resolving clinicians’ on-line information needs: a brief history of buttons
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Resolving Clinicians’ On-Line Information Needs: A Brief History of Buttons. James J. Cimino, M.D. Biomedical Informatics and Medicine Columbia University June 24, 2005. Objectives. Studying clinician information needs Evolution of infobuttons Research issues The Coumadin Story. - PowerPoint PPT PresentationTRANSCRIPT
Resolving Clinicians’ On-Line Information Needs:
A Brief History of Buttons
James J. Cimino, M.D.Biomedical Informatics and Medicine
Columbia UniversityJune 24, 2005
Objectives
• Studying clinician information needs
• Evolution of infobuttons
• Research issues
• The Coumadin Story
Everybody is worried about losing their job to automation. They’re afraid they’ll be replaced by a button. But I’m smart. I’m going to get a job in the factory where they make the buttons.
- Jackie Gleason, The Jackie Gleason Show, circa 1968
1984 1986 1988 1990 1992 1994 1996 1998 2000 2002 2004
Covell et al.Information Needs
Studying Information Needs
Covell DG, Uman GC, Manning PR. Information needs in office practice: are they being met? Ann Intern Med. 1985 Oct;103(4):596-9.
Findings of Observational Studies
• 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
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!
Information for Decision-Making
Information for Decision-Making
?MRSA
Information for Decision-Making
1984 1986 1988 1990 1992 1994 1996 1998 2000 2002 2004
Covel et al.Information Needs
UMLSProject
Unified Medical Language System
The purpose of the UMLS is to improve the ability of computer programs to “understand” the biomedical meaning in user inquiries and to use this understanding to retrieve and integrate relevant machine-readable information for users.
- Donald A.B. Lindberg 1986/1993
1984 1986 1988 1990 1992 1994 1996 1998 2000 2002 2004
Covel et al.Information Needs
UMLSProject
First Versionof UMLS
ICD9MeSH
MedlineButton
First Attempt: The Medline Button
• CIS (WebCIS’s predecessor) on mainframe• BRS/Colleague (Medline) on same mainframe• Get them to talk to each other• Search using patient diagnoses and procedures
First Attempt: The Medline Button
• CIS (WebCIS’s predecessor) on mainframe• BRS/Colleague (Medline) on same mainframe• Get them to talk to each other• Search using patient diagnoses and procedures• Technical success• Practical failure
1984 1986 1988 1990 1992 1994 1996 1998 2000 2002 2004
Covel et al.Information Needs
UMLSProject
First Versionof UMLS
ICD9MeSH
MedlineButton
Mosaic
Web-basedGeneric Queries
PubMED
WebCIS
1984 1986 1988 1990 1992 1994 1996 1998 2000 2002 2004
G.O. BarnettDXplain
Covel et al.Information Needs
UMLSProject
First Versionof UMLS
ICD9MeSH
MedlineButton
Mosaic
Web-basedGeneric Queries
PubMED
Web DXplain
DXplainButton
WebCIS
Cholesterol
Hypercholesterolemia
Serum Cholesterol Test
Serum Specimen
Serum
From Data to Findings
Abnormalities ofSerum Cholesterol
1984 1986 1988 1990 1992 1994 1996 1998 2000 2002 2004
G.O. BarnettDXplain
Covel et al.Information Needs
UMLSProject
First Versionof UMLS
ICD9MeSH
MedlineButton
Mosaic
Infobuttons
Web-basedGeneric Queries
PubMED
Web DXplain
DXplainButton
WebCIS
Information Resource Usage
6%
4%
4%
4%
51%
3%3%7%
6%
1% 1%10% MicromedexPharmacy IBSensitivity IBCulture IBOvid MedlineOnline FormularyHarrison'sPubMedJournalsMedlinePlusICD9-CMOther Resources
12% IBs
Context-Specific Resource Use
0%
20%
40%
60%
80%
100%
Sensitivity IB
Culture IB
Pharmacy IB
Medlineplus
ICD9-CM
Journals
PubMed
Harrison's
Formulary
Ovid Medline
Micromedex
“Just in Time” Education
MRSA
“Just in Time” Education
UnderstandInformation
Needs
1MRSA
“Just in Time” Education
Get InformationFrom EMR
UnderstandInformation
Needs
1
2
MRSA
“Just in Time” Education
Get InformationFrom EMR
ResourceSelection
UnderstandInformation
Needs
1
2
3
MRSA
“Just in Time” Education
Get InformationFrom EMR
ResourceSelection
ResourceTerminology
UnderstandInformation
Needs
1
24
3
MRSA
“Just in Time” Education
Get InformationFrom EMR
ResourceSelection
ResourceTerminology
UnderstandInformation
Needs
AutomatedTranslation
1
254
3
MRSA
“Just in Time” Education
Get InformationFrom EMR
ResourceSelection
ResourceTerminology
QueryingUnderstandInformation
Needs
AutomatedTranslation
1
254
6
3
MRSA
“Just in Time” Education
Get InformationFrom EMR
ResourceSelection
ResourceTerminology
Querying
Presentation
UnderstandInformation
Needs
AutomatedTranslation
1
254
6
37
MRSA
Research Issues
• What are the information needs?
