Use of Online Resources While Using a Clinical Information System

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Use of Online Resources While Using a Clinical
Information System

• James J. Cimino, MD Jianhua Li, MD
• Mark Graham, PhD, Leanne M. Currie, RN, MS
  Mureen Allen, MB BS Suzanne Bakken, RN, DNSc,
  Vimla L. Patel, PhD
• Department of Biomedical Informatics
• Columbia University

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Information Needs Study
Study 2 Identify information resources currently
being used
Study 1A Identify information needs events
2A Log file analysis
2B Survey
Characteristics of Resource Use
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Understanding Resource Use

• Are clinicians using resources to answer
  patient-related questions?
• What resources do clinicians use?
• Do they use resources differently depending on
  the context?

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Methods

• Log file captures clinician use of resources
• Records user, function, location
• User type determined from user directory
• Context of use can be inferred

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Logging Information Resource Use
WebCIS Logon Screen
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Log File Examples

• 161438Resourcenobody156.1.5.1salk.cpmc.colum
  bia.edu/mdxdocs
• 161646WebCISciminoj156.1.5.1lab2003-03-02-0
  5.19.00.819650
• 161855WebCISciminoj156.1.5.1healthresource
• 162118Resourceciminoj156.1.5.1salk.cpmc.colu
  mbia.edu/mdxdocs
• 162430WebCISciminoj156.1.5.1lab1997-09-02-1
  5.54.00.359121
• 162512WebCISciminoj156.1.5.1pubmed
• 162548WebCISciminoj156.1.5.1micromedex
• 163238WebCISciminoj156.1.5.1phar
• 162548WebCISciminoj156.1.5.1micromedex

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Log File Results

• Six months of log files
• 38,763 health resources
• 14,036 anonymous health resources
• 19,913 health resources from WebCIS
• 4,814 infobuttons
• 2,607 users
• 51 resident physicians
• 34 attending physicians
• 5 nurses
• 10 other (pharmacists, administrators, etc.)

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Information Resource Usage
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Information Use Contexts
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Context-Specific Resource Use
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Methods

• Log file captures clinician use of resources
• Records user, function, location
• User type determined from user directory
• Context of use can be inferred

• Log file captures clinician use of resources
• Records user, function, location
• User type determined from user directory
• Context of use can be inferred

• Questionnaire to determine
• Are they using resources through our system?
• Why do they use resources?
• What resources do they use?
• What resources do they like?
• What other resources do clinicians use?
• Do survey results match log files?

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Survey Population

• 1055 resources users in 01/03
• 250 randomly surveyed
• 45 (18) returned
• 23 attendings
• 19 housestaff
• 3 nurses
• 1 pharmacist

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Using Resources through WebCIS

• 14 anonymous only
• 17 in WebCIS only
• 11 both
• 3 neither
• All used resources in WebCIS

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Why do they use resources?

• 43 for patient-specific issues
• 23 for general knowledge
• 3 for other reasons
• writing
• teaching
• studying

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What resources do they use? Like?

• No marked difference between user types
• Log files corroborated usage claims
• 26/45 said do not use (although 38/45 used)

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What about other resources?

• Reources used
• Up To Date
• MD Consult
• New England Journal of Medicine
• Epocrates
• Google
• Books
• Reasons for use
• 28 for patient-specific issues
• 25 for general knowledge
• 1 for teaching

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Lessons Learned

• Log files representative of resource use
• Our users tend to use Health Resources page
• Surveys reflect observed usage
• Micromedex is most popular resource
• Other resources needed (e.g. UpToDate)
• Resource use is for patient-specific reasons
• Most resource use is within patient context
• Laboratory results are most popular context
• Context does influence resource use
• Infobuttons actually get used!
• Infobuttons can be preferred!

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Information Needs Study
Method Development
Study 2 Identify information resources currently
being used
Study 1A Identify information needs events

2A Log file analysis
2B Survey
Characteristics of Information Needs Events
Observational Study
Characteristics of Resource Use
Study 1B Classify Information Needs Events

Categories of Generic Question
Classification
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Where Do We Go From Here?

• Up To Date has been added
• Infobutton Manager matches context to questions
• Focus on laboratory-related questions
• Focus on ways to exploit Micromedex
• Extend Infobutton Manager to other institutions
• www.dmi.columbia.edu/homepages/ciminoj/Infobutton
  s.html

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Conclusions From the Three Studies

• Information needs arise while using clinical
  systems
• Needs can be detected and characterized
• Information needs are context-specific
• Information needs are stereotypic
• Satisfaction is often unsuccessful or deferred
• Resource use is context-specific
• Infobuttons are a viable way to resolve needs
• Offer context-specific retrievals for specific
  needs
• Provide shortcut to popular resources
• Infobuttons are an institution- and
  application-independent way to improve resolution
  of information needs and reduce medical errors

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Acknowledgments

• National Library of Medicine research grant
• National Library of Medicine training grant
• Rick Gallagher for log file support
• www.dmi.columbia.edu/homepages/ciminoj/Infobuttons
  .html