Integrating e-Publishing, Digital Libraries and the

Electronic Medical Record

Jim Cimino

Marco Island

February 4, 19100

Using Evidence in Health Care

• Doctor sees patient data

• Question arises

• Doctor does literature search

• Doctor orders article

• Doctor picks up article that evening

• Doctor makes decision next day

Why aren’t information needs being met?

• Sources are unavailable

• Sources are outdated

• Sources are hard to access

• Access is too time-consuming

Assumptions

• Appropriate publications are available on-line

• Appropriate protection/payment is in place

• Information is available via Web-interface

Issues

• Who is the user?

• Who is the patient?

• What is the context?

• What is the question?

What is the question?

• Review a serum calcium

• Student: What causes a high calcium?

• Physician: How do I treat a high calcium?

• Subspecialist: What’s the latest on biphosphanates?

• Patient: How much calcium should I get in my diet?

What’s Needed for Access? What Implications for e-Publishing?

• The context, the user, and the question

• The medium is the message

• The mechanism for access– Hard-coded URL– Structured document– Search engine– Keyword search– Expert system

Patient Access to their Electronic Medical Record via the World Wide Web

Jim Cimino

Marco Island

February 6, 2000

Columbia’s NII Contract

• Give patients WebCIS

• Link them to on-line information resources

• See what happens

What We Built• Front End

– Security– Tracking– Application management

• Functions– Data entry– Data review– Education– Advice

Our Study

• Institutional Review Board

• Physician recruitment

• Pilot phase

• Larger recruitment

• Healthweek- PBS, February 26/27

Issues

• Security

• What should patients see?

• How do we handle patient questions?

• How do we handle patient corrections?

• What is the patient’s role in data collection?