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?
