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A Truly Meaningful Use of Electronic Health Records Freely Available to All: Automated Anticipation A Truly Meaningful Use of Electronic Health Records Freely Available to All: Automated Anticipation and Resolution of Clinical Information Needs at the Point of Care through Infobuttons James J. Cimino, MD, FACMI, FACP Laboratory for Informatics Development NIH Clinical Center and the National Library of Medicine

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

Studying Information Needs Covell DG, Uman GC, Manning PR. Information needs in office practice: 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.

Knowledge Resources in Clinical Care Knowledge Resources in Clinical Care

Knowledge Resources in Clinical Care ? Knowledge Resources in Clinical Care ?

Information Needs of EHR Users • Common tasks may have common needs • System Information Needs of EHR 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 automate the answer

Infobutton Timeline Covel et al. Information Needs First Version of UMLS Project 1984 1986 Infobutton Timeline Covel et al. Information Needs First Version of UMLS Project 1984 1986 1988 1990 ICD 9 Me. SH 1992 Medline Button 1994 1996 1998 2000 2002 2004 2006 2008

Infobutton Timeline Covel et al. Information Needs G. O. Barnett DXplain 1984 1986 First Infobutton Timeline Covel et al. Information Needs G. O. Barnett DXplain 1984 1986 First Version of UMLS Mosaic UMLS Project 1988 1990 ICD 9 Me. SH Pub. MED Web DXplain 1992 1994 1996 1998 Web. CIS Medline Button DXplain Button Web-based Generic Queries 2000 2002 2004 2006 2008

From Data to Findings Serum Cholesterol Test Serum Specimen Abnormalities of Serum Cholesterol Hypercholesterolemia From Data to Findings Serum Cholesterol Test Serum Specimen Abnormalities of Serum Cholesterol Hypercholesterolemia

Infobutton Timeline Covel et al. Information Needs G. O. Barnett DXplain 1984 1986 First Infobutton Timeline Covel et al. Information Needs G. O. Barnett DXplain 1984 1986 First Version of UMLS Mosaic UMLS Project 1988 1990 ICD 9 Me. SH Pub. MED Web DXplain 1992 1994 Web. CIS Medline Button 1996 1998 2000 Infobuttons DXplain Button Web-based Generic Queries 2002 2004 2006 2008

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

Infobutton Timeline Covel et al. Information Needs G. O. Barnett DXplain 1984 1986 First Infobutton Timeline Covel et al. Information Needs G. O. Barnett DXplain 1984 1986 First Version of UMLS Mosaic UMLS Project 1988 1990 ICD 9 Me. SH Pub. MED Web DXplain 1992 1994 Web. CIS Medline Button 1996 1998 2000 2002 Infobuttons DXplain Button Web-based Generic Queries Infobutton Manager 2004 2006 2008

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

Infobutton Timeline Covel et al. Information Needs G. O. Barnett DXplain 1984 1986 First Infobutton Timeline Covel et al. Information Needs G. O. Barnett DXplain 1984 1986 First Version of UMLS Mosaic UMLS Project 1988 1990 ICD 9 Me. SH Pub. MED Infobutton Manager Standard Web DXplain 1992 1994 Web. CIS Medline Button 1996 1998 2000 2002 Infobuttons DXplain Button Web-based Generic Queries Infobutton Manager Micromedex Infobutton Access 2004 2006 2008

Infobutton Timeline Covel et al. Information Needs G. O. Barnett DXplain 1984 1986 First Infobutton Timeline Covel et al. Information Needs G. O. Barnett DXplain 1984 1986 First Version of UMLS Mosaic UMLS Project 1988 1990 ICD 9 Me. SH Pub. MED Infobutton Manager Standard Web DXplain 1992 1994 Web. CIS Medline Button 1996 1998 2000 2002 Micromedex Infobutton Access 2004 2006 2008 Infobuttons DXplain Button Web-based Generic Queries Infobutton Manager Librarian Infobutton Tailoring Environment (LITE)

Institution Customization Tasks Page of Links Institution i Patient (with age and gender) User Institution Customization Tasks Page of Links Institution i Patient (with age and gender) User (Physician, Nurse, etc. ) Clinical Application with Infobutton Link The Librarian Infobutton Tailoring Environment (LITE) Institutional Librarian (or other LITE users) Infobutton Manager Knowledge Base

Infobutton Timeline Covel et al. Information Needs 1986 1988 1990 Infobutton Manager Standard Pub. Infobutton Timeline Covel et al. Information Needs 1986 1988 1990 Infobutton Manager Standard Pub. MED Mosaic UMLS Project G. O. Barnett DXplain 1984 First Version of UMLS Micromedex Infobutton Access Web DXplain 1992 1994 1996 1998 2000 2002 Meanginful Use Stage 2 2004 2006 2008 2010 2012 2014 Infobuttons ICD 9 Me. SH Web. CIS Medline Button DXplain Button Web-based Generic Queries Infobutton Manager Librarian Infobutton Tailoring Environment (LITE)

Conclusions • Infobuttons improve patient care • The World Wide Web makes resources available Conclusions • Infobuttons improve patient care • The World Wide Web makes resources available and makes integration feasible, even easy • The HL 7 standard is driving adoption by clinical system vendors and knowledge vendors • EHRs achieve meaningful use with infobuttons • Open. Infobutton and LITE allow everyone to play

www. infobuttons. com www. infobuttons. com

www. infobuttons. org www. infobuttons. org

lite. bmi. utah. edu lite. bmi. utah. edu

www. openinfobuttons. org www. openinfobuttons. org