Transcript Infobuttons LITE: The Librarian Infobutton Tailoring

Webinar:
Publishing for the EHR 101
James J. Cimino
Chief, Laboratory for Informatics Development
National Institutes of Health Clinical Center
May 20, 2008
Today’s Topics
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My personal information needs
The Medline Button
Infobuttons
Clinician use of information resources
The Infobutton Manager
Methods for accessing sources
The HL7 standard for Infobutton Managers
Librarian Infobutton Tailoring Environment
My Personal Information Needs
Addressing Information Needs with
Infobuttons
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Clinical information systems evoke information
needs
Clinician’s computer has access to resources
Context can be used to predict need
Context can be used to automate retrieval
Infobuttons
Anticipate
Need and
Provide
Queries
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First Attempt: The Medline Button
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CIS on mainframe
BRS/Colleague (Medline) on same mainframe
Get them to talk to each other
Search using diagnoses and procedures
Admission Profile
----------------------------------------------------------------------------Admission Date: 01/03/95 Discharge Date: 02/16/95
Location:
Doctor: CIMINO, JAMES J
Discharge Summary: N
Primary Diagnosis: 410.71
ACUTE MI,SUBENDO INFARC, INITI
M6GS
Select Terms You Are Interested in:
X
X
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410.71
780.3
507.0
426.0
415.1
453.8
428.0
Diseases:
ACUTE MI, SUBENDO INFARC, INITI
CONVULSIONS
FOOD/VOMIT PNEUMONITIS
ATRIOVENT BLOCK COMPLETE
PULMON EMBOLISM/INFARCT
VENOUS THROMBOSIS NEC
CONGESTIVE HEART FAILURE
F8 = for more information
----------------------------------------------------------------------------Help=F1
Search MEDLINE=ENTER
MEDLINE Queries from Admission Profile
----------------------------------------------------------------------------Select a question:
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1.
Does Myocardial Infarction cause Convulsions?
2.
Is Myocardial Infarction caused by Convulsions?
3.
Does Myocardial Infarction occur with Convulsions?
----------------------------------------------------------------------------Help=F1
Search MEDLINE=ENTER
BRS Query from Admission Profile
----------------------------------------------------------------------------(Myocardial Infarction WITH (ET OR SC)) AND (Convulsions WITH CO)
----------------------------------------------------------------------------Help=F1
MEDLINE Queries=ENTER/F3
Session
Edit
Commands
Options
Help
^F File ^E Edit ^A Search ^L Limit ^V View
1
^T Tools
^O Options
Myocardial infarction/et,sc and convulsions/co
Ovid – Medline <1973-1983>
[To select option hold Ctrl and letter indicated.
Enter subject, then press <Enter>
_: _
Press ^Y for Help.]
^Y Help
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First Attempt: The Medline Button
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CIS on mainframe
BRS/Colleague (Medline) on same mainframe
Get them to talk to each other
Search using diagnoses and procedures
Technical success
Practical failure
Infobuttons
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Web-based
More resources
Hardwired links in clinical system
Customize search with concept of interest
Education at the Moment of Need
MRSA
Education at the Moment of Need
MRSA
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Understand
Information
Needs
Education at the Moment of Need
2
Get Information
From EMR
1
Understand
Information
Needs
Education at the Moment of Need
2
Get Information
From EMR
1
Understand
Information
Needs
3
Resource
Selection
Education at the Moment of Need
4
Resource
Terminology
2
Get Information
From EMR
1
Understand
Information
Needs
3
Resource
Selection
Education at the Moment of Need
4
Resource
Terminology
5
2
Automated
Translation
Get Information
From EMR
1
Understand
Information
Needs
3
Resource
Selection
Education at the Moment of Need
4
Resource
Terminology
6
5
2
Automated
Translation
Get Information
From EMR
1
Querying
Understand
Information
Needs
3
Resource
Selection
Education at the Moment of Need
4
Resource
Terminology
5
2
Automated
Translation
Get Information
From EMR
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1
Querying
Understand
Information
Needs
3
Resource
Selection
7
Presentation
Clinician Use of Information Resources
• Observational studies
• Log file analyses
• Surveys
User’s
Workstation
75 foot cable
Video Monitor
Portable Usability Lab
Converter Controller
Microphone
Video Converter
Cassette Recorder
Headphones
VCR
Information Use Contexts
9%
Laboratory
7%
3%
51%
Radiology
2%
Clinic Notes
2%
Pathology
2%
Visit Lists
Pharmacy
Discharge Sum.
24%
Other
Information Resource Usage
12% IBs
10% 1% 1%
6%
51%
6%
4%
4%
4%
3%
7% 3%
Micromedex
Pharmacy IB
Sensitivity IB
Culture IB
Ovid Medline
Online Formulary
Harrison's
PubMed
Journals
MedlinePlus
ICD9-CM
Other Resources
Context-Specific Resource Use
100%
Sensitivity IB
Culture IB
80%
Pharmacy IB
Medlineplus
60%
ICD9-CM
Journals
PubMed
40%
Harrison's
Formulary
20%
Ovid Medline
Micromedex
Ph
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Di
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Ca olic
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What Resources Do They Like?
