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Allen Pavilion Medicine Grand Rounds

Allen Pavilion Medicine Grand Rounds. “Medical Informatics”. James J. Cimino, MD, FACP, FACMI Professor of Medicine and Biomedical Informatics Columbia University May 13, 2004. Allen Pavilion Medicine Grand Rounds. “Recognizing and Resolving Information Needs of WebCIS Users”.

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Allen Pavilion Medicine Grand Rounds

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  1. Allen Pavilion Medicine Grand Rounds “Medical Informatics” James J. Cimino, MD, FACP, FACMI Professor of Medicine and Biomedical Informatics Columbia University May 13, 2004

  2. Allen Pavilion Medicine Grand Rounds “Recognizing and Resolving Information Needs of WebCIS Users” James J. Cimino, MD, FACP, FACMI Professor of Medicine and Biomedical Informatics Columbia University May 13, 2004

  3. 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.

  4. Results of Observational Study • 47 physicians • Observed during a half day of typical practice • Estimated 2-3 questions per physician per day • 269 questions raised about patient management • Only 30% were answered during the patient visit • Usual resource was another physician

  5. Other Observational Studies The information needs of practicing physicians in northeastern New York State. Assessment of physicians' information needs in five Texas counties Information needs of rural health care practitioners in Hawaii. Knowledge management in clinical practice: a systematic review of information seeking behavior in physicians Information needs and information-seeking behaviors of on-call radiology residents Expanding the concept of medical information: an observational study of physicians' information needs Curbside consultation practices and attitudes among primary care physicians and medical subspecialists Information needs of health care professionals in an AIDS outpatient clinic as determined by chart review Methods for assessing information needs of clinicians in ambulatory care. Real-time information-seeking behavior of residency physicians Information seeking in primary care: how physicians choose which clinical questions to pursue and which to leave unanswered Physicians' use of computer software in answering clinical questions. Residents' medical information needs in clinic: are they being met?

  6. Findings • 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

  7. 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!

  8. One-Stop Information Shopping? World Wide Web (The Hyperdocument) Information Resources Health Practitioner Biblio- graphic Database Textbook Expert System

  9. One-Touch Information Shopping World Wide Web (The Facilitator) Information Resources Health Practitioner Biblio- graphic Database Textbook Expert System

  10. Information for Decision-Making

  11. Information for Decision-Making

  12. Information for Decision-Making ? MRSA

  13. Intelligent Decision Support

  14. Intelligent Decision Support

  15. Intelligent Decision Support Query Result ! ? MRSA

  16. Automated Decision Support MRSA

  17. Automated Decision Support 1 MRSA Understand Information Needs

  18. Automated Decision Support 2 Get Information From EMR 1 MRSA Understand Information Needs

  19. Automated Decision Support 2 Get Information From EMR 1 MRSA Understand Information Needs 3 Resource Selection

  20. Automated Decision Support 4 2 Get Information From EMR Resource Terminology 1 MRSA Understand Information Needs 3 Resource Selection

  21. Automated Decision Support 4 5 2 Automated Translation Get Information From EMR Resource Terminology 1 MRSA Understand Information Needs 3 Resource Selection

  22. Automated Decision Support 4 5 2 Automated Translation Get Information From EMR Resource Terminology 6 1 MRSA Querying Understand Information Needs 3 Resource Selection

  23. Automated Decision Support 4 5 2 Automated Translation Get Information From EMR Resource Terminology 6 1 MRSA Querying Understand Information Needs 3 7 Resource Selection Presentation

  24. 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 • Kludge required • Technical success • Practical failure

  25. Research Issues • What are the information needs?

  26. Portable Usability Lab User’s Workstation 75 foot cable Video Monitor Converter Controller Microphone Video Converter Headphones VCR Cassette Recorder

  27. Research Issues • Which context information is important? • What are the information needs?

  28. Context-Dependent Information Needs ! ? Age Sex Role Training Task Data Institution Context

  29. 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?

  30. The Medical Entities Dictionary (MED)

  31. 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?

  32. Under the Hood • Infobutton links in WebCIS pass context to Infobutton Manager (IM) • IM matches context to questions • IM uses MED to translate concepts • IM constructs English questions and Web links

  33. Translation for Decision Support Clinical Data Has ingredient Substance Measured Decision Rule Measures Sensitivity Etiology Drug Information Expert System Injectable Gentamicin Serum Gentamicin Level Gentamicin Gentamicn Sensitivity Test Gentamicin Toxicity

  34. Infobutton Manager Manager • Maintains list of generic questions and links • Maintains list of criteria for matching questions • Placeholders are “fill in the blanks” (Madlibs)

  35. The Coumadin Story • Joe Tennenbaum wants link to Coumadin protocol • First, I have to find the guidelines

  36. The Coumadin Story • Joe Tennenbaum wants link to Coumadin protocol • First, I have to find the guidelines • Then I have to add the question to the IM table

  37. The Coumadin Story • Joe Tennenbaum 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

  38. The Coumadin Story • Joe Tennenbaum 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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