Supporting Medical Decision Making with Electronic Medical Records

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Supporting Medical Decision Making with
Electronic Medical Records

• James J. Cimino
• Departments of Medicine and Medical Informatics
• Columbia University

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Decision Making for Patients and Providers

• Access to (electronic) health records generates
  information needs
• Information needs go unmet
• Best evidence, educational material, training
  programs can address these needs

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One-Stop Information Shopping?
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One-Touch Information Shopping
World Wide Web (The Facilitator)
Information Resources
Health Practitioner
Biblio- graphic Database
Textbook
Expert System
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Information for Decision-Making
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MRSA
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Intelligent Decision Support
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MRSA
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Infobutton Automating the Process

• Questions can be anticipated
• Match information source to question
• Automate the retrieval
• Query can use patient information

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New York Presbyterian Hospital Information
Architecture

• Central repository
• Data Access Modules
• Medical Entities Dictionary
• MedLEE
• CIS
• WebCIS
• PatCIS

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Central Controlled Terminology
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MED Semantic Network
Medical Entity
Plasma Glucose Test
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Automated Decision Support
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Get Information From EMR
Automated Translation
Resource Terminology
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MRSA
Querying
Understand Information Needs
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Resource Selection
Presentation
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Translations with the MED
Injectable Gentamicin
Serum Gentamicin Level
Gentamicin
Gentamicn Sensitivity Test
Gentamicin Toxicity
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EMR and Decision Support

• - understand conditions
• Pharmacy Infobutton - review and teach

• The Medline Button

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EMR and Decision Support

• The Medline Button - understand conditions
• Pharmacy Infobutton

• - review and teach
• Cholesterol Guideline - dietary planning

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EMR and Decision Support

• The Medline Button - understand conditions
• Pharmacy Infobutton - review and teach
• Cholesterol Guideline

• - dietary planning
• DXplain Button - understand findings

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From Test Result to Finding
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EMR and Decision Support

• The Medline Button - understand conditions
• Pharmacy Infobutton - review and teach
• Cholesterol Guideline - dietary planning
• Dxplain Button

• - understand findings
• QingCIS - problem-oriented views

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Smarter Retrievals from the Record

• Repository stores events and results
• Clinical problems at a different level of
  granularity
• Re-use knowledge to map from problems to clinical
  data
• Produce problem-specific views of the medical
  record

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Concept-oriented (Heart)
Radiology 2/28/96 Head CT
Lab 12/28/96 Sickle Cell Test
Admission 3/14/96 Stroke
Lab 1/1/99 Blood Type Test
Radiology 2/1/97 Knee X Ray
Admission 2/14/98 Angina
Discharge 1/15/99 CHF
Radiology 2/23/99 Chest X Ray
Lab 1/1/99 Cardiac Enzyme Test
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EMR and Decision Support

• The Medline Button - understand conditions
• Pharmacy Infobutton - review and teach
• Cholesterol Guideline - dietary planning
• Dxplain Button - understand findings
• QingCIS

• - problem-oriented views
• PatCIS - patient education

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EMR and Decision Support

• The Medline Button - understand conditions
• Pharmacy Infobutton - review and teach
• Cholesterol Guideline - dietary planning
• Dxplain Button - understand findings
• QingCIS - problem-oriented views
• PatCIS

• - patient education
• Lab Infobutton - patient information

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EMR and Decision Support

• The Medline Button - understand conditions
• Pharmacy Infobutton - review and teach
• Cholesterol Guideline - dietary planning
• Dxplain Button - understand findings
• QingCIS - problem-oriented views
• PatCIS - patient education
• Lab Infobutton

• - patient information
• Microbiology Infobuttons - infection control

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EMR and Decision Support

• The Medline Button - understand conditions
• Pharmacy Infobutton - review and teach
• Cholesterol Guideline - dietary planning
• Dxplain Button - understand findings
• QingCIS - problem-oriented views
• PatCIS - patient education
• Lab Infobutton - patient information
• Microbiology Infobuttons

• - infection control
• Mammography Guideline - screening

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EMR and Decision Support

• The Medline Button - understand conditions
• Pharmacy Infobutton - review and teach
• Cholesterol Guideline - dietary planning
• Dxplain Button - understand findings
• QingCIS - problem-oriented views
• PatCIS - patient education
• Lab Infobutton - patient information
• Microbiology Infobuttons - infection control
• Mammography Guideline

• - screening
• Pap Smear Infobutton - screening

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Summary

• Decision making requires high-quality,
  up-to-date, timely information
• The EMR generates information needs
• The EMR can help satisfy information needs
• The Web makes the rest easy
• Further study needed
• When do users need information?
• What information do they need?
• What terminology is needed?
• What are the right resources?
• How can retrievals be facilitated?
• How do we present results?