Infobuttons: Anticipatory Passive Decision Support ACMI Senior Member Presentation James J. Cimino, MD, FACMI Laboratory for Informatics Development NIH Clinical Center and Lister Hill National Center for Biomedical Communications National Library of Medicine Bethesda, Maryland 1
Infobutton (noun): in'·fō·but'·tən – a link from one on-line information system to another that uses contextual information from the former to facilitate the retrieval of relevant information from the latter. Example: links in clinical information systems that provide patient-data-specific links to health knowledge resources. Decision Support. Passive. Anticipatory. 2
Topics • • The Why, When, and How of infobuttons? Research issues Infobutton and infobutton-like systems The HL 7 standard AMIA 2007 demonstration Current status of commercial efforts Librarian Infobutton Tailoring Environment (LITE) 3
Why Infobuttons? 4
Everybody is worried about losing their job to automation. They’re afraid they’ll be replaced by a button. But I’m smart. I’m going to get a job in the factory where they make the buttons. - Jackie Gleason, The Jackie Gleason Show, circa 1968 5
The When of Infobuttons 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) 6
Infobuttons in the Medical Literature Beverly Collins, et al. Attaching Context Sensitive Infobuttons to an EHR Options and Issues. SJ Darmoni, et al. French Infobutton: an academic and… business perspective. Per H Gesteland, et al. Clinician Use and Acceptance of Population-Based Data about Respiratory Pathogens: Implications for Enhancing Population-Based Clinical Practice Sookyung Hyun, et al. Nurses’ Use and Perceptions of Usefulness of National Cancer Institute’s Tobacco-related Cancer Information Service (CIS) Resources. 7 Robert A. Jenders, et al. Standards in Clinical Decision Support: Activities in Health Level Seven.
The How of Infobuttons • 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 may be able to predict the specific need • User is sitting at a computer! • We may be able to automate retrieval 8
Research Issues MRSA 9
Research Issues MRSA 1 Understand Information Needs 10
Research Issues 2 Get Information From EMR MRSA 1 Understand Information Needs 11
Research Issues 2 Get Information From EMR MRSA 1 Understand Information Needs 3 Resource Selection 12
Research Issues 4 2 Get Information From EMR Resource Terminology MRSA 1 Understand Information Needs 3 Resource Selection 13
Research Issues 4 Resource Terminology 5 2 Automated Translation Get Information From EMR MRSA 1 Understand Information Needs 3 Resource Selection 14
Research Issues 4 Resource Terminology 6 Querying 5 2 Automated Translation Get Information From EMR MRSA 1 Understand Information Needs 3 Resource Selection 15
Research Issues 4 Resource Terminology 5 2 Automated Translation Get Information From EMR 6 MRSA Querying 1 Understand Information Needs 3 Resource Selection 7 Presentation 16
Infobutton and Infobutton-like Systems • Columbia University’s Infobutton Manager • Vanderbilt University’s PC-POETS • LDS Hospital’s HELP system • Partners Healthcare System’s Knowledgeliink 17
18
19
20
21
22
23
24
25
26
27
Deployment of Columbia’s Infobutton Manager • • • Columbia University’s Infobutton Manager New York Presbyterian Hospital’s Web. CIS New York Presbyterian Hospital’s Eclipsys New York State Psychiatric Institute’s PSYCKES Regenstrief Medical Record System Crystal Run Healthcare’s (Monroe, NY) (Next. Gen) 28
29
NY Office of Mental Health (Psykes) 30
NY Office of Mental Health (Psykes) 31
Regenstrief Medical Record System 32
Crystal Run Healthcare (Next. Gen) 33
Infobuttons vs. Infobutton Manager Resource s Clinical System Infobutton Query Knowledge Base Context Infobutton Manager Page of Hyperlinks 34
The HL 7 Standard • Approved as Draft Standard for Trial Use (DSTU) • http: //www. hl 7. org/v 3 ballot 2008 MAY/html/ domains/uvds_Contextaware. Information. Retrieval(Infobutton). htm 35
36
37
38
Example 1: In this example the user is looking at a coded problem list of a male, 77 years-old patient with Bacterial Pneumonia. The user clicks on an infobutton that presents a series of questions. The user selects “How do I treat Bacterial Pneumonia? ” The following message payload represents the communication between the Decission Support System and the Information Resource. 39
<? xml version="1. 0" encoding="UTF-8"? > <infobutton. Event. Notification> <effective. Time value="20060706001023"/> <subject 1> <patient. Context> <patient. Person> <administrative. Gender. Code code="M" code. System="2. 16. 840. 1. 113883. 5. 1" code. System. Name="Administrative. Gender" display. Name="Male"/> </patient. Person> <subject. Of> <age> <code="30525 -0" code. System="2. 16. 840. 1. 113883. 6. 1" code. System. Name="LN" display. Name="AGE"/> <value="77" unit="a"/> </age> </subject. Of> </patient. Context> </subject 1> <subject 2> <task. Context> <code="PROBLISTREV" code. System="HL 7 -Infobutton" code. System. Name="HL 7 -infobutton" display. Name="Problem List Review"/> </task. Context> </subject 2> <subject 3> <sub. Topic> <code="Q 000628" code. System="2. 16. 840. 1. 113883. 6. 177" code. System. Name="MSH" display. Name="therapy"/> </sub. Topic> </subject 3> <subject 4> <main. Search. Criteria> <code="D 018410" code. System="2. 16. 840. 1. 113883. 6. 177" 40 code. System. Name="MSH" display. Name="Bacterial Pneumonia">
