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James J. Cimino Departments of Medicine and Medical Informatics Columbia University

Harnessing World Wide Web Technology and Standardized Terminology to Improve Decision Making for Patients and Providers. James J. Cimino Departments of Medicine and Medical Informatics Columbia University. Decision Making for Patients and Providers.

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James J. Cimino Departments of Medicine and Medical Informatics Columbia University

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  1. Harnessing World Wide Web Technology and Standardized Terminology to Improve Decision Making for Patients and Providers James J. Cimino Departments of Medicine and Medical Informatics Columbia University

  2. Decision Making for Patients and Providers • Access to (electronic) health records generates information needs • Information needs go unmet • “Best evidence”, educational material, training programs can address these needs

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

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

  5. Information for Decision-Making

  6. Information for Decision-Making

  7. Information for Decision-Making ? MRSA

  8. Intelligent Decision Support

  9. Intelligent Decision Support

  10. Query Result Intelligent Decision Support ! ? MRSA

  11. Intelligent Decision Support MRSA

  12. Intelligent Decision Support MRSA

  13. Infobutton: Automating the Process • Questions can be anticipated • Match information source to question • Automate the retrieval • Query can use patient information

  14. New York Presbyterian Hospital Information Architecture • Central repository • Data Access Modules • Medical Entities Dictionary • MedLEE • CIS • WebCIS • PatCIS

  15. Central Controlled Terminology

  16. Substance Laboratory Specimen Event Chemical Anatomic Substance Plasma Specimen Diagnostic Procedure Substance Sampled Plasma Laboratory Test Laboratory Procedure Has Specimen Carbo- hydrate Bioactive Substance CHEM-7 Part of Glucose Substance Measured MED Semantic Network Medical Entity Plasma Glucose Test

  17. Automated Decision Support MRSA

  18. Automated Decision Support 1 MRSA Understand Information Needs

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

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

  21. Automated Decision Support 4 2 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 1 MRSA 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 Resource Selection

  24. 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

  25. Summary Reports Intravascular Gentamicin Tests is-a Substance Measured Has ingredient Decision Rule Measures Sensitivity Etiology Drug Information Expert System Translations with the MED Injectable Gentamicin Serum Gentamicin Level Gentamicin Gentamicn Sensitivity Test Gentamicin Toxicity

  26. Terminology and Decision Support - understand conditions • Pharmacy Infobutton • The Medline Button

  27. Terminology and Decision Support • The Medline Button - understand conditions • Pharmacy Infobutton - review and teach • Cholesterol Guideline

  28. Terminology and Decision Support • The Medline Button - understand conditions • Pharmacy Infobutton - review and teach • Cholesterol Guideline - dietary planning • DXplain Button

  29. Terminology and Decision Support • The Medline Button - understand conditions • Pharmacy Infobutton - review and teach • Cholesterol Guideline - dietary planning • Dxplain Button - understand findings • QingCIS

  30. Smarter Retrievals from the Record • Repository stores events and results • Clinical problems at a different level of granularity • Re-use knowledge to map from problems to clinical data • Produce problem-specific views of the medical record

  31. Cardiac Enzyme Heart Disease Chest Creatine Kinase Chest X ray Congestive Heart Failure Angina Intravascular CK Test Chest X ray 2 View Admission :2/14/98 Angina Discharge :1/15/99 CHF Radiology :2/23/99 Chest X Ray Lab :1/1/99 Cardiac Enzyme Test Concept-oriented (Heart) Admission :3/14/96 Stroke Lab :12/28/96 Sickle Cell Test Radiology :2/28/96 Head CT Lab :1/1/99 Blood Type Test Radiology :2/1/97 Knee X Ray Admission :2/14/98 Angina Discharge :1/15/99 CHF Radiology :2/23/99 Chest X Ray Lab :1/1/99 Cardiac Enzyme Test

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