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Web-Based Clinical Information Systems: Architecture, Perils and Promises

Web-Based Clinical Information Systems: Architecture, Perils and Promises. James J. Cimino, M.D. Department of Medical Informatics Columbia University. Web-Based Clinical Information Systems. Clinical Data Access Information Resource Access Integrating Information Resources.

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Web-Based Clinical Information Systems: Architecture, Perils and Promises

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  1. Web-Based Clinical Information Systems: Architecture, Perils and Promises James J. Cimino, M.D. Department of Medical Informatics Columbia University

  2. Web-Based Clinical Information Systems Clinical Data Access Information Resource Access Integrating Information Resources

  3. Clinical Data Access: Architecture Clinical Information System Web Server Clinician

  4. Clinical Data from a Web Server Web Server CGI Static Documents Clinical Information System CGI Multiple Views of Patient Data Clinician

  5. Clinical info from web server (screens) • Static Documents - Reports • Viewers - scanned in written documents • CGI - button list • Viewers - tabular data • Viewers - graphical data • Viewers - ecg • Viewers - xray • Viewers - pathology • Viewers - Image Engine

  6. Clinical Data Access: Promises • Universal access • Platform-independence

  7. Clinical Data Access: Perils • Security • Hypertext Paradigm

  8. Perils: Security • Internet security • Web browser security

  9. Web Browser Security <ENTER> User ID: ciminoj <ENTER> Password: ******** <ENTER> <FORWARD> <BACK> <FORWARD> <BACK> <BACK>

  10. Perils: Hypertext Paradigm • Cognitive Overload • Disorientation • Mismatch with clinical application paradigms

  11. Cognitive Overload Select Function: Choose Document: Select data type: Select graph type:

  12. Disorientation Step 1 Step 2 Step 3 Select Function: Choose Document: Select data type: Select graph type:

  13. Paradigm Mismatch Modify Patient List New Patient List <ENTER> <ENTER> Add Patient <BACK>

  14. Information Resource Access:Architecture Clinical Information System Web Server Internet Clinician Local Information Source Remote Information Source

  15. Information Resource Access:Architecture (screen shots) • Text Databases - Chorus • Search engines - Utah • Expert systems - DXplain

  16. Information Resource Access: Promise • Improved access to knowledge • Economies of scale

  17. Information Resource Access: Perils • Quality • Availability • Permission • Disorientation • Cognitive Overload

  18. Integrating Informatics Islands

  19. Integrating Information Resources: Architecture Vocabulary Server Clinical Information System Web Server Internet Clinician Information Source Information Source

  20. Vocabulary Services Intravascular Glucose Tests Glucose Serum Glucose Plasma Glucose Glycosuria Blood Glucose Abnormalities of Blood Glucose Glucose Preparations Hypoglycemia Hyperglycemia Robitussin Ringer's Lactate

  21. Integrating Information Resources: (screen shots) • lab summary - could be from multiple sources • Drug to pdr example • chest x-ray to information sources (text, pics) • lab to medline • lab to dxplain - gopher • lab to dxplain - front end • lab to dxplain - api • lab to cholesterol

  22. Integration of CGI's <FORM METHOD="POST" ACTION="http://www.cpmc.columbia.edu/triadbin/chguide/0!177!255!!!M!65!!201~202!"><INPUT TYPE="submit" NAME="ACTION" VALUE="GUIDELINE SERVER"></FORM> • CAD: No • LDL: 177 • DIET : Unknown • CHOLESTEROL: 255 • HDL: Unknown • GENDER: Male • AGE: 65 years • PREMATURE MENOPAUSE: Unknown • RISK FACTORS: Family History of CAD (201) Smoker (202)

  23. Integrating Information Resources: Promises • Improved access • Increased usability • Increased usefulness

  24. Integrating Information Resources: Perils • Lack of context • Local variability • Translation errors • Lack of interchange standards • Lack of vocabulary standards • Liability

  25. Challenges • Data servers • Vocabulary • Resource interfaces • User information needs

  26. Challenges: Data servers • Access to repositories • Security • Authentication • Confidentiality

  27. Challenges: Vocabulary • Controlled vocabulary • Translation • Vocabulary services

  28. Challenges: Resource Interfaces • Content • Interface standards • Licensing • Liability

  29. Challenges: User Information Needs • User profiles • Problem orientation • Cognitive processes

  30. Conclusions • Improve access to patient data • Integration of information sources • http://www.cpmc.columbia.edu/cisdemo

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