use of online resources while using a clinical information system james j. cimino, md; jianhua li,...
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Use of Online Resources While Using a Clinical Information System
James J. Cimino, MD; Jianhua Li, MD;Mark Graham, PhD, Leanne M. Currie, RN, MS;
Mureen Allen, MB BS; Suzanne Bakken, RN, DNSc, Vimla L. Patel, PhD
Department of Biomedical InformaticsColumbia University
Categories of Generic Question
Classification
Information Needs Study
Study 2Identify information
resourcescurrently being used
Characteristics of Resource Use
2ALog file analysis
2BSurveyCharacteristics of
Information Needs Events
Observational Study
Study 1AIdentify
information needs events
Study 1BClassify
Information Needs Events
Method Developme
nt
Understanding Resource Use
• Are clinicians using resources to answer patient-related questions?
• What resources do clinicians use?
• Do they use resources differently depending on the context?
Methods
• Log file captures clinician use of resources– Records user, function, location– User type determined from user directory– Context of use can be inferred
Logging Information Resource Use
WebCIS Logon Screen
HealthResources
Page
HealthResource
SystemLog
(anonymous)Health
ResourcesPage
HealthResource
WebCISFunctions
Logon
Log File Examples16:14:38|Resource|nobody|156.1.5.1|salk.cpmc.columbia.edu/mdxdocs
16:16:46|WebCIS|ciminoj|156.1.5.1|lab^2003-03-02-05.19.00.819650
16:18:55|WebCIS|ciminoj|156.1.5.1|healthresource
16:21:18|Resource|ciminoj|156.1.5.1|salk.cpmc.columbia.edu/mdxdocs
16:24:30|WebCIS|ciminoj|156.1.5.1|lab^1997-09-02-15.54.00.359121
16:25:12|WebCIS|ciminoj|156.1.5.1|pubmed
16:25:48|WebCIS|ciminoj|156.1.5.1|micromedex
16:32:38|WebCIS|ciminoj|156.1.5.1|phar
16:25:48|WebCIS|ciminoj|156.1.5.1|micromedex
Log File Results
• Six months of log files
• 38,763 health resources– 14,036 anonymous health resources– 19,913 health resources from WebCIS– 4,814 infobuttons
• 2,607 users– 51% resident physicians– 34% attending physicians– 5% nurses– 10% other (pharmacists, administrators, etc.)
Information Resource Usage
6%
4%
4%
4%
51%
3%3%7%
6%
1% 1%10% MicromedexPharmacy IB
Sensitivity IBCulture IB
Ovid MedlineOnline FormularyHarrison's
PubMedJournals
MedlinePlusICD9-CM
Other Resources
12% IBs
Information Use Contexts
9%
7%3%
2%
2%
2%
24%
51%
Laboratory
Radiology
Clinic Notes
Pathology
Visit Lists
Pharmacy
Discharge Sum.
Other
Context-Specific Resource Use
0%
20%
40%
60%
80%
100%
Sensitivity IB
Culture IB
Pharmacy IB
Medlineplus
ICD9-CM
Journals
PubMed
Harrison's
Formulary
Ovid Medline
Micromedex
Methods
• Log file captures clinician use of resources– Records user, function, location– User type determined from user directory– Context of use can be inferred
• Log file captures clinician use of resources– Records user, function, location– User type determined from user directory– Context of use can be inferred
• Questionnaire to determine:– Are they using resources through our system?– Why do they use resources?– What resources do they use?– What resources do they like?– What other resources do clinicians use?– Do survey results match log files?
Survey Population
• 1055 resources users in 01/03
• 250 randomly surveyed
• 45 (18%) returned– 23 attendings– 19 housestaff– 3 nurses– 1 pharmacist
Using Resources through WebCIS
• 14 anonymous only *
• 17 in WebCIS only
• 11 both
• 3 neither *
* All used resources in WebCIS
Why do they use resources?
• 43 for patient-specific issues
• 23 for general knowledge
• 3 for other reasons– writing– teaching– studying
What resources do they use? Like?
• No marked difference between user types
• Log files corroborated usage claims
• 26/45 said “do not use” (although 38/45 used)
0
5
10
15
20
25
30
35
40
Not Helpful
Somewhat Helpful
Very Helpful
What about other resources?• Reources used:
– Up To Date– MD Consult– New England Journal of Medicine– Epocrates– Google– Books
Reasons for use:28 for patient-specific issues25 for general knowledge1 for teaching
Lessons Learned• Log files representative of resource use:
– Our users tend to use “Health Resources” page– Surveys reflect observed usage
• Micromedex is most popular resource• Other resources needed (e.g. UpToDate)• Resource use is for patient-specific reasons• Most resource use is within patient context• Laboratory results are most popular context• Context does influence resource use• Infobuttons actually get used!• Infobuttons can be preferred!
Information Needs Study
Study 2Identify information
resourcescurrently being used
Characteristics of Information Needs
Events
Characteristics of Resource Use
Categories of Generic Question
2ALog file analysis
Infobutton
Manager
2BSurveyObservatio
nal Study
Study 1AIdentify
information needs events
Study 1BClassify
Information Needs Events
Classification
Method Developme
nt
Where Do We Go From Here?
• Up To Date has been added
• Infobutton Manager matches context to questions
• Focus on laboratory-related questions
• Focus on ways to exploit Micromedex
• Extend Infobutton Manager to other institutions
www.dmi.columbia.edu/homepages/ciminoj/Infobuttons.html
Conclusions From the Three Studies• Information needs arise while using clinical systems• Needs can be detected and characterized• Information needs are context-specific• Information needs are stereotypic• Satisfaction is often unsuccessful or deferred• Resource use is context-specific• Infobuttons are a viable way to resolve needs
– Offer context-specific retrievals for specific needs– Provide shortcut to popular resources
• Infobuttons are an institution- and application-independent way to improve resolution of information needs and reduce medical errors