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A Truly Meaningful Use of Electronic Health Records Freely Available to All: Automated Anticipation and Resolution of Clinical Information Needs at the Point of Care through Infobuttons James J. Cimino, MD, FACMI, FACP Laboratory for Informatics Development NIH Clinical Center and the National Library of Medicine

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Page 1: A Truly Meaningful Use of Electronic Health Records Freely Available to All: Automated Anticipation and Resolution of Clinical Information Needs at the

A Truly Meaningful Use of Electronic

Health Records Freely Available to All:

Automated Anticipation and Resolution of

Clinical Information Needs at the Point of

Care through Infobuttons

James J. Cimino, MD, FACMI, FACP Laboratory for Informatics Development

NIH Clinical Center and the National Library of Medicine

Page 2: A Truly Meaningful Use of Electronic Health Records Freely Available to All: Automated Anticipation and Resolution of Clinical Information Needs at the
Page 3: A Truly Meaningful Use of Electronic Health Records Freely Available to All: Automated Anticipation and Resolution of Clinical Information Needs at the

1984 1986 1988 1990 1992 1994 1996 1998 2000 2002 2004

Covell et al.Information Needs

Infobutton Timeline

Page 4: A Truly Meaningful Use of Electronic Health Records Freely Available to All: Automated Anticipation and Resolution of Clinical Information Needs at the

Studying Information Needs

Covell DG, Uman GC, Manning PR. Information needs in office practice: are they being met? Ann Intern Med. 1985 Oct;103(4):596-9.

Page 5: A Truly Meaningful Use of Electronic Health Records Freely Available to All: Automated Anticipation and Resolution of Clinical Information Needs at the

Knowledge Resources in Clinical Care

Page 6: A Truly Meaningful Use of Electronic Health Records Freely Available to All: Automated Anticipation and Resolution of Clinical Information Needs at the

Knowledge Resources in Clinical Care

?

Page 7: A Truly Meaningful Use of Electronic Health Records Freely Available to All: Automated Anticipation and Resolution of Clinical Information Needs at the
Page 8: A Truly Meaningful Use of Electronic Health Records Freely Available to All: Automated Anticipation and Resolution of Clinical Information Needs at the

Information Needs of EHR 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

• So we may be able to predict the specific need• User is sitting at a computer!• So we may be able to automate the answer

Page 9: A Truly Meaningful Use of Electronic Health Records Freely Available to All: Automated Anticipation and Resolution of Clinical Information Needs at the

1984 1986 1988 1990 1992 1994 1996 1998 2000 2002 2004 2006 2008

Covel et al.Information Needs

UMLSProject

First Versionof UMLS

ICD9MeSH

MedlineButton

Infobutton Timeline

Page 10: A Truly Meaningful Use of Electronic Health Records Freely Available to All: Automated Anticipation and Resolution of Clinical Information Needs at the
Page 11: A Truly Meaningful Use of Electronic Health Records Freely Available to All: Automated Anticipation and Resolution of Clinical Information Needs at the
Page 12: A Truly Meaningful Use of Electronic Health Records Freely Available to All: Automated Anticipation and Resolution of Clinical Information Needs at the
Page 13: A Truly Meaningful Use of Electronic Health Records Freely Available to All: Automated Anticipation and Resolution of Clinical Information Needs at the
Page 14: A Truly Meaningful Use of Electronic Health Records Freely Available to All: Automated Anticipation and Resolution of Clinical Information Needs at the

1984 1986 1988 1990 1992 1994 1996 1998 2000 2002 2004 2006 2008

G.O. BarnettDXplain

Covel et al.Information Needs

UMLSProject

First Versionof UMLS

ICD9MeSH

MedlineButton

Mosaic

Web-basedGeneric Queries

PubMED

Web DXplain

DXplainButton

WebCIS

Infobutton Timeline

Page 15: A Truly Meaningful Use of Electronic Health Records Freely Available to All: Automated Anticipation and Resolution of Clinical Information Needs at the
Page 16: A Truly Meaningful Use of Electronic Health Records Freely Available to All: Automated Anticipation and Resolution of Clinical Information Needs at the
Page 17: A Truly Meaningful Use of Electronic Health Records Freely Available to All: Automated Anticipation and Resolution of Clinical Information Needs at the
Page 18: A Truly Meaningful Use of Electronic Health Records Freely Available to All: Automated Anticipation and Resolution of Clinical Information Needs at the

