Transcript Slide 1

Infobuttons: A Study of Usability
Lily
1
Gutnik ,
2
BSN ,
Sarah Collins RN,
Leanne M. Currie RN,
1
1
James J. Cimino MD , & Vimla L. Patel, PhD, DSc
1,2
DNSc
Columbia University, New York, NY, 1Department of Biomedical Informatics, 2School of Nursing,
PURPOSE
• To determine the usability of the Infobutton interface to resolve
clinicians’ information needs
METHODS: PHASE II
•
Study Design
• Laboratory study examining IM use by nurses and physicians
• Survey of satisfaction with the infobutton manager
Participants
• 2 nurses (RN), 1 physician (MD), and 1 physician’s assistant (PA)
Procedures:
• Participants were given a script with 3 scenarios with a set of
tasks
• Participants were asked to "think aloud" as they used the IM and
the resources
• Morae™ software was used to capture the computer screen and
the audio recording of the user
BACKGROUND
• Studies of clinician’s information needs while treating patients have
shown that the resolution of these needs is often deferred or fails,
which may lead to medical errors
• The Infobutton Manager (IM) was developed to help improve the
resolution of information needs by providing users with links to on-line
health information resources
• The aim of this study was to determine the usability of the Infobutton
interface to resolve clinicians’ information needs
•
•
•
•
CONCLUSIONS
Clinicians commonly have information needs as they treat their patients
• Nurses have information needs throughout their day
• During laboratory sessions with 4 clinicians, 79 information needs
events were observed
The most commonly occurring question types were:
• “What are my patient's data?” and “Can drug x cause (adverse)
finding y?”
Most information needs events were successful, and domain-related
Frequent documentation by nurses in the CCU suggests that the IM may
provide a useful and accessible link for clinicians seeking information
resources at the point of care
This study accentuated the need to be mindful of information overload
RESULTS: PHASE II
METHODS: PHASE I
Study Design
• Ethnographic evaluation of the clinical work environment
Participants
• One nurse in the Coronary Care Unit (CCU)
Procedures
• Data collection was limited to note-taking and asking basic questions
regarding CCU workflow and the use of technologies
• Data were coded to characterize general clinical information system
(CIS) related activities and communication between RN and team
RESULTS: PHASE I
Phase I: Ethnographic Observation
• Information needs were observed to occur at two time points when the
nurse was using the CIS during the workday:
1. At the beginning of shift when reviewing the electronic chart
2. During documentation of nursing activities throughout the day (e.g.,
after each patient assessment)
Question Types
MD1
PA
RN1
RN2
Total
What is the drug of choice for condition x?
What is the cause of symptom x?
What test is indicated in situation x?
What is the dose of drug x?
How should I treat condition x?
How should I manage condition x?
What is the cause of physical finding x?
What is the cause of test finding x?
Can drug x cause (adverse) finding y?
Could this patient have condition x?
What are my patient's data?
How do we do this here?
What are this institution-specific data?
What is this?
What is the expected outcome?
Total
0
0
0
2
0
2
0
0
5
1
0
3
2
1
0
16
0
0
0
5
0
5
0
0
3
0
3
4
2
3
0
25
0
1
0
1
0
3
0
0
5
0
5
0
3
4
1
23
0
0
0
1
0
0
0
0
1
0
7
0
3
3
0
15
0
1
0
9
0
10
0
0
14
1
15
7
10
11
1
79
RESULTS: PHASE II
Information Needs Taxonomy Items
Success
Deferred
Failure
Subject
Domain
Institution
Subject-Institution
Subject-Domain
Institution-Domain
Subject-Domain-Institution
Information Retrieval-Internal Source
Information Retrieval-External Source
Calculation
Natural Language Processing
MD 1
12
1
3
0
0
0
0
10
6
0
3
12
1
0
PA RN3 RN4 Total
16 15
5
48
2
2
10
15
7
6
0
16
0
2
0
2
6
7
3
16
0
2
3
5
0
0
0
0
9
6
8
33
10
4
1
21
0
2
0
2
10
6
7
26
14 17
8
51
1
0
0
2
0
0
0
0
INFOBUTTONS IN USE: Examples of Context Specific Links to Web-based Materials
Information Needs Coding Framework
Type of Need
Domain
D-I
S-D
S-D-I
Institution
S-I
Subject
Expression of Need: Implicit/Explicit
Basis of Need: Foreground/Background
Context in CIS: e.g., Lab, Pharmacy, CPOE
Resource Type: Human/Computer/Paper
Success Rate: Success/Deferred/Failed
Web-based Medical Reference
Web-based Calculator
Question Types
From Ely’s Taxonomy:
1. What is the drug of choice for condition x?
2. What is the cause of symptom x?
3. What test is indicated in situation x?
4. What is the dose of drug x?
5. How should I treat condition x (not limited to drug
treatment)?
6. How should I manage condition x (not specifying
diagnostic or therapeutic)?
7. What is the cause of physical finding x?
8. What is the cause of test finding x?
9. Can drug x cause (adverse) finding y?
From Infobutton Project:
1. Could this patient have condition x?
2. What are my patient's data?
3. How do we do this here?
4. What is this institution-specific data?
5. What is this?
ACKNOWLEDGMENTS: This project was supported by US National Library of Medicine 1R01LM07593.
Web-based Patient Education Materials