Transcript Use of Online Resources While Using a Clinical Information

Technical Aspects of the
Infobutton Manager
James J. Cimino
Columbia University
Overview
• History (Medline Button and Infobuttons
• Architectural Overview of the Infobutton Manager
• Demo (WebCIS and Eclipsys)
• How Infobutton Manager links work
• Terminology Issues
• Integrating with clinical systems
• How can I play?
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
_
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:
_
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
1
Infobutton Manager Architecture
Infobutton Manager
L
i
n
k
s
Context Table
Question
Selection
Instantiation
Context
Matching
Question Table
C
o
n
t
e
x
t
Resolving Clinician Information Needs
Infobutton Manager
4
Question
Selection
5
Presentation
Of Questions
6
Query a
Resource
3
Context
Matching
Infobutton
2
Extract
Context Data
1
Information
Need Triggered
By Clinical Data
7
Presentation of
Query Results
Demonstrations
• WebCIS
• Eclipsys XA
How Infobutton Manager Links Work
• Simple link
• Concept-based link
• Simple search
• Concept-based search
• Intelligent agent
• Calculator
• Match concept of interest to class(es)
• Identify context based on class(es)
• Retrieve question(s) for context
• Sort by “priority”
• Return HTML page of links (URLs)
How Infobutton Manager Links Work
• Simple link
• Concept-based
link
• Simple search
• Concept-based
search
• Intelligent agent
• Calculator
• Question has “hardcoded” URL
e.g.:
“www.columbia.edu/potassium.pdf”
How Infobutton Manager Links Work
• Simple link
• Concept-based
link
• Simple search
• Concept-based
search
• Intelligent agent
• Calculator
http://infonet.nyp.org/Pharmacy/Pharmacy-M/AdultPotassium_030503_.pdf
How Infobutton Manager Links Work
• Simple link
• Concept-based
link
• Simple search
• Concept-based
search
• Intelligent agent
• Calculator
• Translate concept of interest to
controlled term
• Find controlled term in data dictionary
• Obtain term attribute for constructing
URL from data dictionary
• Construct URL, e.g.:
www.columbia.edu/lab/<>.html
+ cl001900
.
www.columbia.edu/lab/cl001900.html
How Infobutton Manager Links Work
• Simple link
• Concept-based
link
• Simple search
• Concept-based
search
• Intelligent agent
• Calculator
http://cpmclabinfo.cpmc.columbia.edu/chapter/mono/cl001900.htm#Container
How Infobutton Manager Links Work
• Simple link
• Concept-based
link
• Simple search
• Concept-based
search
• Intelligent agent
• Calculator
Insert concept of interest into CGI
function call as a parameter
e.g.:
www.Uptodate.com/search.cgi?term=<>
+ POTASSIUM
.
www.Uptodate.com/search.cgi?term=POTASSIUM
How Infobutton Manager Links Work
• Simple link
• Concept-based
link
• Simple search
• Concept-based
search
• Intelligent agent
• Calculator
http://…./vocab.asp&search=POTASSIUM&submit=Go&app=utdol
How Infobutton Manager Links Work
• Simple link
• Concept-based
link
• Simple search
• Concept-based
search
• Intelligent agent
• Calculator
• Translate concept of interest to
controlled term
• Obtain term translation from data
dictionary
• Insert translated term into CGI
function call as a parameter
e.g.:
pubmed.gov/search.cgi?term=<>[MeSH+Terms]
+ Potassium
.
pubmed.gov/search.cgi?term=Potassium[MeSH+
Terms]
How Infobutton Manager Links Work
• Simple link
• Concept-based
link
• Simple search
• Concept-based
search
• Intelligent agent
• Calculator
http://…/entrez/query.fcgi?…POTASSIUM[MeSH+Terms]+toxicity[MeSH+…
How Infobutton Manager Links Work
• Simple link
• Concept-based
link
• Simple search
• Concept-based
search
• Intelligent agent
• Calculator
• Resource is not a simple
document or search CGI
• Log-on, navigation or other
interaction required
• Multiple context parameters used
• Agent:
- parses context parameters
- interacts with resource
- parses results
- presents summary
- may modify links
How Infobutton Manager Links Work
• Simple link
• Concept-based
link
• Simple search
• Concept-based
search
• Intelligent agent
• Calculator
…#PDRADR01
How Infobutton Manager Links Work
• Simple link
• Concept-based
link
• Simple search
• Concept-based
search
• Intelligent agent
• Calculator
• No resource available
• Interaction too complex
• Create self-contained agent:
- parses context parameters
- constructs Web page
- presents results
- may have Infobuttons of its own
How Infobutton Manager Links Work
• Simple link
• Concept-based
link
• Simple search
• Concept-based
search
• Intelligent agent
• Calculator
The Coumadin Story
• Chair of Medicine wants link to Coumadin
protocol
• First, I have to find the guidelines
The Coumadin Story
• Chair of Medicine wants link to Coumadin
protocol
• First, I have to find the guidelines
• Then I have to add the question to the IM table
The Coumadin Story
• Chair of Medicine 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…
The Coumadin Story
• Chair of Medicine 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…
• … and I’m done - about 15 minutes.