40
35
30
15
25
Not Helpful
20
Somewhat Helpful
Very Helpful
10
5
0
Infobuttons vs. Infobutton Manager
Resource s
Clinical System
Infobutton
Query
Knowledge
Base
Context
Infobutton
Manager
Page
of
Hyperlinks
Measurement of Benefits
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Easy to use: 92%
Question on list >50% of time: 89%
Answered question: 69%
Useful: 77%
Helpful >50% of time: 90%
Positive effect on care: 74%
New York Presbyterian Hospital (Eclipsys)
New York Presbyterian Hospital (Eclipsys)
New York Presbyterian Hospital (Eclipsys)
New York Presbyterian Hospital (Eclipsys)
NY Office of Mental Health (Psykes)
NY Office of Mental Health (Psykes)
Regenstrief Medical Record System
Crystal Run Healthcare (NextGen)
Methods for Accessing Sources
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Simple link
Concept-based link
Simple search
Concept-based search
Intelligent agent
Calculator
Au
g0
N 2
ov
-0
Fe 2
bM 03
ay
Au 03
g0
N 3
ov
-0
Fe 3
bM 04
ay
Au 04
g0
N 4
ov
-0
Fe 4
bM 05
ay
Au 05
g0
N 5
ov
-0
Fe 5
bM 06
ay
Au 06
g0
N 6
ov
-0
Fe 6
bM 07
ay
Au 07
g07
Usage in Lab Contexts
2500
2000
1500
HR-LabDetail
IM-LabDetail
1000
500
0
Aug-07
May-07
Feb-07
Nov-06
Aug-06
May-06
Feb-06
Nov-05
Aug-05
May-05
Feb-05
Nov-04
Aug-04
May-04
Feb-04
Nov-03
Aug-03
May-03
Feb-03
Nov-02
Aug-02
Usage in In-Patient Drug Contexts
700
600
500
400
HR-InPatientDrugs
IM-InPatientDrugs
300
200
100
0
Aug-07
May-07
Feb-07
Nov-06
Aug-06
May-06
Feb-06
Nov-05
Aug-05
May-05
Feb-05
Nov-04
Aug-04
May-04
Feb-04
Nov-03
Aug-03
May-03
Feb-03
Nov-02
Aug-02
Usage in Diagnosis Context
900
800
700
600
500
HR-Diagnoses
400
IM-Diagnoses
300
200
100
0
Au
g0
N 2
ov
-0
Fe 2
bM 03
ay
Au 03
g0
N 3
ov
-0
Fe 3
bM 04
ay
Au 04
g0
N 4
ov
-0
Fe 4
bM 05
ay
Au 05
g0
N 5
ov
-0
Fe 5
b0
M 6
ay
Au 06
g0
N 6
ov
-0
Fe 6
bM 07
ay
Au 07
g07
Usage in Lab Order Entry Context
140
120
100
80
HR-LabOrder
60
IM-LabOrder
40
20
0
Aug-07
May-07
Feb-07
Nov-06
Aug-06
May-06
Feb-06
Nov-05
Aug-05
May-05
Feb-05
Nov-04
Aug-04
May-04
Feb-04
Nov-03
Aug-03
May-03
Feb-03
Nov-02
Aug-02
Usage in InPat Drug Order Entry
350
300
250
200
HR-DrugOrder
IM-DrugOrder
150
100
50
0
No Standard in Place
API
http://resource1.com/search.cgi?
Resource 1
search = “azithromycin AND dose”
http://resource2.com/
Clinical
Information
System
i
API
Infobutton
Manager
query = "azithromycin"[MeSH Terms]
AND dose[All Fields]
API
Resource 2
http://www.resource3.com/search.cgi?
searchConcept = 3333 ^ azithromycin
filter = 11 ^ dosage
API
Resource 3
Standards-Based Integration
HL7
Clinical
Information
System
i
HL7
Columbia
Intermountain
HL7
HL7
Resource 1
HL7
Resource 2
Partners
HL7
Resource 3
AMIA 2007 Demo Participants
• Health care & academic institutions
– Intermountain Healthcare, Columbia
University, Partners Healthcare
• Content providers
– Wolters Kluwer Health, ACP, Micromedex,
UpToDate, Ebsco, Lexicomp
Institution-Specific Requirements
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What are the users’ information needs?
In what contexts do those needs arise?
What resources will resolve the needs?
Terminology?
How can the Infobutton Manager be
integrated into the clinical information
system?
Institution Customization
• Institution librarians know their clients best
• Institution librarians know their resources
• How can librarians populate Infobutton
Manager tables?
• Terminology is institution-specific
• How do we handle institution-specific data
translation?
LITE Research Plan
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Conduct community assessment
Refine LITE features
Establish forum for feedback from librarians
Develop LITE in an iterative manner
Develop a user manual and tutorial
Evaluate usability of LITE by librarians
Evaluate the use of LITE
Disseminate the results of the project
Promote the use of the IM and LITE
Conclusions
• Infobuttons can anticipate and resolve
clinicians’ information needs
• Institution-specific tailoring is required
• LITE will make Infobutton Manager accessible
• HL7 standard will simplify links from commercial
clinical systems
• HL7 link to knowledge resources is feasible
Acknowledgments
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Jianhua Li
Many student contributors
Guilherme Del Fiol
Noemie Elhadad
National Library of Medicine
www.infobuttons.org
lite.dbmi.columbia.edu