1. 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 Approaches to Resolving the Clinical Information System Users Theoretical, Empirical, and Practical Unmet Information Needs of

2. 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

3. 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)

4. 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)

5. 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}

6. Context-Dependent Information Needs AgeSex TrainingRole DataTask Context ? ! Institution

7. Empirical Approach 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

8. Portable Usability Lab User’s Workstation Microphone Video Converter 75 foot cable Converter Controller Cassette Recorder VCR Headphones Video Monitor

10. Practical Approach Context passed to Infobutton Manager (IM) IM matches context to information needs Search strategies are instantiated Questions (links) are returned to user

11. Matching Context to Need ContextContext Context Matching Question Selection Instantiation InfobuttonsInfobuttons Infobutton Manager Context Table Question Table

12. Context Parameters Patient: age, gender User: physician, nurse, student, patient, … Setting: lab reports, medications, … Concept of interest: lab test, drug, …

13. 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 <>?

15. 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">

19. 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

20. Status Report 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

21. Discussion 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

22. Context Parameters Patient: age, gender User: physician, nurse, student, patient, … Setting: lab reports, medications, … Concept of interest: lab test, drug, … Institution: CPMC, RMRS, LDS, …

25. 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

26. Acknowledgments National Library of Medicine grant R01-LM07593 Research assistants: –Anne-Marie Ramierez –Mark Graham –Leanne Currie