Just In Time Education: Linking Clinical and Educational Systems

1. Just In Time Education:Linking Clinical and Educational Systems James J. Cimino, MD Professor of Medicine and Biomedical Informatics Columbia University May 19, 2004

2. G.O. 1984 1986 1988 1990 1992 1994 1996 1998 2000 2002 2004

3. Covell et al. Information Needs G.O. Barnett DXplain 1984 1986 1988 1990 1992 1994 1996 1998 2000 2002 2004

4. 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.

5. Results of Observational Study • 47 physicians • Observed during a half day of typical practice • Estimated 2-3 questions per physician per day • 269 questions raised about patient management • Only 30% were answered during the patient visit • Usual resource was another physician

6. Other Observational Studies The information needs of practicing physicians in northeastern New York State. Assessment of physicians' information needs in five Texas counties Information needs of rural health care practitioners in Hawaii. Knowledge management in clinical practice: a systematic review of information seeking behavior in physicians Information needs and information-seeking behaviors of on-call radiology residents Expanding the concept of medical information: an observational study of physicians' information needs Curbside consultation practices and attitudes among primary care physicians and medical subspecialists Information needs of health care professionals in an AIDS outpatient clinic as determined by chart review Methods for assessing information needs of clinicians in ambulatory care. Real-time information-seeking behavior of residency physicians Information seeking in primary care: how physicians choose which clinical questions to pursue and which to leave unanswered Physicians' use of computer software in answering clinical questions. Residents' medical information needs in clinic: are they being met?

7. Findings • 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

8. 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!

9. Information for Decision-Making

10. Information for Decision-Making

11. Information for Decision-Making ? MRSA

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

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

14. Covel et al. Information Needs Don Lindberg UMLS G.O. Barnett DXplain 1984 1986 1988 1990 1992 1994 1996 1998 2000 2002 2004

15. 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

16. Covel et al. Information Needs First Version of UMLS Don Lindberg UMLS G.O. Barnett DXplain ICD9 MeSH Medline Button 1984 1986 1988 1990 1992 1994 1996 1998 2000 2002 2004

17. 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 • Kludge required

23. 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 • Kludge required • Technical success • Practical failure

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

27. Covel et al. Information Needs First Version of UMLS PubMED Mosaic Don Lindberg UMLS 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

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

32. Covel et al. Information Needs First Version of UMLS PubMED Mosaic Don Lindberg UMLS 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

38. Education at the Moment of Need MRSA

39. Education at the Moment of Need 1 MRSA Understand Information Needs

40. Education at the Moment of Need 2 Get Information From EMR 1 MRSA Understand Information Needs

41. Education at the Moment of Need 2 Get Information From EMR 1 MRSA Understand Information Needs 3 Resource Selection

42. Education at the Moment of Need 4 2 Get Information From EMR Resource Terminology 1 MRSA Understand Information Needs 3 Resource Selection

43. Education at the Moment of Need 4 5 2 Automated Translation Get Information From EMR Resource Terminology 1 MRSA Understand Information Needs 3 Resource Selection

44. Education at the Moment of Need 4 5 2 Automated Translation Get Information From EMR Resource Terminology 6 1 MRSA Querying Understand Information Needs 3 Resource Selection

45. Education at the Moment of Need 4 5 2 Automated Translation Get Information From EMR Resource Terminology 6 1 MRSA Querying Understand Information Needs 3 7 Resource Selection Presentation

46. Research Issues • What are the information needs?

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

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

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