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

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

One-Stop Information Shopping?

World Wide Web(The Hyperdocument)

InformationResources

Biblio-graphic

Database

Textbook

ExpertSystem

HealthPractitioner

One-Touch Information Shopping

InformationResources

World Wide Web(The Facilitator)

Biblio-graphic

Database

Textbook

ExpertSystem

HealthPractitioner

Information for Decision-Making

Information for Decision-Making

?MRSA

Information for Decision-Making

Intelligent Decision Support

Intelligent Decision Support

Query

MRSA

Intelligent Decision Support

?

Result

!

MRSA

Intelligent Decision Support

MRSA

Intelligent Decision Support

Infobutton: Automating the Process

• Questions can be anticipated

• Match information source to question

• Automate the retrieval

• Query can use patient information

New York Presbyterian Hospital Information Architecture

• Central repository

• Data Access Modules

• Medical Entities Dictionary

• MedLEE

• CIS

• WebCIS

• PatCIS

Central Controlled Terminology

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

Automated Decision Support

MRSA

Automated Decision Support

UnderstandInformation

Needs

1MRSA

Automated Decision Support

Get InformationFrom EMR

UnderstandInformation

Needs

1

2

MRSA

Automated Decision Support

Get InformationFrom EMR

ResourceSelection

UnderstandInformation

Needs

1

2

3

MRSA

Automated Decision Support

Get InformationFrom EMR

ResourceSelection

ResourceTerminology

UnderstandInformation

Needs

1

24

3

MRSA

Automated Decision Support

Get InformationFrom EMR

ResourceSelection

ResourceTerminology

UnderstandInformation

Needs

AutomatedTranslation

1

254

3

MRSA

Automated Decision Support

Get InformationFrom EMR

ResourceSelection

ResourceTerminology

QueryingUnderstandInformation

Needs

AutomatedTranslation

1

254

6

3

MRSA

Automated Decision Support

Get InformationFrom EMR

ResourceSelection

ResourceTerminology

Querying

Presentation

UnderstandInformation

Needs

AutomatedTranslation

1

254

6

3

7

MRSA

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

• The Medline Button

Terminology and Decision Support

- understand conditions• Pharmacy Infobutton

• The Medline Button - understand conditions• Pharmacy Infobutton

Terminology and Decision Support

- review and teach• Cholesterol Guideline

• The Medline Button - understand conditions• Pharmacy Infobutton - review and teach• Cholesterol Guideline

Terminology and Decision Support

- dietary planning• DXplain Button

• The Medline Button - understand conditions• Pharmacy Infobutton - review and teach• Cholesterol Guideline - dietary planning• Dxplain Button

Terminology and Decision Support

- understand findings• QingCIS

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

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

• 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

• 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

• 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

• 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

• 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

• 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

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?