RESULTS: PHASE II

1
Infobuttons A Study of Usability Lily Gutnik1,
Sarah Collins RN, BSN2, Leanne M. Currie RN,
DNSc1,2 James J. Cimino MD1, Vimla L. Patel,
PhD, DSc1Columbia University, New York, NY,
1Department of Biomedical Informatics, 2School of
Nursing,

• METHODS PHASE II
• Study Design
• Laboratory study examining IM use by nurses and
  physicians
• Survey of satisfaction with the infobutton
  manager
• Participants
• 2 nurses (RN), 1 physician (MD), and 1
  physicians assistant (PA)
• Procedures
• Participants were given a script with 3 scenarios
  with a set of tasks
• Participants were asked to "think aloud" as they
  used the IM and the resources
• Morae software was used to capture the computer
  screen and the audio recording of the user

• PURPOSE
• To determine the usability of the Infobutton
  interface to resolve clinicians information
  needs

• CONCLUSIONS
• Clinicians commonly have information needs as
  they treat their patients
• Nurses have information needs throughout their
  day
• During laboratory sessions with 4 clinicians, 79
  information needs events were observed
• The most commonly occurring question types were
• What are my patient's data? and Can drug x
  cause (adverse) finding y?
• Most information needs events were successful,
  and domain-related
• Frequent documentation by nurses in the CCU
  suggests that the IM may provide a useful and
  accessible link for clinicians seeking
  information resources at the point of care
• This study accentuated the need to be mindful of
  information overload

• BACKGROUND
• Studies of clinicians information needs while
  treating patients have shown that the resolution
  of these needs is often deferred or fails, which
  may lead to medical errors
• The Infobutton Manager (IM) was developed to help
  improve the resolution of information needs by
  providing users with links to on-line health
  information resources
• The aim of this study was to determine the
  usability of the Infobutton interface to resolve
  clinicians information needs

RESULTS PHASE II

• METHODS PHASE I
• Study Design
• Ethnographic evaluation of the clinical work
  environment
• Participants
• One nurse in the Coronary Care Unit (CCU)
• Procedures
• Data collection was limited to note-taking and
  asking basic questions regarding CCU workflow and
  the use of technologies
• Data were coded to characterize general clinical
  information system (CIS) related activities and
  communication between RN and team

RESULTS PHASE II
Question Types MD1 PA RN1 RN2 Total
What is the drug of choice for condition x? 0 0 0 0 0
What is the cause of symptom x? 0 0 1 0 1
What test is indicated in situation x? 0 0 0 0 0
What is the dose of drug x? 2 5 1 1 9
How should I treat condition x? 0 0 0 0 0
How should I manage condition x? 2 5 3 0 10
What is the cause of physical finding x? 0 0 0 0 0
What is the cause of test finding x? 0 0 0 0 0
Can drug x cause (adverse) finding y? 5 3 5 1 14
Could this patient have condition x? 1 0 0 0 1
What are my patient's data? 0 3 5 7 15
How do we do this here? 3 4 0 0 7
What are this institution-specific data? 2 2 3 3 10
What is this? 1 3 4 3 11
What is the expected outcome? 0 0 1 0 1
Total 16 25 23 15 79
Information Needs Taxonomy Items MD 1 PA RN3 RN4 Total
Success 12 16 15 5 48
Deferred 1 2 2 10 15
Failure 3 7 6 0 16
Subject 0 0 2 0 2
Domain 0 6 7 3 16
Institution 0 0 2 3 5
Subject-Institution 0 0 0 0 0
Subject-Domain 10 9 6 8 33
Institution-Domain 6 10 4 1 21
Subject-Domain-Institution 0 0 2 0 2
Information Retrieval-Internal Source 3 10 6 7 26
Information Retrieval-External Source 12 14 17 8 51
Calculation 1 1 0 0 2
Natural Language Processing 0 0 0 0 0

• RESULTS PHASE I
• Phase I Ethnographic Observation
• Information needs were observed to occur at two
  time points when the nurse was using the CIS
  during the workday
• 1. At the beginning of shift when reviewing the
  electronic chart
• 2. During documentation of nursing activities
  throughout the day (e.g., after each patient
  assessment)

INFOBUTTONS IN USE Examples of Context Specific
Links to Web-based Materials
Web-based Medical Reference
Web-based Patient Education Materials
Web-based Calculator
Information Needs Coding Framework

• Question Types
• From Elys Taxonomy
• What is the drug of choice for condition x?
• What is the cause of symptom x?
• What test is indicated in situation x?
• What is the dose of drug x?
• How should I treat condition x (not limited to
  drug treatment)?
• How should I manage condition x (not specifying
  diagnostic or therapeutic)?
• What is the cause of physical finding x?
• What is the cause of test finding x?
• Can drug x cause (adverse) finding y?
• From Infobutton Project
• Could this patient have condition x?
• What are my patient's data?
• How do we do this here?
• What is this institution-specific data?
• What is this?

Expression of Need Implicit/Explicit Basis of
Need Foreground/Background Context in CIS
e.g., Lab, Pharmacy, CPOE Resource Type
Human/Computer/Paper Success Rate
Success/Deferred/Failed
ACKNOWLEDGMENTS This project was supported by US
National Library of Medicine 1R01LM07593.