1. RESULTS: PHASE II INFOBUTTONS IN USE: Examples of Context Specific Links to Web-based Materials 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 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 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) Infobuttons: A Study of Usability Lily Gutnik 1, Sarah Collins RN, BSN 2, Leanne M. Currie RN, DNSc 1,2 James J. Cimino MD 1, & Vimla L. Patel, PhD, DSc 1 Columbia University, New York, NY, 1 Department of Biomedical Informatics, 2 School of Nursing, 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 ACKNOWLEDGMENTS: This project was supported by US National Library of Medicine 1R01LM07593. 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? 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 PURPOSE To determine the usability of the Infobutton interface to resolve clinicians’ information needs Information Needs Coding Framework S-I D-I S-D-I S-D Type of Need RESULTS: PHASE II Information Needs Taxonomy ItemsMD 1PARN3RN4Total Success121615548 Deferred1221015 Failure376016 Subject00202 Domain067316 Institution00235 Subject-Institution00000 Subject-Domain1096833 Institution-Domain6104121 Subject-Domain-Institution00202 Information Retrieval-Internal Source3106726 Information Retrieval-External Source121417851 Calculation11002 Natural Language Processing00000 Question TypesMD1PARN1RN2Total What is the drug of choice for condition x?00000 What is the cause of symptom x?00101 What test is indicated in situation x?00000 What is the dose of drug x?25119 How should I treat condition x?00000 How should I manage condition x?253010 What is the cause of physical finding x?00000 What is the cause of test finding x?00000 Can drug x cause (adverse) finding y?535114 Could this patient have condition x?10001 What are my patient's data?035715 How do we do this here?34007 What are this institution-specific data?223310 What is this?134311 What is the expected outcome?00101 Total1625231579 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 Web-based Medical Reference Web-based Patient Education Materials Web-based Calculator