Allen Pavilion Medicine Grand Rounds

1
Allen Pavilion Medicine Grand Rounds
Medical Informatics

• James J. Cimino, MD, FACP, FACMI
• Professor of Medicine and Biomedical Informatics
• Columbia University
• May 13, 2004

2
Allen Pavilion Medicine Grand Rounds
Recognizing and Resolving Information Needs of
WebCIS Users

• James J. Cimino, MD, FACP, FACMI
• Professor of Medicine and Biomedical Informatics
• Columbia University
• May 13, 2004

3
Studying Information Needs

• Covell DG, Uman GC, Manning PR. Information needs
  in office practice are they being met? Ann
  Intern Med. 1985 Oct103(4)596-9.

4
Results of Observational Study

• 47 physicians
• Observed during a half day of typical practice
• Estimated 2-3 questions per physician per day
• 269 questions raised about patient management
• Only 30 were answered during the patient visit
• Usual resource was another physician

5
Other Observational Studies

• The information needs of practicing physicians in
  northeastern New York State.
• Assessment of physicians' information needs in
  five Texas counties
• Information needs of rural health care
  practitioners in Hawaii.
• Knowledge management in clinical practice a
  systematic review of information seeking behavior
  in physicians
• Information needs and information-seeking
  behaviors of on-call radiology residents
• Expanding the concept of medical information an
  observational study of physicians' information
  needs
• Curbside consultation practices and attitudes
  among primary care physicians and medical
  subspecialists
• Information needs of health care professionals in
  an AIDS outpatient clinic as determined by chart
  review
• Methods for assessing information needs of
  clinicians in ambulatory care.
• Real-time information-seeking behavior of
  residency physicians
• Information seeking in primary care how
  physicians choose which clinical questions to
  pursue and which to leave unanswered
• Physicians' use of computer software in answering
  clinical questions.
• Residents' medical information needs in clinic
  are they being met?

6
Findings

• Information needs occur often
• They are often unresolved
• Computer-based resources are underused
• Lack of knowledge of existence
• Lack of access
• Lack of navigational skills
• Perceived lack of time

7
Information Needs of CIS Users

• Stereotypical tasks suggest recurrent needs
• System knows
• Who the user is
• Who the patient is
• What the user is doing
• What information the user is looking at
• User is sitting at a computer!

8
One-Stop Information Shopping?
9
One-Touch Information Shopping
World Wide Web (The Facilitator)
Information Resources
Health Practitioner
Biblio- graphic Database
Textbook
Expert System
10
Information for Decision-Making
11
Information for Decision-Making
12
Information for Decision-Making
?
MRSA
13
Intelligent Decision Support
14
Intelligent Decision Support
15
Intelligent Decision Support
!
?
MRSA
16
Automated Decision Support
MRSA
17
Automated Decision Support
1
MRSA
Understand Information Needs
18
Automated Decision Support
2
Get Information From EMR
1
MRSA
Understand Information Needs
19
Automated Decision Support
2
Get Information From EMR
1
MRSA
Understand Information Needs
3
Resource Selection
20
Automated Decision Support
2
4
Get Information From EMR
Resource Terminology
1
MRSA
Understand Information Needs
3
Resource Selection
21
Automated Decision Support
2
5
4
Get Information From EMR
Automated Translation
Resource Terminology
1
MRSA
Understand Information Needs
3
Resource Selection
22
Automated Decision Support
2
5
4
Get Information From EMR
Automated Translation
Resource Terminology
6
1
MRSA
Querying
Understand Information Needs
3
Resource Selection
23
Automated Decision Support
2
5
4
Get Information From EMR
Automated Translation
Resource Terminology
6
1
MRSA
Querying
Understand Information Needs
3
7
Resource Selection
Presentation
24
First Attempt The Medline Button

• CIS (WebCISs predecessor) on mainframe
• BRS/Colleague (Medline) on same mainframe
• Get them to talk to each other
• Search using patient diagnoses and procedures
• Kludge required
• Technical success
• Practical failure

25
Research Issues

• What are the information needs?

26
Portable Usability Lab
Users Workstation
75 foot cable
Video Monitor
Converter Controller
Microphone
Video Converter
Headphones
VCR
Cassette Recorder
27
(No Transcript)
28
Research Issues

• What are the information needs?

• Which context information is important?

29
Context-Dependent Information Needs
30
Research Issues

• What are the information needs?
• Which context information is important?

• What resources can satisfy needs?
• How can retrieval be automated?
• What context data are used?
• How are the data translated?

31
The Medical Entities Dictionary (MED)
32
Research Issues

• What are the information needs?
• Which context information is important?
• What resources can satisfy needs?
• How can retrieval be automated?
• What context data are used?
• How are the data translated?

• How are the data transmitted?

33
(No Transcript)
34
(No Transcript)
35
(No Transcript)
36
(No Transcript)
37
(No Transcript)
38
(No Transcript)
39
(No Transcript)
40
Under the Hood

• Infobutton links in WebCIS pass context to
  Infobutton Manager (IM)
• IM matches context to questions
• IM uses MED to translate concepts
• IM constructs English questions and Web links

41
Translation for Decision Support
Injectable Gentamicin
Serum Gentamicin Level
Gentamicin
Gentamicn Sensitivity Test
Gentamicin Toxicity
42
Infobutton Manager Manager

• Maintains list of generic questions and links
• Maintains list of criteria for matching questions
• Placeholders are fill in the blanks (Madlibs)

43
The Coumadin Story

• Joe Tennenbaum wants link to Coumadin protocol
• First, I have to find the guidelines

44
(No Transcript)
45
The Coumadin Story

• Joe Tennenbaum wants link to Coumadin protocol
• First, I have to find the guidelines

• Then I have to add the question to the IM table

46
(No Transcript)
47
The Coumadin Story

• Joe Tennenbaum wants link to Coumadin protocol
• First, I have to find the guidelines
• Then I have to add the question to the IM table

• Finally, I link the question to the context

48
(No Transcript)
49
The Coumadin Story

• Joe Tennenbaum wants link to Coumadin protocol
• First, I have to find the guidelines
• Then I have to add the question to the IM table
• Finally, I link the question to the context

• Voilá!

50
(No Transcript)
51
(No Transcript)
52
(No Transcript)
53
Next Steps

• Repeat the observational study
• Look at system logs to see if
• Infobutton use is rising
• Use of other resources is falling
• Order entry Infobuttons
• Collaboration with Regenstrief and LDS
• Infobutton Manager to be an ANSI standard

54
Conclusions

• Information needs arise while using CIS
• Infobuttons are easy to build
• Are they the right buttons?
• Will information needs be satisfied?
• Will care improve?

55
Acknowledgments

• National Library of Medicine
• The team
• Jianhua Li
• Sue Bakken
• Vimla Patel
• Mureen Allen
• Leanne Currie
• Mark Graham

www.dmi.columbia.edu/homepages/ciminoj/Infobuttons
.html Any users out there?