http: //www. e-resource. com/api? infobutton. Event. Notification. effective. Time. v=20060706001023& assigned. Entity. name. r=Organization. Username&assigned. Entity. certificate. Text. r=organization-password& patient. Person. administrative. Gender. Code. c=F&patient. Person. administrati ve. Gender. Code. dn=Female age. v. v=77&age. v. unit=a age. Group. v. c=D 000368&age. Group. v. cs=2. 16. 840. 1. 113883. 6. 177&age. Grou p. v. dn=Aged task. Context. c. c=PROBLISTREV&task. Context. c. dn=Problem+list+review& sub. Topic. c. c=Q 000628&sub. Topic. c. cs=2. 16. 840. 1. 113883. 6. 177&sub. Topic. c. dn=therapy main. Search. Criteria. c. c=D 018410&main. Search. Criteria. c. cs=2. 16. 840. 1. 113 883. 6. 177& main. Search. Criteria. c. dn=Bacterial+Pneumonia& main. Search. Criteria. c. ot=Pneumonia 41
AMIA 2007 Demo Participants • Health care & academic institutions – Intermountain Healthcare, Columbia University, Partners Healthcare • Content providers – Wolters Kluwer Health, ACP, EBSCO, Thomson/Micromedex, Up. To. Date, Lexicomp 42
43
44
45
46
47
48
Current Status of Clinical Systems • Epic – Info. Button with direct connection to specific resources • Eclipsys – Infobutton tab using HL 7 standard 49
Current Status of Infobutton Managers • University of Utah – Applications: HELP 2 Clinical Desktop, narrative practice guidelines – HL 7 compliant, but using original API – Resources: Micromedex, Clineguide, MDConsult, Pub. Med, Medline Plus, Genetics Home Reference, Gene Tests, Uptodate, Ebsco (Cochrane and CINAHL), ARUP Consult, ICD 9 search web site, Intermountain Care Process modules, Intermountain geriatric drug monographs – Context parameters: task context, main search criteria, age, gender, subtopic, observation interpretation (for labs), content recipient, and authentication parameters 50
Current Status of Infobutton Managers • Columbia University – Applications: Web. CIS, Eclipsys, Regenstrief Medical Record System, generic – HL 7 compliant, but using original API – Resources: Anion Gap Calculator, ARUP Reference Manual, Beers Criteria, Cancer. WEB, CPMC Lab Manual, Drug. Consult, First. Consult , Dxplain, ECG Interpreter, Eclipsys Training, Harrisons Principles of Internal Medicine, Lab Tests Online, Lexi. Comp, MCW Pregnancy Calculator, Medicine on the Net, Micromedex, Miriam-Webster, National Guidelines Clearinghouse , NYPH Antibiotics Guidelines, One. Look, Proquest, Pub. Med, Rhuematology. org, Rx. List, Up. To. Date – Context parameters: task context, main search criteria, age, gender, user type, user ID, medical record number, 51 authentication parameters, “other available data”
Current Status of Knowledge Sources • Thomson/Reuters – Applications: Mediware Worx, Ex Libris, Crown, "Ask Mayo“ – Limited HL 7 compliance – Resources: (Micromedex) Clinical Drug, Clinical Disease, Clinical Lab, Consumer Drug, Consumer Disease, Consumer Lab, Clinical Checkpoints – Context parameters: Application, Care Setting, Institution, Content Target, Language, Subtopics • EBSCO – Resources: Medline, Dynamed, CINAHL – HL 7 Info. Button Manager; working to extend functionality – Translator 52
Current Status of Knowledge Sources • Wolters Kluwer – Resources: Clin-eguide – HL 7: Clin-eguide – Parameters: Provider Information, ICD 9 -CM, SNOMED CT, LOINC, Rx. Norm, result high/low, age, age group, subtopic, such as diagnosis or treatment • Elsevier – Resources: Drug. Consult, First. Consult • PIER – currently in hibernation 53
Institution Customization Tasks Infobutton Manager Maintenance Tool System Maintainer Functions: Browse Add Update Delete Translation Table Term Translation Context Table Context Matching Infobutton Table Query Construction Clinician Page of Links 54
Librarian Infobutton Tailoring Environment (LITE) Context Definition Terminology Specification Institution Librarian Question Construction Infobutton Manager Translation Table Term Translation Context Table Context Matching Infobutton Table Query Construction Page of Links Resource Selection Resource Utilization Clinician Infobutton Manager Log File LITE Auditing Infobutton Manager Monitoring LITE Log File 55
LITE Research Plan 1) 2) 3) 4) 5) 6) Establish librarian user community Refine LITE features Collect feedback from librarians Develop documentation Collect feedback from librarians Go to (2) 56
57
58
59
60
61
62
63
64
65
66
67
68
69
70
71
72
73
74
75
76
77
Conclusions • Infobuttons and infobutton-like applications have a long history of development in the informatics community • Context-specific links improve patient care • The World Wide Web made resources available and made integration feasible • The HL 7 standard is driving adoption by clinical system vendors and knowledge vendors • Tools are needed to enable institution-specific customization • Join LITE and help out 78
Acknowledgments • • • Jianhua Li Many student contributors Steve Johnson Sue Bakken Leanne Currie Guilherme Del Fiol Saverio Maviglia Noemie Elhadad National Library of Medicine 79
www. infobuttons. com 80
www. infobuttons. org 81
lite. dbmi. columbia. edu 82
Buttons. - Jimmy Cimino, 1956 83
Скачать презентацию Infobuttons Anticipatory Passive Decision Support ACMI Senior Member
12e9a21da2038f48150d689eac3b87cd.ppt