The Librarian Infobutton Tailoring Environment

(LITE)

James J. Cimino

National Institutes of Health and Columbia University

Today’s Topics

• Clinician Information Needs• Infobuttons• Infobutton Managers• The Coumadin Story• Institution-Specific Requirements• Infobutton Manager Customization Tasks• Librarian Infobutton Tailoring Environment

– Research plan– Initial efforts– Getting involved

Health Knowledge for Decision Support

Infobuttons

Anticipate Need and Provide Queries

i

Information Needs of CIS 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

• We can predict the specific need

• User is sitting at a computer!

• We can automate information retrieval

First Attempt: The Medline Button

• CIS on mainframe

• BRS/Colleague (Medline) on same mainframe

• Get them to talk to each other

• Search using diagnoses and procedures

First Attempt: The Medline Button

• CIS on mainframe

• BRS/Colleague (Medline) on same mainframe

• Get them to talk to each other

• Search using diagnoses and procedures• Technical success

• Practical failure

Education at the Moment of Need

MRSA

Education at the Moment of Need

UnderstandInformation

Needs

1MRSA

Education at the Moment of Need

Get InformationFrom EMR

UnderstandInformation

Needs

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MRSA

Education at the Moment of Need

Get InformationFrom EMR

ResourceSelection

UnderstandInformation

Needs

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MRSA

Education at the Moment of Need

Get InformationFrom EMR

ResourceSelection

ResourceTerminology

UnderstandInformation

Needs

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MRSA

Education at the Moment of Need

Get InformationFrom EMR

ResourceSelection

ResourceTerminology

UnderstandInformation

Needs

AutomatedTranslation

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MRSA

Education at the Moment of Need

Get InformationFrom EMR

ResourceSelection

ResourceTerminology

QueryingUnderstandInformation

Needs

AutomatedTranslation

1

254

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MRSA

Education at the Moment of Need

Get InformationFrom EMR

ResourceSelection

ResourceTerminology

Querying

Presentation

UnderstandInformation

Needs

AutomatedTranslation

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MRSA

Research Issues

• What are the information needs?

• Which context information is important?

• What resources can satisfy needs?

• How can retrieval be automated?

– What context data are used?

– How are the data translated?

Infobuttons vs. Infobutton Manager

Pageof

Hyperlinks

InfobuttonClinical System Resourc

e

InfobuttonManager

ContextQuery

KnowledgeBase

s

The Coumadin Story

• Chair of Medicine wants link to Coumadin protocol

• First, I have to find the guidelines

The Coumadin Story

• Chair of Medicine wants link to Coumadin protocol

• First, I have to find the guidelines

• Then I have to add the question to the IM table

The Coumadin Story

• Chair of Medicine wants link to Coumadin protocol• First, I have to find the guidelines• Then I have to add the question to the IM table

• Finally, I link the question to the context

The Coumadin Story

• Chair of Medicine wants link to Coumadin protocol• First, I have to find the guidelines• Then I have to add the question to the IM table• Finally, I link the question to the context

• Voilá!

Usage in Lab Contexts

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HR-LabDetail

IM-LabDetail

Usage in In-Patient Drug Contexts

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HR-InPatientDrugs

IM-InPatientDrugs

Usage in Diagnosis Context

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HR-Diagnoses

IM-Diagnoses

Usage in Lab Order Entry Context

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HR-LabOrder

IM-LabOrder

Usage in InPat Drug Order Entry

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IM-DrugOrder

Institution-Specific Requirements

• What are the users’ information needs?

• In what contexts do those needs arise?

• What resources will resolve the needs?

• Terminology????????

• How can the Infobutton Manager be integrated into the clinical information system?

New York Presbyterian Hospital (Eclipsys)

NY Office of Mental Health (Psykes)

NY Office of Mental Health (Psykes)

Regenstrief Medical Record System

Cryststal Run Healthcare (NextGen)

Infobutton ManagerMaintenance Tool

Functions:Browse

AddUpdateDelete

Clinician

Infobutton Manager

TranslationTable

TermTranslation

ContextTable

ContextMatching

InfobuttonTable

QueryConstruction

Page ofLinks

SystemMaintainer

Institution Customization Tasks

Institution Customization

• Institution librarians know their clients best

• Institution librarians know their resources

• How can librarians populate Infobutton Manager tables?

• Terminology is institution-specific

• How do we handle institution-specific data translation?

Librarian Infobutton Tailoring Environrment (LITE)

• Specify user contexts

• Identify terminology in each context

• Information needs in each context

• Resources for resolving information needs

• Automating translation and querying

Infobutton ManagerMaintenance Tool

Functions:Browse

AddUpdateDelete

Clinician

Infobutton Manager

TranslationTable

TermTranslation

ContextTable

ContextMatching

InfobuttonTable

QueryConstruction

Page ofLinks

SystemMaintainer

Institution Customization Tasks

LITE TasksLibrarian Infobutton

Tailoring Environment(LITE)

InfobuttonManagerLog File

LITELog File

LITE Auditing

LITE Monitoring

Infobutton ManagerMonitoring

InstitutionLibrarian

ContextDefinition

ResourceUtilization

TerminologySpecification

QuestionConstruction

ResourceSelection

Clinician

Infobutton Manager

TranslationTable

TermTranslation

ContextTable

ContextMatching

InfobuttonTable

QueryConstruction

Page ofLinks

LITE Research Plan• Conduct community assessment

• Refine LITE features

• Establish forum for feedback from librarians

• Develop LITE in an iterative manner

• Develop a user manual and tutorial

• Evaluate usability of LITE by librarians

• Evaluate the use of LITE

• Disseminate the results of the project

• Promote the use of the IM and LITE

Initial Efforts

• Drupal site

• Community of users

• Clear through Institutional Review Board

• Enroll “subjects”

• Make each draft a forum topic

• Collect feedback

• Iterate

Conclusion

• Infobuttons can anticipate and resolve clinicians’ information needs

• Institution-specific tailoring is required• International standard will stimulate wider

adoption• Librarian Infobutton Tailoring Environment

will put the Infobutton Manager on autopilot• Enrollment now open• Demo version of LITE in testing now!

Acknowledgments

• Jianhua Li• Many student contributors• Guilherme Del Fiol• Noemie Elhadad• National Library of Medicine• NC/NMLG and MLGSC&A

www.infobuttons.org

lite.dbmi.columbia.edu