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Integration of Health Information Resources into Electronic Health Records

Integration of Health Information Resources into Electronic Health Records. Guilherme Del Fiol, MD, MS Intermountain Healthcare University of Utah, Salt Lake City, UT

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Integration of Health Information Resources into Electronic Health Records

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  1. Integration of Health Information Resources into Electronic Health Records Guilherme Del Fiol, MD, MSIntermountain HealthcareUniversity of Utah, Salt Lake City, UT James J. Cimino, MD Department of Biomedical Informatics, Columbia University, New York, NYSaverio Maviglia, MD, MScPartners Healthcare System, Boston, MANick AckersonThomson Micromedex, Greenwood Village, CO

  2. Most answers can be found on the Web Barriers Used less than10% of the time Errors: 770,000 injuries and deaths annually in the US Point-of-care information needs 2 questions out of every 3 patients seen i Most questions left unanswered

  3. Topics of this Panel What are the benefits? Are people using infobuttons? How can I have infobuttons in my institution? Have content providers bought into this? Healthcare organizations EHR developers Contentproviders Are there any standards?

  4. Integration of Health Information Resources into Electronic Health Records  James J. Cimino, M.D. Department of Biomedical Informatics Columbia University College of Physicians and Surgeons 2006 AMIA Fall Symposium

  5. The Columbia/NYPH Infobutton Manager • Are people using infobuttons? • What are the benefits? • Are there any standards? • Are content providers bought into this? • How can I have Infobuttons in my institution?

  6. Infobuttons at My Institution • What is an Infobutton Manager? • How does the CU/NYPH Infobutton Manager work? • How do I integrate the CU/NYPH Infobutton Manager • Who is using the CU/NYPH Infobutton Manager? • How can I use the CU/NYPH Infobutton Manager

  7. Infobuttons at My Institution • What is an Infobutton Manager? • How does the CU/NYPH Infobutton Manager work? • How do I integrate the CU/NYPH Infobutton Manager • Who is using the CU/NYPH Infobutton Manager? • How can I use the CU/NYPH Infobutton Manager?

  8. Resource s Clinical System Infobutton Context Infobutton Manager Page of Hyperlinks Infobuttons vs. Infobutton Manager

  9. Infobuttons at My Institution • What is an CU/NYPH Infobutton Manager? • How does the CU/NYPH Infobutton Manager work? • How do I integrate the CU/NYPH Infobutton Manager • Who is using the CU/NYPH Infobutton Manager? • How can I use the CU/NYPH Infobutton Manager?

  10. Infobuttons at My Institution • What is an CU/NYPH Infobutton Manager? • How does the CU/NYPH Infobutton Manager work? • How do I integrate the CU/NYPH Infobutton Manager • Who is using the CU/NYPH Infobutton Manager? • How can I use the CU/NYPH Infobutton Manager?

  11. How Does the Infobutton Manager Work? Clinical Application/User’s Browser Integrate Link https://flux.cpmc.columbia.edu/webcisdev13/wc_infomanage.cgi? MRN=<xxx>&info_institute=<xxx>&info_med=<xxx>&info_context=<xxx>&info_usertype=<xxx>&info_age=<xxx>&info_sex=<xxx>

  12. Fill in Parameter Values How Does the Infobutton Manager Work? Clinical Application/User’s Browser Integrate Link https://flux.cpmc.columbia.edu/webcisdev13/wc_infomanage.cgi? MRN=3131313&info_institute=GENERIC&info_med=sodium& info_context=LabDetail&info_usertype=MD&info_age=22& info_sex=F

  13. Fill in Parameter Values User Clicks On Link Write to Log File Identify Terminology Translate to Terms of Interest How Does the Infobutton Manager Work? Clinical Application/User’s Browser Integrate Link Institute=CPMC & Context=LabDetail Concept=“sodium” Terms= CPMC Serum Sodium Test Sodium Ion Hypernatremia Hyponatremia CU/NYPH Infobutton Manager

  14. User Clicks On Link Call Resource Fill in Parameter Values Display Page Of Links User Clicks On Link Write to Log File Generate List of Questions/Links Write to Log File Identify Terminology Match Parameters to Contexts Translate to Terms of Interest How Does the Infobutton Manager Work? Clinical Application/User’s Browser Integrate Link CU/NYPH Infobutton Manager

  15. Infobuttons at My Institution • What is an CU/NYPH Infobutton Manager? • How does the CU/NYPH Infobutton Manager work? • How do I integrate the CU/NYPH Infobutton Manager • Who is using the CU/NYPH Infobutton Manager? • How can I use the CU/NYPH Infobutton Manager?

  16. Infobuttons at My Institution • What is an CU/NYPH Infobutton Manager? • How does the CU/NYPH Infobutton Manager work? • How do I integrate the CU/NYPH Infobutton Manager • Who is using the CU/NYPH Infobutton Manager? • How can I use the CU/NYPH Infobutton Manager?

