1. Webinar: Publishing for the EHR 101 James J. Cimino Chief, Laboratory for Informatics Development National Institutes of Health Clinical Center May 20, 2008

2. Today’s Topics My personal information needs The Medline Button Infobuttons Clinician use of information resources The Infobutton Manager Methods for accessing sources The HL7 standard for Infobutton Managers Librarian Infobutton Tailoring Environment

3. My Personal Information Needs

4. Addressing Information Needs with Infobuttons Clinical information systems evoke information needs Clinician’s computer has access to resources Context can be used to predict need Context can be used to automate retrieval

5. Infobuttons Anticipate Need and Provide Queries i

6. First Attempt: The Medline Button CIS on mainframe BRS/Colleague (Medline) on same mainframe Get them to talk to each other Search using diagnoses and procedures

11. First Attempt: The Medline Button CIS on mainframe BRS/Colleague (Medline) on same mainframe Get them to talk to each other Search using diagnoses and procedures Technical success Practical failure

12. Infobuttons Web-based More resources Hardwired links in clinical system Customize search with concept of interest

18. Education at the Moment of Need MRSA

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

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

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

22. Education at the Moment of Need Get Information From EMR Resource Selection Resource Terminology Understand Information Needs 1 24 3

23. Education at the Moment of Need Get Information From EMR Resource Selection Resource Terminology Understand Information Needs Automated Translation 1 254 3

24. Education at the Moment of Need Get Information From EMR Resource Selection Resource Terminology Querying Understand Information Needs Automated Translation 1 254 6 3

25. Education at the Moment of Need Get Information From EMR Resource Selection Resource Terminology Querying Presentation Understand Information Needs Automated Translation 1 254 6 3 7

26. Clinician Use of Information Resources Observational studies Log file analyses Surveys

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

28. Information Use Contexts

29. Information Resource Usage 12% IBs

30. Context-Specific Resource Use

31. What Resources Do They Like?

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

40. Measurement of Benefits Easy to use: 92% Question on list >50% of time: 89% Answered question: 69% Useful: 77% Helpful >50% of time: 90% Positive effect on care: 74%

41. New York Presbyterian Hospital (Eclipsys)

45. NY Office of Mental Health (Psykes)

47. Regenstrief Medical Record System

48. Crystal Run Healthcare (NextGen)

49. Methods for Accessing Sources Simple link Concept-based link Simple search Concept-based search Intelligent agent Calculator

50. Usage in Lab Contexts

51. Usage in In-Patient Drug Contexts

52. Usage in Diagnosis Context

53. Usage in Lab Order Entry Context

54. Usage in InPat Drug Order Entry

55. Infobutton Manager API No Standard in Place Clinical Information System i Resource 1 API http://resource1.com/search.cgi? http://resource1.com/search.cgi? search = “ azithromycin AND dose ” Resource 3 API http://www.resource3.com/search.cgi? http://www.resource3.com/search.cgi? searchConcept = 3333 ^ azithromycin filter = 11 ^ dosage Resource 2 API http://resource2.com/ query = "azithromycin"[MeSH Terms] AND dose[All Fields]

56. Resource 3 HL7 Standards-Based Integration Intermountain HL7 Partners HL7 Columbia HL7 Resource 2 HL7 Resource 1 HL7 Clinical Information System i

58. AMIA 2007 Demo Participants Health care & academic institutions –Intermountain Healthcare, Columbia University, Partners Healthcare Content providers –Wolters Kluwer Health, ACP, Micromedex, UpToDate, Ebsco, Lexicomp

65. Institution-Specific Requirements What are the users’ information needs? In what contexts do those needs arise? What resources will resolve the needs? Terminology? How can the Infobutton Manager be integrated into the clinical information system?

66. Institution Customization Institution librarians know their clients best Institution librarians know their resources How can librarians populate Infobutton Manager tables? Terminology is institution-specific How do we handle institution-specific data translation?

67. LITE Research Plan Conduct community assessment Refine LITE features Establish forum for feedback from librarians Develop LITE in an iterative manner Develop a user manual and tutorial Evaluate usability of LITE by librarians Evaluate the use of LITE Disseminate the results of the project Promote the use of the IM and LITE

68. Conclusions Infobuttons can anticipate and resolve clinicians’ information needs Institution-specific tailoring is required LITE will make Infobutton Manager accessible HL7 standard will simplify links from commercial clinical systems HL7 link to knowledge resources is feasible

69. Acknowledgments Jianhua Li Many student contributors Guilherme Del Fiol Noemie Elhadad National Library of Medicine

70. www.infobuttons.org

71. lite.dbmi.columbia.edu