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
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Infobuttons: Anticipatory Passive Decision Support ACMI Senior Member Presentation
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. - PowerPoint PPT Presentation
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Infobuttons:Anticipatory Passive Decision Support
ACMI Senior Member Presentation
James J. Cimino, MD, FACMI
Laboratory for Informatics DevelopmentNIH Clinical Center
and
Lister Hill National Center for Biomedical CommunicationsNational Library of Medicine
Bethesda, Maryland
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.
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
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 PracticeSookyung Hyun, et al. Nurses’ Use and Perceptions of Usefulness of National Cancer
Institute’s Tobacco-related Cancer Information Service (CIS) Resources.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
Research Issues
MRSA
Research Issues
UnderstandInformation
Needs
1MRSA
Research Issues
Get InformationFrom EMR
UnderstandInformation
Needs
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ResourceSelection
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ResourceTerminology
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ResourceSelection
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Needs
AutomatedTranslation
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MRSA
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ResourceSelection
ResourceTerminology
QueryingUnderstandInformation
Needs
AutomatedTranslation
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ResourceSelection
ResourceTerminology
Querying
Presentation
UnderstandInformation
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MRSA
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
Deployment of Columbia’s Infobutton Manager
• Columbia University’s Infobutton Manager• New York Presbyterian Hospital’s WebCIS• New York Presbyterian Hospital’s Eclipsys• New York State Psychiatric Institute’s PSYCKES• Regenstrief Medical Record System• Crystal Run Healthcare’s (Monroe, NY) (NextGen)
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.
• Epic – InfoButton with direct connection to specific resources
• Eclipsys – Infobutton tab using HL7 standard
Current Status of Infobutton Managers
• University of Utah
– Applications: HELP2 Clinical Desktop, narrative practice guidelines
– HL7 compliant, but using original API
– Resources: Micromedex, Clineguide, MDConsult, PubMed, Medline Plus, Genetics Home Reference, Gene Tests, Uptodate, Ebsco (Cochrane and CINAHL), ARUP Consult, ICD9 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
Current Status of Infobutton Managers
• Columbia University– Applications: WebCIS, Eclipsys, Regenstrief Medical Record
System, generic – HL7 compliant, but using original API– Resources: Anion Gap Calculator, ARUP Reference Manual,
Beers Criteria, CancerWEB, CPMC Lab Manual, DrugConsult, FirstConsult , Dxplain, ECG Interpreter, Eclipsys Training, Harrisons Principles of Internal Medicine, Lab Tests Online, LexiComp, MCW Pregnancy Calculator, Medicine on the Net, Micromedex, Miriam-Webster, National Guidelines Clearinghouse , NYPH Antibiotics Guidelines, OneLook, Proquest, PubMed, Rhuematology.org, RxList, UpToDate
– Context parameters: task context, main search criteria, age, gender, user type, user ID, medical record number, authentication parameters, “other available data”
Current Status of Knowledge Sources• Thomson/Reuters
– Applications: Mediware Worx, Ex Libris, Crown, "Ask Mayo“
• 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 HL7 standard is driving adoption by clinical system vendors and knowledge vendors
• Tools are needed to enable institution-specific customization
• Join LITE and help out
Acknowledgments
• Jianhua Li• Many student contributors• Steve Johnson• Sue Bakken• Leanne Currie• Guilherme Del Fiol• Saverio Maviglia• Noemie Elhadad• National Library of Medicine