  17. Agree on Domain And Terminology Identify Resources Identify Questions Determine Method for Automated Retrieval Identify Contexts Integrate with Clinical System to Pass Parameters Add Everything to the Infobutton Manager Manager How do I integrate the Infobutton Manager? Contact me: jjc7@columbia.edu

  18. Infobuttons at My Institution • What is an CU/NYPH Infobutton Manager? • How does the CU/NYPH Infobutton Manager work? • How do I integrate the CU/NYPH Infobutton Manager • Who is using the CU/NYPH Infobutton Manager? • How can I use the CU/NYPH Infobutton Manager?

  19. Infobuttons at My Institution • What is an CU/NYPH Infobutton Manager? • How does the CU/NYPH Infobutton Manager work? • How do I integrate the CU/NYPH Infobutton Manager • Who is using the CU/NYPH Infobutton Manager? • How can I use the CU/NYPH Infobutton Manager?

  20. Use of the CU/NYPH Infobutton Manager • WebCIS (CU/NYPH) • Eclipsys (NYPH)

  21. Use of the CU/NYPH Infobutton Manager • WebCIS (CU/NYPH) • Eclipsys (NYPH) • Psyckes (NYSPI)

  22. Use of the CU/NYPH Infobutton Manager • WebCIS (CU/NYPH) • Eclipsys (NYPH) • Psyches (NYSPI) • RMRS (Regenstrief)

  23. Use of the CU/NYPH Infobutton Manager • WebCIS (CU/NYPH) • Eclipsys (NYPH) • Psyches (NYSPI) • RMRS (Regenstrief) • NextGen (Crystal Run Healthcare)

  24. Use of the CU/NYPH Infobutton Manager • WebCIS (CU/NYPH) • Eclipsys (NYPH) • Psyches (NYSPI) • RMRS (Regenstrief) • NextGen (Crystal Run Healthcare)

  25. Infobuttons at My Institution • What is an CU/NYPH Infobutton Manager? • How does the CU/NYPH Infobutton Manager work? • How do I integrate the CU/NYPH Infobutton Manager • Who is using the CU/NYPH Infobutton Manager? • How can I use the CU/NYPH Infobutton Manager?

  26. Infobuttons at My Institution • What is an CU/NYPH Infobutton Manager? • How does the CU/NYPH Infobutton Manager work? • How do I integrate the CU/NYPH Infobutton Manager • Who is using the CU/NYPH Infobutton Manager? • How can I use the CU/NYPH Infobutton Manager?

  27. Do you want to use the Columbia IM? • Contact me: jjc7@columbia.edu • Help with terminology/context/questions • Adoption of HL7 • Librarian Infobutton Tailoring Environment (LITE) • Supported by NLM Grant R01LM07593 • For more information: http://www.dbmi.columbia.edu/cimino/Infobuttons.html

  28. KnowledgeLink S68: Integration of Health Information Resources into EHRs Saverio Maviglia, MD, MSc Partners Healthcare System Harvard Medical School Boston, MA

  29. KnowledgeLink v1 “digoxin” HTML Source Application (LMR) Target Reference (Micromedex or Skolar)

  30. KL v1: Typical Use • Infrequent • 2.3x/mo average (0.5 median, range 0.1-100) • 0.7% of patient encounters, varying by • Provider role (0.8% primary care MDs, 0.3% specialist MDs, 1.1% NPs, 0.3% other) • Provider gender (females 1.0%, males 0.5%) • Target resource (0.9% MDX, 0.3% Skolar) • Site (range 0-18% of encounters) • Quick • 4 pages accessed per use (only 1 content page) • 21 sec spent per content page

  31. EFFECTIVENESS AND SATISFACTION • 84% of all KnowledgeLink queries are answered • 17% of physician use results in a change in management, 33% among specialists • >=80% rated KnowledgeLink positively on • Ease of use • Relevance • Speed • Impact on patient care

  32. Comments • General Praise • Knowledge link is fantastic. VERY useful. • Great resource!! • I love knowledge link • Quality of Care • …very helpful with patient-directed questions during the visit • I was able to quickly answer the patient’s question …the patient had been promptly served on his needs • This info actually saved me from making a medical error…I rarely use this feature of the LMR, but this time it really helped me • Convenience • Knowledge Link is a great time saver…handy and easy to use. • I really like having the ability to look up drugs without having to change screens • I really like having the information available one click away from the med list • I was very happy to be able to click on the information link as I was pulling up the prescription • To have info on meds right at my fingertips is a great timesaver • it is very helpful to have all the information right at my finger tips instead of browsing through multiple book sources

  33. User Requests for KL II

  34. LMR eMAR Results Source Applications KnowledgeLink v2 Micromedex Skolar UpToDate KnowledgeLink Manager BWH guidelines Target References

  35. Links chosen and ordered according to • Context (meds, labs, disease) • Source app (LMR, eMAR, Results) • Provider (MD, RN, Pharm, other) • Clinic • Easy to modify/change search, restrict to patient information links, or print

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