Cholesterol

Hypercholesterolemia

Serum Cholesterol Test

Serum Specimen

Serum

From Data to Findings

Abnormalities ofSerum Cholesterol

Page 19: A Truly Meaningful Use of Electronic Health Records Freely Available to All: Automated Anticipation and Resolution of Clinical Information Needs at the

1984 1986 1988 1990 1992 1994 1996 1998 2000 2002 2004 2006 2008

G.O. BarnettDXplain

Covel et al.Information Needs

UMLSProject

First Versionof UMLS

ICD9MeSH

MedlineButton

Mosaic

Infobuttons

Web-basedGeneric Queries

PubMED

Web DXplain

DXplainButton

WebCIS

Infobutton Timeline

Page 20: A Truly Meaningful Use of Electronic Health Records Freely Available to All: Automated Anticipation and Resolution of Clinical Information Needs at the
Page 21: A Truly Meaningful Use of Electronic Health Records Freely Available to All: Automated Anticipation and Resolution of Clinical Information Needs at the
Page 22: A Truly Meaningful Use of Electronic Health Records Freely Available to All: Automated Anticipation and Resolution of Clinical Information Needs at the
Page 23: A Truly Meaningful Use of Electronic Health Records Freely Available to All: Automated Anticipation and Resolution of Clinical Information Needs at the
Page 24: A Truly Meaningful Use of Electronic Health Records Freely Available to All: Automated Anticipation and Resolution of Clinical Information Needs at the
Page 25: A Truly Meaningful Use of Electronic Health Records Freely Available to All: Automated Anticipation and Resolution of Clinical Information Needs at the

Portable Usability LabUser’s Workstation

Microphone

Video Converter

75 foot cable

Converter Controller

Cassette RecorderVCR

Headphones

Video Monitor

Page 26: A Truly Meaningful Use of Electronic Health Records Freely Available to All: Automated Anticipation and Resolution of Clinical Information Needs at the
Page 27: A Truly Meaningful Use of Electronic Health Records Freely Available to All: Automated Anticipation and Resolution of Clinical Information Needs at the

1984 1986 1988 1990 1992 1994 1996 1998 2000 2002 2004 2006 2008

G.O. BarnettDXplain

Covel et al.Information Needs

UMLSProject

First Versionof UMLS

ICD9MeSH

MedlineButton

Mosaic

Infobuttons

Web-basedGeneric Queries

InfobuttonManager

PubMED

Web DXplain

DXplainButton

WebCIS

Infobutton Timeline

Page 28: A Truly Meaningful Use of Electronic Health Records Freely Available to All: Automated Anticipation and Resolution of Clinical Information Needs at the

Infobuttons vs. Infobutton Manager

Pageof

Hyperlinks

InfobuttonClinical System Resourc

e

InfobuttonManager

ContextQuery

KnowledgeBase

s

Page 29: A Truly Meaningful Use of Electronic Health Records Freely Available to All: Automated Anticipation and Resolution of Clinical Information Needs at the
Page 30: A Truly Meaningful Use of Electronic Health Records Freely Available to All: Automated Anticipation and Resolution of Clinical Information Needs at the
Page 31: A Truly Meaningful Use of Electronic Health Records Freely Available to All: Automated Anticipation and Resolution of Clinical Information Needs at the
Page 32: A Truly Meaningful Use of Electronic Health Records Freely Available to All: Automated Anticipation and Resolution of Clinical Information Needs at the
Page 33: A Truly Meaningful Use of Electronic Health Records Freely Available to All: Automated Anticipation and Resolution of Clinical Information Needs at the
Page 34: A Truly Meaningful Use of Electronic Health Records Freely Available to All: Automated Anticipation and Resolution of Clinical Information Needs at the
Page 35: A Truly Meaningful Use of Electronic Health Records Freely Available to All: Automated Anticipation and Resolution of Clinical Information Needs at the

