harnessing world wide web technology and standardized terminology to improve decision making for...
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Harnessing World Wide Web Technology and Standardized Terminology to Improve Decision
Making for Patients and Providers
James J. CiminoDepartments of Medicine and Medical
InformaticsColumbia University
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Decision Making for Patients and Providers
• Access to (electronic) health records generates information needs
• Information needs go unmet
• “Best evidence”, educational material, training programs can address these needs
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One-Stop Information Shopping?
World Wide Web(The Hyperdocument)
InformationResources
Biblio-graphic
Database
Textbook
ExpertSystem
HealthPractitioner
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One-Touch Information Shopping
InformationResources
World Wide Web(The Facilitator)
Biblio-graphic
Database
Textbook
ExpertSystem
HealthPractitioner
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Information for Decision-Making
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Information for Decision-Making
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?MRSA
Information for Decision-Making
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Intelligent Decision Support
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Intelligent Decision Support
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Query
MRSA
Intelligent Decision Support
?
Result
!
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MRSA
Intelligent Decision Support
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MRSA
Intelligent Decision Support
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Infobutton: Automating the Process
• Questions can be anticipated
• Match information source to question
• Automate the retrieval
• Query can use patient information
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New York Presbyterian Hospital Information Architecture
• Central repository
• Data Access Modules
• Medical Entities Dictionary
• MedLEE
• CIS
• WebCIS
• PatCIS
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Central Controlled Terminology
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MED Semantic NetworkMedicalEntity
PlasmaGlucose
Test
LaboratorySpecimen
PlasmaSpecimen
AnatomicSubstance
Plasma Substance
Sampled
Part of
Has S
pecimen
Substance Measured
LaboratoryProcedure
CHEM-7
LaboratoryTest
Event
DiagnosticProcedure
Substance
BioactiveSubstance
Glucose
Chemical
Carbo-hydrate
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Automated Decision Support
MRSA
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Automated Decision Support
UnderstandInformation
Needs
1MRSA
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Automated Decision Support
Get InformationFrom EMR
UnderstandInformation
Needs
1
2
MRSA
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Automated Decision Support
Get InformationFrom EMR
ResourceSelection
UnderstandInformation
Needs
1
2
3
MRSA
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Automated Decision Support
Get InformationFrom EMR
ResourceSelection
ResourceTerminology
UnderstandInformation
Needs
1
24
3
MRSA
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Automated Decision Support
Get InformationFrom EMR
ResourceSelection
ResourceTerminology
UnderstandInformation
Needs
AutomatedTranslation
1
254
3
MRSA
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Automated Decision Support
Get InformationFrom EMR
ResourceSelection
ResourceTerminology
QueryingUnderstandInformation
Needs
AutomatedTranslation
1
254
6
3
MRSA
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Automated Decision Support
Get InformationFrom EMR
ResourceSelection
ResourceTerminology
Querying
Presentation
UnderstandInformation
Needs
AutomatedTranslation
1
254
6
3
7
MRSA
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Translations with the MED
Gentamicin
EtiologyMeasures
Sensitivity
Substance Measured
InjectableGentamicin
Gentamicn Sensitivity
Test
SerumGentamicin
Level
is-a
IntravascularGentamicin
Tests
GentamicinToxicity
Has ingredient
SummaryReports
DecisionRule
ExpertSystem
DrugInformation
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• The Medline Button
Terminology and Decision Support
- understand conditions• Pharmacy Infobutton
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• The Medline Button - understand conditions• Pharmacy Infobutton
Terminology and Decision Support
- review and teach• Cholesterol Guideline
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• The Medline Button - understand conditions• Pharmacy Infobutton - review and teach• Cholesterol Guideline
Terminology and Decision Support
- dietary planning• DXplain Button
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• The Medline Button - understand conditions• Pharmacy Infobutton - review and teach• Cholesterol Guideline - dietary planning• Dxplain Button
Terminology and Decision Support
- understand findings• QingCIS
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Smarter Retrievals from the Record
• Repository stores events and results
• Clinical problems at a different level of granularity
• Re-use knowledge to map from problems to clinical data
• Produce problem-specific views of the medical record
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Chest X rayCongestive
Heart Failure
Intravascular CK Test
CreatineKinase
Chest X ray 2 View
Cardiac Enzyme
Angina
Lab :1/1/99 Lab :1/1/99 Cardiac Enzyme TestCardiac Enzyme Test
Radiology :2/23/99 Radiology :2/23/99 Chest X RayChest X Ray
Radiology :2/28/96 Radiology :2/28/96 Head CTHead CT
Lab :12/28/96 Lab :12/28/96 Sickle Cell TestSickle Cell Test
Admission :3/14/96 Admission :3/14/96 StrokeStroke
Admission :2/14/98Admission :2/14/98AnginaAngina
Lab :1/1/99 Lab :1/1/99 Blood Type TestBlood Type Test
Radiology :2/1/97 Radiology :2/1/97 Knee X RayKnee X Ray
Concept-oriented(Heart)
Heart Disease
Chest
Discharge :1/15/99Discharge :1/15/99 CHFCHF
Discharge :1/15/99Discharge :1/15/99 CHFCHF
Admission :2/14/98Admission :2/14/98AnginaAngina
Lab :1/1/99 Lab :1/1/99 Cardiac Enzyme TestCardiac Enzyme Test
Radiology :2/23/99 Radiology :2/23/99 Chest X RayChest X Ray
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• The Medline Button - understand conditions• Pharmacy Infobutton - review and teach• Cholesterol Guideline - dietary planning• Dxplain Button - understand findings• QingCIS
Terminology and Decision Support
- nurse-oriented views• PatCIS
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• The Medline Button - understand conditions• Pharmacy Infobutton - review and teach• Cholesterol Guideline - dietary planning• Dxplain Button - understand findings• QingCIS - nurse-oriented views• PatCIS
Terminology and Decision Support
- patient education• Lab Infobutton
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• The Medline Button - understand conditions• Pharmacy Infobutton - review and teach• Cholesterol Guideline - dietary planning• Dxplain Button - understand findings• QingCIS - nurse-oriented views• PatCIS - patient education• Lab Infobutton
Terminology and Decision Support
- patient information• Microbiology Infobuttons
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• The Medline Button - understand conditions• Pharmacy Infobutton - review and teach• Cholesterol Guideline - dietary planning• Dxplain Button - understand findings• QingCIS - nurse-oriented views• PatCIS - patient education• Lab Infobutton - patient information• Microbiology Infobuttons
Terminology and Decision Support
- infection control• Mammography Guideline
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• The Medline Button - understand conditions• Pharmacy Infobutton - review and teach• Cholesterol Guideline - dietary planning• Dxplain Button - understand findings• QingCIS - nurse-oriented views• PatCIS - patient education• Lab Infobutton - patient information• Microbiology Infobuttons - infection control• Mammography Guideline
Terminology and Decision Support
- teaching• Pap Smear Infobutton
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• The Medline Button - understand conditions• Pharmacy Infobutton - review and teach• Cholesterol Guideline - dietary planning• Dxplain Button - understand findings• QingCIS - nurse-oriented views• PatCIS - patient education• Lab Infobutton - patient information• Microbiology Infobuttons - infection control• Mammography Guideline - teaching• Pap Smear Infobutton
Terminology and Decision Support
• - coping and support
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Summary
• Terminology translation facilitates retrievals• The Web makes the rest easy• Further study needed:
– When do nurses need information?– What information do they need? – What terminology is needed?– What are the right resources?– How can retrievals be facilitated?– How do we present results?