Transcript Theoretical Empirical and Practical Approaches to Resolving the

Theoretical, Empirical, and Practical
Approaches to Resolving the
Unmet Information Needs of
Clinical Information System Users
James J. Cimino MD, Jianhua Li MD,
Suzanne Bakken RN DNSc, Vimla L. Patel PhD
Department of (Bio)Medical Informatics
Columbia University
New York, New York, USA
Information Needs of CIS Users
• Unmet information needs in practice
• Unmet needs lead to deferred or uninformed
decisions (errors!)
• Information needs of CIS users not studied
Why Care about CIS Users?
• Needs occur when learning new information
• Needs occur during decision making
• Simple setting suggests predictable needs
• Setting is conducive to resolving needs
• Retrieval may be accomplished automatically
(infobuttons)
A Brief History of Infobuttons
• 1991: “Medline Button” translated ICD9 to
MeSH and performed Medline searches
• 1994: World Wide Web
• 1994: First CPMC Web-based CIS
• 1996: WebCIS
• 1996: Infobuttons link microbiology and
medication data to PubMed and Micromedex
• 1997: Infobuttons for patients (PatCIS)
Theoretical Approach
• Theory: Information needs are situated
• Hypothesis: needs arising during use of a CIS
are predictable based on context
• IF {detect the context} THEN {predict need}
• IF {predict need} THEN {address need}
• IF {address need} THEN {reduce unmet needs}
• IF {reduce unmet needs} THEN {reduce errors}
Context-Dependent Information Needs
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Age
Sex
Role Training
!
Task
Context
Data
Institution
Empirical Approach
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Direct observation of CIS users
“Think aloud” about information needs
Data capture: video (screen) and audio
Transcription: articulation of needs
Coding: characterize needs and contexts
Summariation: needs and contexts
User’s
Workstation
75 foot cable
Portable Usability Lab Video Monitor
Converter Controller
Microphone
Video Converter
Cassette Recorder
Headphones
VCR
Practical Approach
• Context passed to Infobutton Manager (IM)
• IM matches context to information needs
• Search strategies are instantiated
• Questions (links) are returned to user
Matching Context to Need
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Infobutton Manager
Context Table
Question
Selection
Instantiation
Context
Matching
Question Table
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Context Parameters
• Patient: age, gender
• User: physician, nurse, student, patient, …
• Setting: lab reports, medications, …
• Concept of interest: lab test, drug, …
Infobutton Parameters
• Question type: fixed, fill-in-the-blank
• Source type: simple query, additional data
• URL:
http://www.guideline.gov/SEARCH/search_results.asp?
sSearch_string=<>&bSort_by_date=&query_id=&
bDebug=&results=10&view=search_results
• Question:
What are guidelines for evaluation of <>?
<a href="Javascript:get_info('35702')"><img src="info.gif"></a>
function get_info(mc){ var infowin = window.open("","INFO");
infowin.focus(); document.INFO.info_med.value=mc;
document.INFO.submit(); }
<form method="POST" name=“INFO”
action="wc_infomanage.cgi">
<input type="HIDDEN" name="info_med" value="">
<input type="HIDDEN" name="info_context" value="LabDetail">
<input type="HIDDEN" name="info_institute" value="CPMC">
<input type="HIDDEN" name="DOB" value="1951-05-26">
<input type="HIDDEN" name="SEX" value="F">
<input type="HIDDEN" name="USER" value="ciminoj">
</form>
Evaluation Plan
• Baseline observation
– Creation of Infobutton Manager tables
– Resources used
– Unmet information needs
• Log of access to online resources
• Introduction of infobuttons
– Usability studies
• Log of access to online resources (infobuttons)
• Post-intervention observation
– Use of infobuttons and other resources
– Unmet information needs
Status Report
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Infobutton Manager built
Web-based table management tools built
Log files being collected
Three nursing stations, CCU and clinic
5 days of data
15 hours of audio/video
Needs coded along six dimensions
– patient/institution
– administrative/health knowledge
– foreground/background
– explicit/implicit
– human/computer/paper
– success/failure/deferred
Discussion
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Empirical method is detecting needs
Summarizarion is next step
Technical approach is feasible
Evaluation should detect impact
Information needs may be universal
Our approach is institution independent
Context Parameters
• Patient: age, gender
• User: physician, nurse, student, patient, …
• Setting: lab reports, medications, …
• Concept of interest: lab test, drug, …
• Institution: CPMC, RMRS, LDS, …
<form method="POST" action="wc_infomanage.cgi">
<input type="HIDDEN" name="info_med" value=“35702">
<input type="HIDDEN" name="info_context" value="LabDetail">
<input type="HIDDEN" name="info_institute" value="CPMC">
<input type="HIDDEN" name="DOB" value="1951-05-26">
<input type="HIDDEN" name="SEX" value="F">
<input type="HIDDEN" name="USER" value="ciminoj">
</form>
<form method="POST" action="wc_infomanage.cgi">
<input type="HIDDEN" name="info_med" value=“DIGOXIN|..">
<input type="HIDDEN" name="info_context" value="LabDetail">
<input type="HIDDEN" name="info_institute" value=“RMRS">
<input type="HIDDEN" name="DOB" value="1951-05-26">
<input type="HIDDEN" name="SEX" value="F">
<input type="HIDDEN" name="USER" value="ciminoj">
</form>
Conclusions
• Theoretical, empirical and practical
approaches are working synergistically
• Satisfaction of CIS users’ needs is feasible
• Other institutions can share if they have:
– Web-based CIS
– Users with information needs
Acknowledgments
• National Library of Medicine
grant R01-LM07593
• Research assistants:
– Anne-Marie Ramierez
– Mark Graham
– Leanne Currie