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Personalized Prediction and Resolution of Clinician Information Needs
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  1. Personalized Prediction and Resolution of Clinician Information Needs James J. Cimino, M.D. Departments of Biomedical Informatics and Medicine Columbia University

  2. Covell et al. Information Needs 1984 1986 1988 1990 1992 1994 1996 1998 2000 2002 2004

  3. Studying Information Needs Covell DG, Uman GC, Manning PR. Information needs in office practice: are they being met? Ann Intern Med. 1985 Oct;103(4):596-9.

  4. Findings of Observational Studies • Information needs occur often • They are often unresolved • Computer-based resources are underused: • Lack of knowledge of existence • Lack of access • Lack of navigational skills • Perceived lack of time

  5. Information Needs in Clinical Care ?

  6. Clinical Information for Decision Support

  7. Health Knowledge for Decision Support

  8. Automated Clinical Decision Support Alerting and Reminder System

  9. Clinical Decision Support Systems

  10. Modes of Decision Support Clinical Data or Knowledge Yes Yes Yes What is the Information Retrieved? Retrieval Uses Knowledge? Retrieval Uses Clinical Data? User Recognizes Need? Decision Support Mode Patient Info Yes Maybe No Clinical Data Knowledge Yes No No Knowledge Alerting No Yes Yes Knowledge ?

  11. Infobuttons Anticipate Need and Provide Queries i

  12. 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 • So: We may be able to predict the specific need • User is sitting at a computer! • So: We may be able to get an answer automatically

  13. Covel et al. Information Needs UMLS Project 1984 1986 1988 1990 1992 1994 1996 1998 2000 2002 2004

  14. Unified Medical Language System The purpose of the UMLS is to improve the ability of computer programs to “understand” the biomedical meaning in user inquiries and to use this understanding to retrieve and integrate relevant machine-readable information for users. - Donald A.B. Lindberg 1986/1993

  15. Covel et al. Information Needs First Version of UMLS UMLS Project ICD9 MeSH Medline Button 1984 1986 1988 1990 1992 1994 1996 1998 2000 2002 2004

  16. First Attempt: The Medline Button • CIS (WebCIS’s predecessor) on mainframe • BRS/Colleague (Medline) on same mainframe • Get them to talk to each other • Search using patient diagnoses and procedures

  17. First Attempt: The Medline Button • CIS (WebCIS’s predecessor) on mainframe • BRS/Colleague (Medline) on same mainframe • Get them to talk to each other • Search using patient diagnoses and procedures • Technical success • Practical failure

  18. Covel et al. Information Needs First Version of UMLS PubMED Mosaic UMLS Project WebCIS ICD9 MeSH Medline Button Web-based Generic Queries 1984 1986 1988 1990 1992 1994 1996 1998 2000 2002 2004

  19. Covel et al. Information Needs First Version of UMLS PubMED Mosaic UMLS Project G.O. Barnett DXplain Web DXplain WebCIS ICD9 MeSH Medline Button DXplain Button Web-based Generic Queries 1984 1986 1988 1990 1992 1994 1996 1998 2000 2002 2004

  20. Covel et al. Information Needs First Version of UMLS PubMED Mosaic UMLS Project G.O. Barnett DXplain Web DXplain WebCIS Infobuttons ICD9 MeSH Medline Button DXplain Button Web-based Generic Queries 1984 1986 1988 1990 1992 1994 1996 1998 2000 2002 2004

  21. “Just in Time” Education MRSA

  22. “Just in Time” Education 1 MRSA Understand Information Needs

  23. “Just in Time” Education 2 Get Information From EMR 1 MRSA Understand Information Needs

  24. “Just in Time” Education 2 Get Information From EMR 1 MRSA Understand Information Needs 3 Resource Selection

  25. “Just in Time” Education 4 2 Get Information From EMR Resource Terminology 1 MRSA Understand Information Needs 3 Resource Selection

  26. “Just in Time” Education 4 5 2 Automated Translation Get Information From EMR Resource Terminology 1 MRSA Understand Information Needs 3 Resource Selection

  27. “Just in Time” Education 4 5 2 Automated Translation Get Information From EMR Resource Terminology 6 1 MRSA Querying Understand Information Needs 3 Resource Selection

  28. “Just in Time” Education 4 5 2 Automated Translation Get Information From EMR Resource Terminology 6 1 MRSA Querying Understand Information Needs 3 7 Resource Selection Presentation

  29. Research Issues • What are the information needs?

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

  31. Morae screen capture

  32. Research Issues • What are the information needs?

  33. Information Resource Use According to Log Files 12% IBs

  34. Research Issues • Which context information is important? • What are the information needs?