Linking Knowledge to Patient Care

1. Digital Library Linking Knowledge to Patient Care

2. Planning for the Integration of the Digital Library, Clinical Decision Support, & Evidence at the Point of Care Linda Matula Schwartz, MDE, Information Specialist Barbara Iobst, MLS, AHIP, Library Director

3. IAIMS: Integrated Advanced Information Management Systems • $150,000 planning grant received from the National Library of Medicine • April 1, 2006 – March 31, 2007 • Purpose

4. Lehigh Valley Hospital and Health Network • Three major facilities • 800 beds, 50,000 admissions/yr, 435,000 outpatient visits/yr • 1,100 physicians, 6,000 employees • Most Wired Hospital 2003-2006

5. Clinical Decision Support Digital Library EPOC Patient Portal Telehealth Information Domains

6. IAIMS: Grant Objectives • Identify existing IT planning processes • Create idealized IT plans for each domain • Plan for IT coordination among domains • Determine objectives for future testing and evaluation grant • Collaboration for long term strategic planning across domains • Evaluate and disseminate results of the planning process

7. Pre-IAIMS Information Integration

8. Ultimate Goal for Integration

9. Digital Library: Mapping the Flow of Knowledge Based Content Management Literature Hospital Administration Knowledge Based Content Patient Education & Consumer Resources Patient Portal Research Literature Clinical Literature Clinical Decision Support Professional Education Community CAPOE EHMR Patients EPOC

10. Digital Library Mission • Identification of appropriate knowledge-based information (KBI) products • Bibliographic Databases • Evidence Based Content • Electronic Books and Journals • Clinical Calculators and Decision Support Tools • Pediatric weight-based dosing calculator • Clinical Guidelines from Professional Organizations • Consumer Health content • Expert rules/core measure programs • Medical images

11. Event Summary

12. Digital Library Domain Data Collection via Event Summaries Path of investigation Content Evaluation Event Summary Clinical Decision Support Domain Dr. Levick ES ES EPOC Domain Dr. Rae-Grant Identify/Evaluate KBI Content Identify Seamless Interface with CAPOE/EHMR ES Identify Weight Based Pediatric Dosage Calculator Global Pharmacy PEPID Dr. Bond Teleintensivist ES ES Accupedia Bob Begliomini Pharmacy Administrator Chris Marucci Pharmacy Director ES ES

13. Digital Library Mission • Plan for content evaluation process of KBI programs • Identify key stakeholders in clinical areas to act as content evaluators • Determine an evaluation process and datacollection tool

14. Digital Library Mission • Education on use of KBI programs accessible through the Digital Library

15. Survey Results:Common Issues for KBI Domains • Lack of knowledge about what resources are available • Ease of access to resources • Speed of getting results • Education on how to use resources • Access to full text – especially PDFs • Information specific to specialty areas

16. Increased Training

17. Digital Library Mission • Education on use of KBI programs accessible through the Digital Library • Joint EBPx workshops with Nurse Researcher • Meetings with clinical teams for EBM projects • Creation of online tutorials and program guides

18. Digital Library Mission • Identification of a seamless interface to organize access to multiple KBI resources including POC access • VISIBILITY! – Library website, branding • Conversion of print to electronic access • A-Z Journal List • Electronic book list by subject • Electronic Current Awareness Program • Creation of Subject Guides by specialty • InfoButtons Technology • Federated Search Tools

19. Survey Results

20. Pre-IAIMS Information Integration

21. IAIMS Integrationat 6 Months: Library as Pivotal Content Source for Three Domains

22. Seamless Integration Interface Identification of InfoButtons as Potential Interface MLA 2006 Plenary Session session Library discussion groups (MEDLIB) Literature reviews Vendor discussions Features • Ability to integrate a variety of KBI content at POC • Ability to harvest context (patient, provider, institution) from CAPOE/EHMR • Ability to tailor the resources offered to a user based on context • Cross platform access – desktop, handheld, wireless

23. Key Factors Encouraging Investigation of InfoButtons • Identification of experts • Identification of current research projects • Identification of a trend in vendor initiatives • Literature review • Discovery of proposed status as NISO HL7 interoperability standard for exchanging data with CAPOE/EHMR • Discovery that GE/IDX (CareCast) is currently investigating an InfoButton interface • Evidence of success – Columbia NY Presbyterian and Intermountain HC, Kaiser Permanente

24. Results of Consultation: Dr. Cimino… …informed IAIMS team about the InfoButtons clinical information system and technical aspects of integration … presented evidence about IB use at NY Presbyterian and impact on patient care … reviewed our CAPOE/EHMR and suggested areas in which InfoButtons could be integrated … suggested a collaboration on an immediate pilot project with his expert assistance on integration and use of the InfoButton Manager

25. Future Thinking Capability of requesting librarian assistance from POC – Recommendation from Clinical Decision Support domain Investigation into Shareable Active Guideline Environment (SAGE) project at Kaiser Permanente Context triggered clinical images to support clinical care

26. Future Thinking If InfoButtons were implemented, mining the log data for provider context from the search queries could be beneficial as an indicator of: • Need for additional KBI resources • Content to be included in InfoButton access • Areas in which nursing or medical education can be targeted

27. LVHHN IAIMS Website http://iaims.lvh.org/

28. Digital Library Linking Knowledge to Patient Care