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Use of Online Resources While Using a Clinical Information System

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Title: Use of Online Resources While Using a Clinical Information System Author: James Cimino Last modified by: James Cimino Created Date: 10/24/2003 1:50:26 AM – PowerPoint PPT presentation

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Title: Use of Online Resources While Using a Clinical Information System


1
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

2
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
3
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?

4
Methods
  • Log file captures clinician use of resources
  • Records user, function, location
  • User type determined from user directory
  • Context of use can be inferred

5
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11
Logging Information Resource Use
WebCIS Logon Screen
12
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

13
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.)

14
Information Resource Usage
15
Information Use Contexts
16
Context-Specific Resource Use
17
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?

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

19
Using Resources through WebCIS
  • 14 anonymous only
  • 17 in WebCIS only
  • 11 both
  • 3 neither
  • All used resources in WebCIS

20
Why do they use resources?
  • 43 for patient-specific issues
  • 23 for general knowledge
  • 3 for other reasons
  • writing
  • teaching
  • studying

21
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)

22
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

23
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!

24
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
25
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

26
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

27
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
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