Infobuttons: Context-specific Links from Clinical Systems to On-Line Knowledge Resources to

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Infobuttons Context-specific Links from
Clinical Systems to On-Line Knowledge Resources
to Anticipate and Address Clinician Information
Needs at the Point of Care

• James J. Cimino
• Chief, Laboratory for Informatics Development
• National Institutes of Health Clinical Center
• University of Maryland, School of Nursing, April
  18, 2008

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Todays Topics

• 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

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Health Knowledge for Decision Support
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Health Knowledge for Decision Support
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Infobuttons
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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

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First Attempt The Medline Button

• CIS on mainframe
• BRS/Colleague (Medline) on same mainframe
• Get them to talk to each other
• Search using diagnoses and procedures

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First Attempt The Medline Button

• 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

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Education at the Moment of Need
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Education at the Moment of Need
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Understand Information Needs
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Education at the Moment of Need
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Get Information From EMR
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Understand Information Needs
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Education at the Moment of Need
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Get Information From EMR
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Understand Information Needs
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Resource Selection
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Education at the Moment of Need
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Get Information From EMR
Resource Terminology
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Understand Information Needs
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Resource Selection
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Education at the Moment of Need
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Get Information From EMR
Automated Translation
Resource Terminology
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Understand Information Needs
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Resource Selection
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Education at the Moment of Need
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5
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Get Information From EMR
Automated Translation
Resource Terminology
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Querying
Understand Information Needs
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Resource Selection
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Education at the Moment of Need
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5
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Get Information From EMR
Automated Translation
Resource Terminology
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Querying
Understand Information Needs
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Resource Selection
Presentation
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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?

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Infobuttons vs. Infobutton Manager
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The Coumadin Story

• Chair of Medicine wants link to Coumadin protocol
• First, I have to find the guidelines

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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

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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

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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
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Usage in In-Patient Drug Contexts
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Usage in Diagnosis Context
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Usage in Lab Order Entry Context
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Usage in InPat Drug Order Entry
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Institution-Specific Requirements

• 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?

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New York Presbyterian Hospital (Eclipsys)
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NY Office of Mental Health (Psykes)
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NY Office of Mental Health (Psykes)
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Regenstrief Medical Record System
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Cryststal Run Healthcare (NextGen)
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Institution Customization Tasks
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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?

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Librarian Infobutton Tailoring Environrment (LITE)

• Specify user contexts
• Identify terminology in each context
• Information needs in each context
• Resources for resolving information needs
• Automating translation and querying

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Institution Customization Tasks
System Maintainer
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LITE Tasks
Librarian Infobutton Tailoring Environment (LITE)

Context Definition
Translation Table
Term Translation
Context Table
Context Matching
Institution Librarian
Infobutton Table
Query Construction
LITE Auditing
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LITE Research Plan

• 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

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Initial Efforts

• Drupal site
• Community of users
• Clear through Institutional Review Board
• Enroll subjects
• Make each draft a forum topic
• Collect feedback
• Iterate

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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!

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Acknowledgments

• Jianhua Li
• Many student contributors
• Guilherme Del Fiol
• Noemie Elhadad
• National Library of Medicine

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www.infobuttons.org
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lite.dbmi.columbia.edu