1. Infobuttons: Context-specific Links from Clinical Systems to On-Line Knowledge Resources to Anticipate and Address Clinician Information Needs at the Point of Care James J. Cimino Chief, Laboratory for Informatics Development National Institutes of Health Clinical Center University of Maryland, School of Nursing, April 18, 2008

2. Today’s Topics Clinician Information Needs Infobuttons Infobutton Managers The Coumadin Story Institution-Specific Requirements Infobutton Manager Customization Tasks Librarian Infobutton Tailoring Environment –Research plan –Initial efforts –Getting involved

3. Health Knowledge for Decision Support

5. Infobuttons Anticipate Need and Provide Queries i

6. Information Needs of CIS 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 We can predict the specific need User is sitting at a computer! We can automate information retrieval

7. 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

12. 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

13. Education at the Moment of Need i

14. Understand Information Needs 1 i

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

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

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

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

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

20. 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 i

21. Research Issues What are the information needs? Which context information is important? What resources can satisfy needs? How can retrieval be automated? –What context data are used? –How are the data translated?

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

40. The Coumadin Story Chair of Medicine wants link to Coumadin protocol First, I have to find the guidelines

42. The Coumadin Story Chair of Medicine wants link to Coumadin protocol First, I have to find the guidelines Then I have to add the question to the IM table

44. The Coumadin Story Chair of Medicine wants link to Coumadin protocol First, I have to find the guidelines Then I have to add the question to the IM table Finally, I link the question to the context

46. The Coumadin Story Chair of Medicine wants link to Coumadin protocol First, I have to find the guidelines Then I have to add the question to the IM table Finally, I link the question to the context Voilá!

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. 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?

56. New York Presbyterian Hospital (Eclipsys)

57. NY Office of Mental Health (Psykes)

59. Regenstrief Medical Record System

60. Cryststal Run Healthcare (NextGen)

62. Infobutton Manager Maintenance Tool Functions: Browse Add Update Delete Clinician Infobutton Manager Translation Table Term Translation Context Table Context Matching Infobutton Table Query Construction Page of Links System Maintainer Institution Customization Tasks

64. 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?

65. Librarian Infobutton Tailoring Environrment (LITE) Specify user contexts Identify terminology in each context Information needs in each context Resources for resolving information needs Automating translation and querying

66. Infobutton Manager Maintenance Tool Functions: Browse Add Update Delete Clinician Infobutton Manager Translation Table Term Translation Context Table Context Matching Infobutton Table Query Construction Page of Links System Maintainer Institution Customization Tasks

67. LITE Tasks Librarian Infobutton Tailoring Environment (LITE) Infobutton Manager Log File LITE Log File LITE Auditing LITE Monitoring Infobutton Manager Monitoring Institution Librarian Context Definition Resource Utilization Terminology Specification Question Construction Resource Selection Clinician Infobutton Manager Translation Table Term Translation Context Table Context Matching Infobutton Table Query Construction Page of Links

68. 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

69. Initial Efforts Drupal site Community of users Clear through Institutional Review Board Enroll “subjects” Make each draft a forum topic Collect feedback Iterate

72. Conclusion Infobuttons can anticipate and resolve clinicians’ information needs Institution-specific tailoring is required International standard will stimulate wider adoption Librarian Infobutton Tailoring Environment will put the Infobutton Manager on autopilot Enrollment now open!

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

74. www.infobuttons.org

75. lite.dbmi.columbia.edu