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Allen Pavilion Medicine Grand Rounds

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Allen Pavilion Medicine Grand Rounds Medical Informatics James J. Cimino, MD, FACP, FACMI Professor of Medicine and Biomedical Informatics – PowerPoint PPT presentation

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Title: 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
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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
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35
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36
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37
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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
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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
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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
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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
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51
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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?
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