, you’d have to attribute next to nothing resource-wise to the project; like 500 megabytes of RAM and very few process cycles.”

Using Google Analytics to see what features were utilized the most, IUH recently redesigned the wiki to make it more efficient. The revamped version provides quick links for single-click access to links such as on-call tips, references, schedules, templates, phone numbers and public wiki pages.

“I think a wiki provides a platform for unified communication and helps to decentralize the responsibility for keeping the information up to date,” concluded Kohli. “The phone list is maintained by the residents, so they are all responsible to each other for the quality of the content.

“From an IT person’s perspective, you have to provide staff the tools to accomplish their jobs as effectively as possible, and wikis are one of those tools.”