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Supporting Medical Decision Making with Electronic Medical Records

Supporting Medical Decision Making with Electronic Medical Records. James J. Cimino Departments of Medicine and Medical Informatics Columbia University. Decision Making for Patients and Providers. Access to (electronic) health records generates information needs Information needs go unmet

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Supporting Medical Decision Making with Electronic Medical Records

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  1. Supporting Medical Decision Making with Electronic Medical Records 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. World Wide Web (The Hyperdocument) Information Resources Health Practitioner Biblio- graphic Database Textbook Expert System One-Stop Information Shopping?

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

  5. Information for Decision-Making ? MRSA

  6. Query Result Intelligent Decision Support ! ? MRSA

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

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

  9. Central Controlled Terminology

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

  11. Automated Decision Support 4 5 2 Automated Translation Get Information From EMR Resource Terminology 6 1 MRSA Querying Understand Information Needs 3 7 Resource Selection Presentation

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

  13. EMR and Decision Support - understand conditions • Pharmacy Infobutton - review and teach • The Medline Button

  14. EMR and Decision Support • The Medline Button - understand conditions • Pharmacy Infobutton - review and teach • Cholesterol Guideline - dietary planning

  15. EMR and Decision Support • The Medline Button - understand conditions • Pharmacy Infobutton - review and teach • Cholesterol Guideline - dietary planning • DXplain Button - understand findings

  16. 32412 Intravascular Specimen 32308 Intravascular Glucose Tests 31987 Glucose 32703 Serum Glucose Tests 42486 Decreased Abnormal Finding in Body Substance 42485 Elevated Abnormal Finding in Body Substance 1600 Gluc 1600 44 L 42527 Abnormal Level of Blood Glucose 3286 Hypoglycemia 42541 Hyperglycemia 3286 Hypoglycemia From Test Result to Finding

  17. EMR and Decision Support • The Medline Button - understand conditions • Pharmacy Infobutton - review and teach • Cholesterol Guideline - dietary planning • Dxplain Button - understand findings • QingCIS - problem-oriented views

  18. 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

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

  20. EMR and Decision Support • The Medline Button - understand conditions • Pharmacy Infobutton - review and teach • Cholesterol Guideline - dietary planning • Dxplain Button - understand findings • QingCIS - problem-oriented views • PatCIS - patient education

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