1984 1986 1988 1990 1992 1994 1996 1998 2000 2002 2004 2006 2008

G.O. BarnettDXplain

Covel et al.Information Needs

UMLSProject

First Versionof UMLS

ICD9MeSH

MedlineButton

Mosaic

Infobuttons

Web-basedGeneric Queries

InfobuttonManager

InfobuttonManagerStandard

PubMED

Web DXplain

DXplainButton

WebCIS

MicromedexInfobutton

Access

Infobutton Timeline

Page 36: A Truly Meaningful Use of Electronic Health Records Freely Available to All: Automated Anticipation and Resolution of Clinical Information Needs at the

1984 1986 1988 1990 1992 1994 1996 1998 2000 2002 2004 2006 2008

G.O. BarnettDXplain

Covel et al.Information Needs

UMLSProject

First Versionof UMLS

ICD9MeSH

MedlineButton

Mosaic

Infobuttons

Web-basedGeneric Queries

InfobuttonManager

InfobuttonManagerStandard

PubMED

Web DXplain

DXplainButton

WebCIS

MicromedexInfobutton

Access

LibrarianInfobuttonTailoring

Environment(LITE)

Infobutton Timeline

Page 37: A Truly Meaningful Use of Electronic Health Records Freely Available to All: Automated Anticipation and Resolution of Clinical Information Needs at the

Institution Customization Tasks

i

Clinical Applicationwith Infobutton Link

User (Physician,Nurse, etc.)

Patient (with ageand gender)

Institution

InfobuttonManager

Page of Links

Infobutton ManagerKnowledge Base

Institutional Librarian(or other LITE users)

The Librarian Infobutton Tailoring Environment

(LITE)

Page 38: A Truly Meaningful Use of Electronic Health Records Freely Available to All: Automated Anticipation and Resolution of Clinical Information Needs at the

1984 1986 1988 1990 1992 1994 1996 1998 2000 2002 2004 2006 2008 2010 2012 2014

G.O. BarnettDXplain

Covel et al.Information Needs

UMLSProject

First Versionof UMLS

ICD9MeSH

MedlineButton

Mosaic

Infobuttons

Web-basedGeneric Queries

InfobuttonManager

InfobuttonManagerStandard

PubMED

Web DXplain

DXplainButton

WebCIS

MicromedexInfobutton

Access

LibrarianInfobuttonTailoring

Environment(LITE)

Infobutton Timeline

MeanginfulUse Stage 2

Page 39: A Truly Meaningful Use of Electronic Health Records Freely Available to All: Automated Anticipation and Resolution of Clinical Information Needs at the

Conclusions

• Infobuttons improve patient care

• The World Wide Web makes resources available and makes integration feasible, even easy

• The HL7 standard is driving adoption by clinical system vendors and knowledge vendors

• EHRs achieve meaningful use with infobuttons

• OpenInfobutton and LITE allow everyone to play

Page 40: A Truly Meaningful Use of Electronic Health Records Freely Available to All: Automated Anticipation and Resolution of Clinical Information Needs at the

www.infobuttons.com

Page 41: A Truly Meaningful Use of Electronic Health Records Freely Available to All: Automated Anticipation and Resolution of Clinical Information Needs at the

www.infobuttons.org

Page 42: A Truly Meaningful Use of Electronic Health Records Freely Available to All: Automated Anticipation and Resolution of Clinical Information Needs at the

lite.bmi.utah.edu

Page 43: A Truly Meaningful Use of Electronic Health Records Freely Available to All: Automated Anticipation and Resolution of Clinical Information Needs at the

www.openinfobuttons.org


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