1. Harnessing World Wide Web Technology and Standardized Terminology to Improve Decision Making for Patients and Providers James J. Cimino Departments of Medicine and Medical Informatics Columbia University

2. Decision Making for Patients and Providers Access to (electronic) health records generates information needs Information needs go unmet “Best evidence”, educational material, training programs can address these needs

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

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

5. Information for Decision-Making

7. ? MRSA Information for Decision-Making

8. Intelligent Decision Support

10. Query MRSA Intelligent Decision Support ? Result !

11. MRSA Intelligent Decision Support

12. MRSA Intelligent Decision Support

13. Infobutton: Automating the Process Questions can be anticipated Match information source to question Automate the retrieval Query can use patient information

14. New York Presbyterian Hospital Information Architecture Central repository Data Access Modules Medical Entities Dictionary MedLEE CIS WebCIS PatCIS

15. Central Controlled Terminology

16. MED Semantic Network Medical Entity Plasma Glucose Test Laboratory Specimen Plasma Specimen Anatomic Substance Plasma Substance Sampled Part of Has Specimen Substance Measured Laboratory Procedure CHEM-7 Laboratory Test Event Diagnostic Procedure Substance Bioactive Substance Glucose Chemical Carbo- hydrate

17. Automated Decision Support MRSA

18. Automated Decision Support Understand Information Needs 1 MRSA

19. Automated Decision Support Get Information From EMR Understand Information Needs 1 2 MRSA

20. Automated Decision Support Get Information From EMR Resource Selection Understand Information Needs 1 2 3 MRSA

21. Automated Decision Support Get Information From EMR Resource Selection Resource Terminology Understand Information Needs 1 24 3 MRSA

22. Automated Decision Support Get Information From EMR Resource Selection Resource Terminology Understand Information Needs Automated Translation 1 254 3 MRSA

23. Automated Decision Support Get Information From EMR Resource Selection Resource Terminology Querying Understand Information Needs Automated Translation 1 254 6 3 MRSA

24. Automated Decision Support Get Information From EMR Resource Selection Resource Terminology Querying Presentation Understand Information Needs Automated Translation 1 254 6 3 7 MRSA

25. Translations with the MED Gentamicin Etiology Measures Sensitivity Substance Measured Injectable Gentamicin Gentamicn Sensitivity Test Serum Gentamicin Level is-a Intravascular Gentamicin Tests Gentamicin Toxicity Has ingredient Summary Reports Decision Rule Expert System Drug Information

26. The Medline Button Terminology and Decision Support - understand conditions Pharmacy Infobutton

32. The Medline Button - understand conditions Pharmacy Infobutton Terminology and Decision Support - review and teach Cholesterol Guideline

35. The Medline Button - understand conditions Pharmacy Infobutton - review and teach Cholesterol Guideline Terminology and Decision Support - dietary planning DXplain Button

40. The Medline Button - understand conditions Pharmacy Infobutton - review and teach Cholesterol Guideline - dietary planning Dxplain Button Terminology and Decision Support - understand findings QingCIS

41. Smarter Retrievals from the Record Repository stores events and results Clinical problems at a different level of granularity Re-use knowledge to map from problems to clinical data Produce problem-specific views of the medical record

42. Chest X ray Congestive Heart Failure Intravascular CK Test Creatine Kinase Chest X ray 2 View Cardiac Enzyme Angina Lab :1/1/99 Cardiac Enzyme Test Radiology :2/23/99 Chest X Ray Radiology :2/28/96 Head CT Lab :12/28/96 Sickle Cell Test Admission :3/14/96 Stroke Admission :2/14/98 Angina Lab :1/1/99 Blood Type Test Radiology :2/1/97 Knee X Ray Concept-oriented (Heart) Heart Disease Chest Discharge :1/15/99 CHF CHF Discharge :1/15/99 CHF CHF Admission :2/14/98 Angina Lab :1/1/99 Cardiac Enzyme Test Radiology :2/23/99 Chest X Ray

57. The Medline Button - understand conditions Pharmacy Infobutton - review and teach Cholesterol Guideline - dietary planning Dxplain Button - understand findings QingCIS Terminology and Decision Support - nurse-oriented views PatCIS

64. The Medline Button - understand conditions Pharmacy Infobutton - review and teach Cholesterol Guideline - dietary planning Dxplain Button - understand findings QingCIS - nurse-oriented views PatCIS Terminology and Decision Support - patient education Lab Infobutton

66. The Medline Button - understand conditions Pharmacy Infobutton - review and teach Cholesterol Guideline - dietary planning Dxplain Button - understand findings QingCIS - nurse-oriented views PatCIS - patient education Lab Infobutton Terminology and Decision Support - patient information Microbiology Infobuttons

70. The Medline Button - understand conditions Pharmacy Infobutton - review and teach Cholesterol Guideline - dietary planning Dxplain Button - understand findings QingCIS - nurse-oriented views PatCIS - patient education Lab Infobutton - patient information Microbiology Infobuttons Terminology and Decision Support - infection control Mammography Guideline

72. The Medline Button - understand conditions Pharmacy Infobutton - review and teach Cholesterol Guideline - dietary planning Dxplain Button - understand findings QingCIS - nurse-oriented views PatCIS - patient education Lab Infobutton - patient information Microbiology Infobuttons - infection control Mammography Guideline Terminology and Decision Support - teaching Pap Smear Infobutton

76. The Medline Button - understand conditions Pharmacy Infobutton - review and teach Cholesterol Guideline - dietary planning Dxplain Button - understand findings QingCIS - nurse-oriented views PatCIS - patient education Lab Infobutton - patient information Microbiology Infobuttons - infection control Mammography Guideline - teaching Pap Smear Infobutton Terminology and Decision Support - coping and support

77. Summary Terminology translation facilitates retrievals The Web makes the rest easy Further study needed: –When do nurses need information? –What information do they need? –What terminology is needed? –What are the right resources? –How can retrievals be facilitated? –How do we present results?