Portable Usability LabUser’s Workstation
Microphone
Video Converter
75 foot cable
Converter Controller
Cassette Recorder VCRHeadphones
Video Monitor
What are the Information Needs?• Observations:
– Four days, three sites, 159 minutes of videotape
– 154 information needs• 1/3 information about the patient
– Abdominal CT was abnormal, what are LFTs?
• 1/3 institutional information– What specimen do I collect for this test?
• 1/3 health information– What does this pill look like?– What are the patient instructions?
• Computers used 50% of the time• 81/154 needs not satisfied
Research Issues
• Which context information is important?
• What are the information needs?
Context-Dependent Information Needs
Age Sex TrainingRole DataTask
Context
? !
Institution
Research Issues
• What resources can satisfy needs?• How can retrieval be automated?
– What context data are used?– How are the data translated?
• What are the information needs?• Which context information is important?
The Medical Entities Dictionary (MED)
Research Issues
– How are the data transmitted?
• 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?
1984 1986 1988 1990 1992 1994 1996 1998 2000 2002 2004
G.O. BarnettDXplain
Covel et al.Information Needs
UMLSProject
First Versionof UMLS
ICD9MeSH
MedlineButton
Mosaic
Infobuttons
Web-basedGeneric Queries
InfobuttonManager
PubMED
Web DXplain
DXplainButton
WebCIS
Infobuttons vs. Infobutton Manager
Pageof
Hyperlinks
InfobuttonClinical System Resourc
e
InfobuttonManager
Context
s
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.
Discussion• Resources are available• Simple interactions are usually possible• Interaction method (format) issues:
– “Give me a page” vs. “Give me the answer”– Standards needed for asking questions– Standards needed for passing parameters
• Representation (terminology) issues:– Clinical systems use homegrown “standards”– Resources (except PubMed) don’t use any
standards (i.e., they are indexed by text word)
1984 1986 1988 1990 1992 1994 1996 1998 2000 2002 2004
G.O. BarnettDXplain
Covel et al.Information Needs
UMLSProject
First Versionof UMLS
ICD9MeSH
MedlineButton
Mosaic
Infobuttons
Web-basedGeneric Queries
InfobuttonManager
InfobuttonManagerStandard
PubMED
Web DXplain
DXplainButton
WebCIS
Next Steps
• Evaluation
Next Steps
• Evaluation• Order entry Infobuttons• Collaborations: LDS/IHC, Regenstrief and NYSPI• Infobutton Manager to be an ANSI standard
Conclusions• Information needs arise while using CIS• Infobuttons are easy to build• Build it and they may not come• Can retrievals be standardized?• Will information needs be satisfied?• Will care improve?• Resources exist• Creative solutions required• Need to engage resource providers• Infobutton manager provides a platform for
exploration
Button.- Jimmy Cimino, 1956
Acknowledgments• The Columbia team:
– Jianhua Li– Sue Bakken– Vimla Patel– Mureen Allen– Leanne Currie– Mark Graham
• LDS/IHC: Guilherme del Fiol, Stan Huff• Regenstrief: Marc Overhage• NYSPI: Tom White• National Library of Medicine research grant• National Library of Medicine training grant• National Institute of Nursing Research
www.dmi.columbia.edu/homepages/ciminoj/Infobuttons.html