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Resolving Clinicians’ On-Line Information Needs: A Brief History of Buttons

Resolving Clinicians’ On-Line Information Needs: A Brief History of Buttons. James J. Cimino, M.D. Biomedical Informatics and Medicine Columbia University June 24, 2005. Objectives. Studying clinician information needs Evolution of infobuttons Research issues The Coumadin Story.

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Resolving Clinicians’ On-Line Information Needs: A Brief History of Buttons

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  1. Resolving Clinicians’ On-Line Information Needs:A Brief History of Buttons James J. Cimino, M.D. Biomedical Informatics and Medicine Columbia University June 24, 2005

  2. Objectives • Studying clinician information needs • Evolution of infobuttons • Research issues • The Coumadin Story

  3. Everybody is worried about losing their job to automation. They’re afraid they’ll be replaced by a button. But I’m smart. I’m going to get a job in the factory where they make the buttons. - Jackie Gleason, The Jackie Gleason Show, circa 1968

  4. Covell et al. Information Needs 1984 1986 1988 1990 1992 1994 1996 1998 2000 2002 2004

  5. 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.

  6. Findings of Observational Studies • 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. Information for Decision-Making

  9. Information for Decision-Making

  10. Information for Decision-Making ? MRSA

  11. Covel et al. Information Needs UMLS Project 1984 1986 1988 1990 1992 1994 1996 1998 2000 2002 2004

  12. Unified Medical Language System The purpose of the UMLS is to improve the ability of computer programs to “understand” the biomedical meaning in user inquiries and to use this understanding to retrieve and integrate relevant machine-readable information for users. - Donald A.B. Lindberg 1986/1993

  13. Covel et al. Information Needs First Version of UMLS UMLS Project ICD9 MeSH Medline Button 1984 1986 1988 1990 1992 1994 1996 1998 2000 2002 2004

  14. 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

  15. 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 • Technical success • Practical failure

  16. Covel et al. Information Needs First Version of UMLS PubMED Mosaic UMLS Project WebCIS ICD9 MeSH Medline Button Web-based Generic Queries 1984 1986 1988 1990 1992 1994 1996 1998 2000 2002 2004

  17. Covel et al. Information Needs First Version of UMLS PubMED Mosaic UMLS Project G.O. Barnett DXplain Web DXplain WebCIS ICD9 MeSH Medline Button DXplain Button Web-based Generic Queries 1984 1986 1988 1990 1992 1994 1996 1998 2000 2002 2004

  18. From Data to Findings Serum Specimen Abnormalities of Serum Cholesterol Cholesterol Serum Hypercholesterolemia Serum Cholesterol Test

  19. Covel et al. Information Needs First Version of UMLS PubMED Mosaic UMLS Project G.O. Barnett DXplain Web DXplain WebCIS Infobuttons ICD9 MeSH Medline Button DXplain Button Web-based Generic Queries 1984 1986 1988 1990 1992 1994 1996 1998 2000 2002 2004

  20. Information Resource Usage 12% IBs

  21. Context-Specific Resource Use

  22. “Just in Time” Education MRSA

  23. “Just in Time” Education 1 MRSA Understand Information Needs

  24. “Just in Time” Education 2 Get Information From EMR 1 MRSA Understand Information Needs

  25. “Just in Time” Education 2 Get Information From EMR 1 MRSA Understand Information Needs 3 Resource Selection

  26. “Just in Time” Education 4 2 Get Information From EMR Resource Terminology 1 MRSA Understand Information Needs 3 Resource Selection

  27. “Just in Time” Education 4 5 2 Automated Translation Get Information From EMR Resource Terminology 1 MRSA Understand Information Needs 3 Resource Selection

  28. “Just in Time” Education 4 5 2 Automated Translation Get Information From EMR Resource Terminology 6 1 MRSA Querying Understand Information Needs 3 Resource Selection

  29. “Just in Time” Education 4 5 2 Automated Translation Get Information From EMR Resource Terminology 6 1 MRSA Querying Understand Information Needs 3 7 Resource Selection Presentation

  30. Research Issues • What are the information needs?

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

  32. What are the Information Needs? • Observations: • Four days, three sites, 159 minutes of videotape • 154 information needs • 1/3 information about the patient • Abdominal CT was abnormal, what are LFTs? • 1/3 institutional information • What specimen do I collect for this test? • 1/3 health information • What does this pill look like? • What are the patient instructions? • Computers used 50% of the time • 81/154 needs not satisfied

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

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

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