RESULTS: PHASE II

1. Type of Need Infobuttons: A Study of UsabilityLily Gutnik1, Sarah Collins RN, BSN2, Leanne M. Currie RN, DNSc1,2 James J. Cimino MD1, & Vimla L. Patel, PhD, DSc1Columbia University, New York, NY, 1Department of Biomedical Informatics, 2School of Nursing, • METHODS: PHASE II • Study Design • Laboratory study examining IM use by nurses and physicians • Survey of satisfaction with the infobutton manager • Participants • 2 nurses (RN), 1 physician (MD), and 1 physician’s assistant (PA) • Procedures: • Participants were given a script with 3 scenarios with a set of tasks • Participants were asked to "think aloud" as they used the IM and the resources • Morae™ software was used to capture the computer screen and the audio recording of the user • PURPOSE • To determine the usability of the Infobutton interface to resolve clinicians’ information needs • CONCLUSIONS • Clinicians commonly have information needs as they treat their patients • Nurses have information needs throughout their day • During laboratory sessions with 4 clinicians, 79 information needs events were observed • The most commonly occurring question types were: • “What are my patient's data?” and “Can drug x cause (adverse) finding y?” • Most information needs events were successful, and domain-related • Frequent documentation by nurses in the CCU suggests that the IM may provide a useful and accessible link for clinicians seeking information resources at the point of care • This study accentuated the need to be mindful of information overload • BACKGROUND • Studies of clinician’s information needs while treating patients have shown that the resolution of these needs is often deferred or fails, which may lead to medical errors • The Infobutton Manager (IM) was developed to help improve the resolution of information needs by providing users with links to on-line health information resources • The aim of this study was to determine the usability of the Infobutton interface to resolve clinicians’ information needs RESULTS: PHASE II • METHODS: PHASE I • Study Design • Ethnographic evaluation of the clinical work environment • Participants • One nurse in the Coronary Care Unit (CCU) • Procedures • Data collection was limited to note-taking and asking basic questions regarding CCU workflow and the use of technologies • Data were coded to characterize general clinical information system (CIS) related activities and communication between RN and team RESULTS: PHASE II • RESULTS: PHASE I • Phase I: Ethnographic Observation • Information needs were observed to occur at two time points when the nurse was using the CIS during the workday: • 1. At the beginning of shift when reviewing the electronic chart • 2. During documentation of nursing activities throughout the day (e.g., after each patient assessment) INFOBUTTONS IN USE: Examples of Context Specific Links to Web-based Materials Web-based Medical Reference Web-based Patient Education Materials Web-based Calculator Information Needs Coding Framework • Question Types • From Ely’s Taxonomy: • What is the drug of choice for condition x? • What is the cause of symptom x? • What test is indicated in situation x? • What is the dose of drug x? • How should I treat condition x (not limited to drug treatment)? • How should I manage condition x (not specifying diagnostic or therapeutic)? • What is the cause of physical finding x? • What is the cause of test finding x? • Can drug x cause (adverse) finding y? • From Infobutton Project: • Could this patient have condition x? • What are my patient's data? • How do we do this here? • What is this institution-specific data? • What is this? Expression of Need: Implicit/Explicit Basis of Need: Foreground/Background Context in CIS: e.g., Lab, Pharmacy, CPOE Resource Type: Human/Computer/Paper Success Rate: Success/Deferred/Failed ACKNOWLEDGMENTS: This project was supported by US National Library of Medicine 1R01LM07593.