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James J. Cimino MD, Jianhua Li MD, Suzanne Bakken RN DNSc, Vimla L. Patel PhD PowerPoint PPT Presentation


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Theoretical,. and Practical. Empirical, . Approaches to Resolving the. Unmet Information Needs of . Clinical Information System Users. James J. Cimino MD, Jianhua Li MD, Suzanne Bakken RN DNSc, Vimla L. Patel PhD Department of (Bio)Medical Informatics Columbia University

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James J. Cimino MD, Jianhua Li MD, Suzanne Bakken RN DNSc, Vimla L. Patel PhD

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James j cimino md jianhua li md suzanne bakken rn dnsc vimla l patel phd

Theoretical,

and Practical

Empirical,

Approaches to Resolving the

Unmet Information Needs of

Clinical Information System Users

James J. Cimino MD, Jianhua Li MD,

Suzanne Bakken RN DNSc, Vimla L. Patel PhD

Department of (Bio)Medical Informatics

Columbia University

New York, New York, USA


Information needs of cis users

Information Needs of CIS Users

  • Unmet information needs in practice

  • Unmet needs lead to deferred or uninformed decisions (errors!)

  • Information needs of CIS users not studied


Why care about cis users

Why Care about CIS Users?

  • Needs occur when learning new information

  • Needs occur during decision making

  • Simple setting suggests predictable needs

  • Setting is conducive to resolving needs

  • Retrieval may be accomplished automatically (infobuttons)


A brief history of infobuttons

A Brief History of Infobuttons

  • 1991: “Medline Button” translated ICD9 to MeSH and performed Medline searches

  • 1994: World Wide Web

  • 1994: First CPMC Web-based CIS

  • 1996: WebCIS

  • 1996: Infobuttons link microbiology and medication data to PubMed and Micromedex

  • 1997: Infobuttons for patients (PatCIS)


Theoretical approach

Theoretical Approach

  • Theory: Information needs are situated

  • Hypothesis: needs arising during use of a CIS are predictable based on context

  • IF {detect the context} THEN {predict need}

  • IF {predict need} THEN {address need}

  • IF {address need} THEN {reduce unmet needs}

  • IF {reduce unmet needs} THEN {reduce errors}


Context dependent information needs

Context-Dependent Information Needs

!

?

Age

Sex

Role

Training

Task

Data

Institution

Context


Empirical approach

Empirical Approach

  • Direct observation of CIS users

  • “Think aloud” about information needs

  • Data capture: video (screen) and audio

  • Transcription: articulation of needs

  • Coding: characterize needs and contexts

  • Summariation: needs and contexts


James j cimino md jianhua li md suzanne bakken rn dnsc vimla l patel phd

Portable Usability Lab

User’s Workstation

75 foot cable

Video Monitor

Converter Controller

Microphone

Video Converter

Headphones

VCR

Cassette Recorder


Practical approach

Practical Approach

  • Context passed to Infobutton Manager (IM)

  • IM matches context to information needs

  • Search strategies are instantiated

  • Questions (links) are returned to user


Matching context to need

Matching Context to Need

Infobutton Manager

I

n

f

o

b

u

t

t

o

n

s

Context

Matching

Context Table

Question

Selection

Question Table

Instantiation

C

o

n

t

e

x

t


Context parameters

Context Parameters

  • Patient: age, gender

  • User: physician, nurse, student, patient, …

  • Setting: lab reports, medications, …

  • Concept of interest: lab test, drug, …


Infobutton parameters

Infobutton Parameters

  • Question type: fixed, fill-in-the-blank

  • Source type: simple query, additional data

  • URL:

    http://www.guideline.gov/SEARCH/search_results.asp? sSearch_string=<>&bSort_by_date=&query_id=& bDebug=&results=10&view=search_results

  • Question:

    What are guidelines for evaluation of <>?


James j cimino md jianhua li md suzanne bakken rn dnsc vimla l patel phd

<a href="Javascript:get_info('35702')"><img src="info.gif"></a>

function get_info(mc){ var infowin = window.open("","INFO");

infowin.focus(); document.INFO.info_med.value=mc;

document.INFO.submit(); }

<form method="POST" name=“INFO”

action="wc_infomanage.cgi">

<input type="HIDDEN" name="info_med" value="">

<input type="HIDDEN" name="info_context" value="LabDetail">

<input type="HIDDEN" name="info_institute" value="CPMC">

<input type="HIDDEN" name="DOB" value="1951-05-26">

<input type="HIDDEN" name="SEX" value="F">

<input type="HIDDEN" name="USER" value="ciminoj">

</form>


Evaluation plan

Evaluation Plan

  • Baseline observation

    • Creation of Infobutton Manager tables

    • Resources used

    • Unmet information needs

  • Log of access to online resources

  • Introduction of infobuttons

    • Usability studies

  • Log of access to online resources (infobuttons)

  • Post-intervention observation

    • Use of infobuttons and other resources

    • Unmet information needs


Status report

Status Report

  • Infobutton Manager built

  • Web-based table management tools built

  • Log files being collected

  • Three nursing stations, CCU and clinic

  • 5 days of data

  • 15 hours of audio/video

  • Needs coded along six dimensions

    • patient/institution

    • administrative/health knowledge

    • foreground/background

    • explicit/implicit

    • human/computer/paper

    • success/failure/deferred


Discussion

Discussion

  • Empirical method is detecting needs

  • Summarizarion is next step

  • Technical approach is feasible

  • Evaluation should detect impact

  • Information needs may be universal

  • Our approach is institution independent


Context parameters1

Context Parameters

  • Patient: age, gender

  • User: physician, nurse, student, patient, …

  • Setting: lab reports, medications, …

  • Concept of interest: lab test, drug, …

  • Institution: CPMC, RMRS, LDS, …


James j cimino md jianhua li md suzanne bakken rn dnsc vimla l patel phd

<form method="POST" action="wc_infomanage.cgi">

<input type="HIDDEN" name="info_med" value=“35702">

<input type="HIDDEN" name="info_context" value="LabDetail">

<input type="HIDDEN" name="info_institute" value="CPMC">

<input type="HIDDEN" name="DOB" value="1951-05-26">

<input type="HIDDEN" name="SEX" value="F">

<input type="HIDDEN" name="USER" value="ciminoj">

</form>


James j cimino md jianhua li md suzanne bakken rn dnsc vimla l patel phd

<form method="POST" action="wc_infomanage.cgi">

<input type="HIDDEN" name="info_med" value=“DIGOXIN|..">

<input type="HIDDEN" name="info_context" value="LabDetail">

<input type="HIDDEN" name="info_institute" value=“RMRS">

<input type="HIDDEN" name="DOB" value="1951-05-26">

<input type="HIDDEN" name="SEX" value="F">

<input type="HIDDEN" name="USER" value="ciminoj">

</form>


Conclusions

Conclusions

  • Theoretical, empirical and practical approaches are working synergistically

  • Satisfaction of CIS users’ needs is feasible

  • Other institutions can share if they have:

    • Web-based CIS

    • Users with information needs


Acknowledgments

Acknowledgments

  • National Library of Medicine grant R01-LM07593

  • Research assistants:

    • Anne-Marie Ramierez

    • Mark Graham

    • Leanne Currie


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