Transcript Infobuttons LITE: The Librarian Infobutton Tailoring

The Librarian Infobutton
Tailoring Environment
(LITE)
James J. Cimino
National Institutes of Health and
Columbia University
Today’s Topics
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Clinician Information Needs
Infobuttons
Infobutton Managers
The Coumadin Story
Institution-Specific Requirements
Infobutton Manager Customization Tasks
Librarian Infobutton Tailoring Environment
– Research plan
– Initial efforts
– Getting involved
Health Knowledge for Decision Support
Infobuttons
Anticipate
Need and
Provide
Queries
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Information Needs of CIS Users
• Common tasks may have common needs
• System knows:
– Who the user is
– Who the patient is
– What the user is doing
– What information the user is looking at
• We can predict the specific need
• User is sitting at a computer!
• We can automate information retrieval
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?
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Is Myocardial Infarction caused by Convulsions?
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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
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^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>
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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
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
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Get Information
From EMR
MRSA
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Understand
Information
Needs
Education at the Moment of Need
2
Get Information
From EMR
MRSA
1
Understand
Information
Needs
3
Resource
Selection
Education at the Moment of Need
4
2
Get Information
From EMR
Resource
Terminology
MRSA
1
Understand
Information
Needs
3
Resource
Selection
Education at the Moment of Need
4
Resource
Terminology
5
2
Automated
Translation
Get Information
From EMR
MRSA
1
Understand
Information
Needs
3
Resource
Selection
Education at the Moment of Need
4
Resource
Terminology
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5
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Automated
Translation
Get Information
From EMR
MRSA
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Querying
Understand
Information
Needs
3
Resource
Selection
Education at the Moment of Need
4
Resource
Terminology
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Automated
Translation
Get Information
From EMR
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MRSA
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Querying
Understand
Information
Needs
3
Resource
Selection
7
Presentation
Research Issues
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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?
Infobuttons vs. Infobutton Manager
Resource s
Clinical System
Infobutton
Query
Knowledge
Base
Context
Infobutton
Manager
Page
of
Hyperlinks
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
• Voilá!
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Usage in Lab Contexts
2500
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1500
HR-LabDetail
IM-LabDetail
1000
500
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Usage in In-Patient Drug Contexts
700
600
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HR-InPatientDrugs
300
IM-InPatientDrugs
200
100
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Usage in Diagnosis Context
900
800
700
600
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400
300
200
100
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HR-Diagnoses
IM-Diagnoses
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Usage in Lab Order Entry Context
140
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HR-LabOrder
60
IM-LabOrder
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Usage in InPat Drug Order Entry
350
300
250
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HR-DrugOrder
150
IM-DrugOrder
100
50
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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?
New York Presbyterian Hospital (Eclipsys)
NY Office of Mental Health (Psykes)
NY Office of Mental Health (Psykes)
Regenstrief Medical Record System
Cryststal Run Healthcare (NextGen)
Institution Customization Tasks
Infobutton Manager
Infobutton Manager
Maintenance Tool
System
Maintainer
Functions:
Browse
Add
Update
Delete
Translation
Table
Term
Translation
Context
Table
Context
Matching
Infobutton
Table
Query
Construction
Clinician
Page of
Links
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?
Librarian Infobutton Tailoring
Environrment (LITE)
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Specify user contexts
Identify terminology in each context
Information needs in each context
Resources for resolving information needs
Automating translation and querying
Institution Customization Tasks
Infobutton Manager
Infobutton Manager
Maintenance Tool
System
Maintainer
Functions:
Browse
Add
Update
Delete
Translation
Table
Term
Translation
Context
Table
Context
Matching
Infobutton
Table
Query
Construction
Clinician
Page of
Links
LITE Tasks
Librarian Infobutton
Tailoring Environment
(LITE)
Context
Definition
Terminology
Specification
Institution
Librarian
Question
Construction
Infobutton Manager
Translation
Table
Term
Translation
Context
Table
Context
Matching
Infobutton
Table
Query
Construction
Page of
Links
Resource
Selection
Resource
Utilization
Infobutton
Manager
Log File
LITE Auditing
Infobutton Manager
Monitoring
LITE Monitoring
Clinician
LITE
Log File
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
Initial Efforts
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Drupal site
Community of users
Clear through Institutional Review Board
Enroll “subjects”
Make each draft a forum topic
Collect feedback
Iterate
Conclusion
• Infobuttons can anticipate and resolve
clinicians’ information needs
• Institution-specific tailoring is required
• International standard will stimulate wider
adoption
• Librarian Infobutton Tailoring Environment
will put the Infobutton Manager on autopilot
• Enrollment now open
• Demo version of LITE in testing now!
Acknowledgments
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Jianhua Li
Many student contributors
Guilherme Del Fiol
Noemie Elhadad
National Library of Medicine
NC/NMLG and MLGSC&A
www.infobuttons.org
lite.dbmi.columbia.edu