1. A Truly Meaningful Use of Electronic Health Records Freely Available to All: Automated Anticipation and Resolution of Clinical Information Needs at the Point of Care through Infobuttons James J. Cimino, MD, FACMI, FACP Laboratory for Informatics Development NIH Clinical Center and the National Library of Medicine

3. 1984 1986 1988 1990 1992 1994 1996 1998 2000 2002 2004 Covell et al. Information Needs Infobutton Timeline

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. Knowledge Resources in Clinical Care

6. ?

8. Information Needs of EHR Users 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 So we may be able to predict the specific need User is sitting at a computer! So we may be able to automate the answer

9. 1984 1986 1988 1990 1992 1994 1996 1998 2000 2002 2004 2006 2008 Covel et al. Information Needs UMLS Project First Version of UMLS ICD9  MeSH Medline Button Infobutton Timeline

14. 1984 1986 1988 1990 1992 1994 1996 1998 2000 2002 2004 2006 2008 G.O. Barnett DXplain Covel et al. Information Needs UMLS Project First Version of UMLS ICD9  MeSH Medline Button Mosaic Web-based Generic Queries PubMEDWeb DXplain DXplain Button WebCIS Infobutton Timeline

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

19. 1984 1986 1988 1990 1992 1994 1996 1998 2000 2002 2004 2006 2008 G.O. Barnett DXplain Covel et al. Information Needs UMLS Project First Version of UMLS ICD9  MeSH Medline Button Mosaic Infobuttons Web-based Generic Queries PubMEDWeb DXplain DXplain Button WebCIS Infobutton Timeline

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

27. 1984 1986 1988 1990 1992 1994 1996 1998 2000 2002 2004 2006 2008 G.O. Barnett DXplain Covel et al. Information Needs UMLS Project First Version of UMLS ICD9  MeSH Medline Button Mosaic Infobuttons Web-based Generic Queries Infobutton Manager PubMEDWeb DXplain DXplain Button WebCIS Infobutton Timeline

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

35. 1984 1986 1988 1990 1992 1994 1996 1998 2000 2002 2004 2006 2008 G.O. Barnett DXplain Covel et al. Information Needs UMLS Project First Version of UMLS ICD9  MeSH Medline Button Mosaic Infobuttons Web-based Generic Queries Infobutton Manager Infobutton Manager Standard PubMEDWeb DXplain DXplain Button WebCIS Micromedex Infobutton Access Infobutton Timeline

36. 1984 1986 1988 1990 1992 1994 1996 1998 2000 2002 2004 2006 2008 G.O. Barnett DXplain Covel et al. Information Needs UMLS Project First Version of UMLS ICD9  MeSH Medline Button Mosaic Infobuttons Web-based Generic Queries Infobutton Manager Infobutton Manager Standard PubMEDWeb DXplain DXplain Button WebCIS Micromedex Infobutton Access Librarian Infobutton Tailoring Environment (LITE) Infobutton Timeline

37. Institution Customization Tasks i Clinical Application with Infobutton Link User (Physician, Nurse, etc.) Patient (with age and gender) Institution Infobutton Manager Page of Links Infobutton Manager Knowledge Base Institutional Librarian (or other LITE users) The Librarian Infobutton Tailoring Environment (LITE)

38. 1984 1986 1988 1990 1992 1994 1996 1998 2000 2002 2004 2006 2008 2010 2012 2014 G.O. Barnett DXplain Covel et al. Information Needs UMLS Project First Version of UMLS ICD9  MeSH Medline Button Mosaic Infobuttons Web-based Generic Queries Infobutton Manager Infobutton Manager Standard PubMED Web DXplain DXplain Button WebCIS Micromedex Infobutton Access Librarian Infobutton Tailoring Environment (LITE) Infobutton Timeline Meanginful Use Stage 2

39. Conclusions Infobuttons improve patient care The World Wide Web makes resources available and makes integration feasible, even easy The HL7 standard is driving adoption by clinical system vendors and knowledge vendors EHRs achieve meaningful use with infobuttons OpenInfobutton and LITE allow everyone to play

40. www.infobuttons.com

41. www.infobuttons.org

42. lite.bmi.utah.edu

43. www.openinfobuttons.org