Infobuttons

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Infobuttons

• James J. Cimino
• Chief, Laboratory for Informatics Development
• National Institutes of Health Clinical Center
• Senior Scientist, Lister Hill Center for
  Biomedical Communications
• National Library of Medicine

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Resolving Computer-Inspired Information Needs

• Providing patient information evokes additional
  information needs
• These needs are stereotypical
• Resources exist to address these needs
• If we can predict the needs, we can provide links
• Information available in the context can be used
  to target the resources

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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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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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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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Infobuttons vs. Infobutton Manager
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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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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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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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AMIA 2007 Demo Participants

• Health care academic institutions
• Intermountain Healthcare, Columbia University,
  Partners Healthcare
• Content providers
• Wolters Kluwer Health, ACP, Micromedex,
  UpToDate, Ebsco, Lexicomp

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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?
• How do we deal with terminology?
• How can the Infobutton Manager be integrated into
  the clinical information system?
• The institutions librarian is the best person to
  resolve most of these issues

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Institution Customization Tasks
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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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Status Report

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

• 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

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Acknowledgments

• Jianhua Li for programming
• Many student contributors
• Guilherme Del Fiol (U of Utah)
• Noemie Elhadad
• National Library of Medicine