How can I play?
• Can your system evoke a Web browser?
• Can you customize the URL?
“GET” Method:
<a href=“flux.cpmc.columbia.edu/webcisdev13/wc_infomanage.cgi?
Info_institute=CPMC&info_med=1560&info_context=LabDetail”> <img
info.gif\"></a>
- OR “POST” Method:
<form method="POST" TARGET="INFO" NAME="INFO"
action="flux.cpmc.columbia.edu/webcisdev13/wc_infomanage.cgi">
<input type="HIDDEN" name="info_institute" value="CPMC">
<input type="HIDDEN" name="info_med" value="1560">
<input type="HIDDEN" name="info_context" value="LabDetail">
<input type="HIDDEN" name=“DOB" value="1951-05-26">
<input type="HIDDEN" name=“info_age" value=“52">
<input type="HIDDEN" name=“info_sex" value="F">
<input type="HIDDEN" name=“info_usertype" value=“MD">
<input type="HIDDEN" name=“info_mrn" value="3131313">
<input type="HIDDEN" name=“info_user" value="ciminoj">
<input type="HIDDEN" name="info_other" value="1560|6.8|10.020.0|mg/l|1559|29.7|20.0-40.0|mg/l|">
</form>
Note that “1560” is the MED Code for Serum Phenytoin Test. Other acceptable values
for info_med include “14877-5” (the LOINC Code) and “PHENYTOIN”.
How can I play?
•
•
•
•
Can your system evoke a Web browser?
Can you customize the URL?
Decide what information needs you have
Decide how you want to address the needs
Infobutton Manager Parameters
Parameter
info_institute
info_med
Name
User's Insitution
Concept of
Interest
info_context
Application
Context
DOB
info_age
info_sex
Date of Birth
Age in Years
Patient Gender
info_usertype User Type
“GET” Method:
info_mrn
Patient Identifier
info_user
User ID
<a href=“flux.cpmc.columbia.edu/webcisdev13/wc_infomanage.cgi?
Other patient
info_other
data
Info_institute=CPMC&info_med=1560&info_context=LabDetail”>
<img
info.gif\"></a>
- OR “POST” Method:
<form method="POST" TARGET="INFO" NAME="INFO"
action="flux.cpmc.columbia.edu/webcisdev13/wc_infomanage.cgi">
<input type="HIDDEN" name="info_institute" value="CPMC">
<input type="HIDDEN" name="info_med" value="1560">
<input type="HIDDEN" name="info_context" value="LabDetail">
<input type="HIDDEN" name=“DOB" value="1951-05-26">
<input type="HIDDEN" name=“info_age" value=“52">
<input type="HIDDEN" name=“info_sex" value="F">
<input type="HIDDEN" name=“info_usertype" value=“MD">
<input type="HIDDEN" name=“info_mrn" value="3131313">
<input type="HIDDEN" name=“info_user" value="ciminoj">
<input type="HIDDEN" name="info_other" value="1560|6.8|10.020.0|mg/l|1559|29.7|20.0-40.0|mg/l|">
</form>
Allowable Values
Required
CPMC, RMRS, LDS
Yes
MED Code, LOINC
Yes
Code or LOINC Name
LabDetail, LabSummary,
RadiologyReport,
Yes
InPatientDrugs,
OutPatientDrugs,
YYYY-MM-DD
No
Integer
No
M or F
No
MD, RN, Other
No
Any string
Any string
Any string (interpreted by
information resource)
No
No
Note that “1560” is the MED Code for Serum Phenytoin Test. Other acceptable values
for info_med include “14877-5” (the LOINC Code) and “PHENYTOIN”.
No
How can I play?
•
•
•
•
•
Can your system evoke a Web browser?
Can you customize the URL?
Decide what information needs you have
Decide how you want to address the needs
Address the terminology issue
Automated Retrieval with Clinical
Data
4
Resource
Terminology
5
2
Automated
Translation
Get Information
From EMR
6
MRSA
1
Querying
Understand
Information
Needs
3
Resource
Selection
7
Presentation
How can I play?
•
•
•
•
•
•
Can your system evoke a Web browser?
Can you customize the URL?
Decide what information needs you have
Decide how you want to address the needs
Address the terminology issue
Coordinate with me
<a href="Javascript:get_info('35702')"><img src="info.gif"></a>
function get_info(mc){ var infowin = window.open("","INFO");
infowin.focus(); document.INFO.info_med.value=mc;
document.INFO.submit(); }
<form method="POST" name=“INFO”
action="wc_infomanage.cgi">
<input type="HIDDEN" name="info_med" value="">
<input type="HIDDEN" name="info_context" value="LabDetail">
<input type="HIDDEN" name="info_institute" value="CPMC">
<input type="HIDDEN" name="DOB" value="1951-05-26">
<input type="HIDDEN" name="SEX" value="F">
<input type="HIDDEN" name="USER" value="ciminoj">
</form>
Acknowledgments
• National Library of Medicine research grant
• National Library of Medicine training grant
• National Institute of Nursing Research
[email protected]
www.dmi.columbia.edu/homepages/ciminoj/Infobuttons.html