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Infobuttons: Anticipatory Passive Decision Support ACMI Senior Member Presentation

Learn about the concept and benefits of infobuttons, their application in medical literature, and the research issues surrounding them. Discover infobutton and infobutton-like systems and the HL7 standard. Explore the use and acceptance of infobuttons by clinicians and nurses.

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Infobuttons: Anticipatory Passive Decision Support ACMI Senior Member Presentation

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  1. Infobuttons:Anticipatory Passive Decision SupportACMI Senior Member Presentation James J. Cimino, MD, FACMI Laboratory for Informatics Development NIH Clinical Center and Lister Hill National Center for Biomedical Communications National Library of Medicine Bethesda, Maryland

  2. Infobutton (noun): in'·fō·but'·tən – a link from one on-line information system to another that uses contextual information from the former to facilitate the retrieval of relevant information from the latter. Example: links in clinical information systems that provide patient-data-specific links to health knowledge resources. Decision Support. Passive. Anticipatory.

  3. Topics • The Why, When, and How of infobuttons? • Research issues • Infobutton and infobutton-like systems • The HL7 standard • AMIA 2007 demonstration • Current status of commercial efforts • Librarian Infobutton Tailoring Environment (LITE)

  4. Why Infobuttons?

  5. 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

  6. The When of Infobuttons Covel et al. Information Needs First Version of UMLS Infobutton Manager Standard PubMED Micromedex Infobutton Access Mosaic UMLS Project G.O. Barnett DXplain Web DXplain WebCIS Infobuttons ICD9 MeSH Medline Button DXplain Button Librarian Infobutton Tailoring Environment (LITE) Infobutton Manager Web-based Generic Queries 1984 1986 1988 1990 1992 1994 1996 1998 2000 2002 2004 2006 2008

  7. Infobuttons in the Medical Literature Beverly Collins, et al. Attaching Context Sensitive Infobuttons to an EHR Options and Issues. SJ Darmoni, et al. French Infobutton: an academic and… business perspective. Per H Gesteland, et al. Clinician Use and Acceptance of Population-Based Data about Respiratory Pathogens: Implications for Enhancing Population-Based Clinical Practice Sookyung Hyun, et al. Nurses’ Use and Perceptions of Usefulness of National Cancer Institute’s Tobacco-related Cancer Information Service (CIS) Resources. Robert A. Jenders, et al. Standards in Clinical Decision Support: Activities in Health Level Seven.

  8. The How of Infobuttons • Common tasks may have common needs • System knows: • Who the user is • Who the patient is • What the user is doing • What information the user is looking at • We may be able to predict the specific need • User is sitting at a computer! • We may be able to automate retrieval

  9. Research Issues MRSA

  10. Research Issues 1 MRSA Understand Information Needs

  11. Research Issues 2 Get Information From EMR 1 MRSA Understand Information Needs

  12. Research Issues 2 Get Information From EMR 1 MRSA Understand Information Needs 3 Resource Selection

  13. Research Issues 4 2 Get Information From EMR Resource Terminology 1 MRSA Understand Information Needs 3 Resource Selection

  14. Research Issues 4 5 2 Automated Translation Get Information From EMR Resource Terminology 1 MRSA Understand Information Needs 3 Resource Selection

  15. Research Issues 4 5 2 Automated Translation Get Information From EMR Resource Terminology 6 1 MRSA Querying Understand Information Needs 3 Resource Selection

  16. Research Issues 4 5 2 Automated Translation Get Information From EMR Resource Terminology 6 1 MRSA Querying Understand Information Needs 3 7 Resource Selection Presentation

  17. Infobutton and Infobutton-like Systems • Columbia University’s Infobutton Manager • Vanderbilt University’s PC-POETS • LDS Hospital’s HELP system • Partners Healthcare System’s Knowledgeliink

  18. Deployment of Columbia’s Infobutton Manager • Columbia University’s Infobutton Manager • New York Presbyterian Hospital’s WebCIS • New York Presbyterian Hospital’s Eclipsys • New York State Psychiatric Institute’s PSYCKES • Regenstrief Medical Record System • Crystal Run Healthcare’s (Monroe, NY) (NextGen)

