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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
1
2
MRSA
Education at the Moment of Need
Get InformationFrom EMR
ResourceSelection
UnderstandInformation
Needs
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3
MRSA
Education at the Moment of Need
Get InformationFrom EMR
ResourceSelection
ResourceTerminology
UnderstandInformation
Needs
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3
MRSA
Education at the Moment of Need
Get InformationFrom EMR
ResourceSelection
ResourceTerminology
UnderstandInformation
Needs
AutomatedTranslation
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3
MRSA
Education at the Moment of Need
Get InformationFrom EMR
ResourceSelection
ResourceTerminology
QueryingUnderstandInformation
Needs
AutomatedTranslation
1
254
6
3
MRSA
Education at the Moment of Need
Get InformationFrom EMR
ResourceSelection
ResourceTerminology
Querying
Presentation
UnderstandInformation
Needs
AutomatedTranslation
1
254
6
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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
0
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Aug-0
2
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HR-DrugOrder
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