Integration of Information Resources at the Point of Need

James J. Cimino, M.D.

Departments of Medicine and Medical Informatics

Columbia University

Information at the Point of Need

• Physicians have information needs

• Information needs go unmet

• Computer-based data contributes to the problem

One-Stop Information Shopping?

World Wide Web(The Hyperdocument)

InformationResources

Biblio-graphic

Database

Textbook

ExpertSystem

CommunityPractitioner

One-Touch Information Shopping

InformationResources

World Wide Web(The Facilitator)

Biblio-graphic

Database

Textbook

ExpertSystem

CommunityPractitioner

Infobutton: Automating the Process

• Questions can be anticipated

• Match information source to question

• Automate the retrieval

• Query can use patient information

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

Obstacles

MRSA

Obstacles

UnderstandInformation

Needs

1MRSA

Obstacles

Get InformationFrom EMR

UnderstandInformation

Needs

1

2

MRSA

Obstacles

Get InformationFrom EMR

ResourceSelection

UnderstandInformation

Needs

1

2

3

MRSA

Obstacles

Get InformationFrom EMR

ResourceSelection

ResourceTerminology

UnderstandInformation

Needs

1

24

3

MRSA

Obstacles

Get InformationFrom EMR

ResourceSelection

ResourceTerminology

UnderstandInformation

Needs

AutomatedTranslation

1

254

3

MRSA

Obstacles

Get InformationFrom EMR

ResourceSelection

ResourceTerminology

QueryingUnderstandInformation

Needs

AutomatedTranslation

1

254

6

3

MRSA

Obstacles

Get InformationFrom EMR

ResourceSelection

ResourceTerminology

Querying

Presentation

UnderstandInformation

Needs

AutomatedTranslation

1

254

6

3

7

MRSA

Integration of Resources

• Drug orders: to Micromedex, Medline

• Culture results: to Medline

• Sensitivities: to Micromedex, Medline

• X-rays to: to X-rays, Medline, U. of Utah

• Lab results: to DXplain

• EMR: to cholesterol guideline, mammography guideline

Summary

• On-line information sources exist• Automated retrievals are possible• Linking the patient-specific record to

patient-relevant medical knowledge• Further study needed:

– how to anticipate questions– how to find the right resources– how to compose search strategies– how to present results