  19. NY Office of Mental Health (Psykes)

  20. NY Office of Mental Health (Psykes)

  21. Regenstrief Medical Record System

  22. Crystal Run Healthcare (NextGen)

  23. Infobuttons vs. Infobutton Manager Resource s Clinical System Infobutton Context Query Knowledge Base Infobutton Manager Page of Hyperlinks

  24. The HL7 Standard • Approved as Draft Standard for Trial Use (DSTU) • http://www.hl7.org/v3ballot2008MAY/html/domains/uvds/uvds_Context-awareInformationRetrieval(Infobutton).htm

  25. Example 1: In this example the user is looking at a coded problem list of a male, 77 years-old patient with Bacterial Pneumonia. The user clicks on an infobutton that presents a series of questions. The user selects “How do I treat Bacterial Pneumonia?” The following message payload represents the communication between the Decission Support System and the Information Resource.

  26. <?xml version="1.0" encoding="UTF-8"?> <infobuttonEventNotification> <effectiveTime value="20060706001023"/> <subject1> <patientContext> <patientPerson> <administrativeGenderCode code="M" codeSystem="2.16.840.1.113883.5.1" codeSystemName="AdministrativeGender" displayName="Male"/> </patientPerson> <subjectOf> <age> <code code="30525-0" codeSystem="2.16.840.1.113883.6.1" codeSystemName="LN" displayName="AGE"/> <value value="77" unit="a"/> </age> </subjectOf> </patientContext> </subject1> <subject2> <taskContext> <code code="PROBLISTREV" codeSystem="HL7-Infobutton" codeSystemName="HL7-infobutton" displayName="Problem List Review"/> </taskContext> </subject2> <subject3> <subTopic> <code code="Q000628" codeSystem="2.16.840.1.113883.6.177" codeSystemName="MSH" displayName="therapy"/> </subTopic> </subject3> <subject4> <mainSearchCriteria> <code code="D018410" codeSystem="2.16.840.1.113883.6.177" codeSystemName="MSH" displayName="Bacterial Pneumonia"> <originalText>Pneumonia</originalText> </code> </mainSearchCriteria> </subject4> </infobuttonEventNotification>

  27. http://www.e-resource.com/api? infobuttonEventNotification.effectiveTime.v=20060706001023& assignedEntity.name.r=Organization-Username&assignedEntity.certificateText.r=organization-password& patientPerson.administrativeGenderCode.c=F&patientPerson.administrativeGenderCode.dn=Female age.v.v=77&age.v.unit=a ageGroup.v.c=D000368&ageGroup.v.cs=2.16.840.1.113883.6.177&ageGroup.v.dn=Aged taskContext.c.c=PROBLISTREV&taskContext.c.dn=Problem+list+review& subTopic.c.c=Q000628&subTopic.c.cs=2.16.840.1.113883.6.177&subTopic.c.dn=therapy mainSearchCriteria.c.c=D018410&mainSearchCriteria.c.cs=2.16.840.1.113883.6.177& mainSearchCriteria.c.dn=Bacterial+Pneumonia& mainSearchCriteria.c.ot=Pneumonia

  28. AMIA 2007 Demo Participants • Health care & academic institutions • Intermountain Healthcare, Columbia University, Partners Healthcare • Content providers • Wolters Kluwer Health, ACP, EBSCO, Thomson/Micromedex, UpToDate, Lexicomp

  29. Current Status of Clinical Systems • Epic – InfoButton with direct connection to specific resources • Eclipsys – Infobutton tab using HL7 standard

  30. Current Status of Infobutton Managers • University of Utah • Applications: HELP2 Clinical Desktop, narrative practice guidelines • HL7 compliant, but using original API • Resources: Micromedex, Clineguide, MDConsult, PubMed, Medline Plus, Genetics Home Reference, Gene Tests, Uptodate, Ebsco (Cochrane and CINAHL), ARUP Consult, ICD9 search web site, Intermountain Care Process modules, Intermountain geriatric drug monographs • Context parameters: task context, main search criteria, age, gender, subtopic, observation interpretation (for labs), content recipient, and authentication parameters

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