Supporting Medical Decision Making with Electronic Medical Records
James J. CiminoDepartments of Medicine and Medical Informatics
Columbia 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
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
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
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
EMR and Decision Support
- understand conditions• Pharmacy Infobutton - review and teach
• The Medline Button - understand conditions• Pharmacy Infobutton
EMR and Decision Support
- review and teach• Cholesterol Guideline - dietary planning
• The Medline Button - understand conditions• Pharmacy Infobutton - review and teach• Cholesterol Guideline
EMR and Decision Support
- dietary planning• DXplain Button - understand findings
From Test Result to Finding
1600 44 L
1600 Gluc
32703 SerumGlucose Tests
32308 IntravascularGlucose Tests
42485 ElevatedAbnormal Findingin Body Substance
42486 DecreasedAbnormal Findingin Body Substance
42541 Hyperglycemia 3286 Hypoglycemia
32412 IntravascularSpecimen
31987 Glucose
42527 AbnormalLevel of Blood
Glucose
3286 Hypoglycemia
• The Medline Button - understand conditions• Pharmacy Infobutton - review and teach• Cholesterol Guideline - dietary planning• Dxplain Button
EMR and Decision Support
- understand findings• QingCIS - problem-oriented views
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
EMR and Decision Support
- problem-oriented views• PatCIS - patient education
• The Medline Button - understand conditions• Pharmacy Infobutton - review and teach• Cholesterol Guideline - dietary planning• Dxplain Button - understand findings• QingCIS - problem-oriented views• PatCIS
EMR and Decision Support
- patient education• Lab Infobutton - patient information
• The Medline Button - understand conditions• Pharmacy Infobutton - review and teach• Cholesterol Guideline - dietary planning• Dxplain Button - understand findings• QingCIS - problem-oriented views• PatCIS - patient education• Lab Infobutton
EMR and Decision Support
- patient information• Microbiology Infobuttons - infection control
• The Medline Button - understand conditions• Pharmacy Infobutton - review and teach• Cholesterol Guideline - dietary planning• Dxplain Button - understand findings• QingCIS - problem-oriented views• PatCIS - patient education• Lab Infobutton - patient information• Microbiology Infobuttons
EMR and Decision Support
- infection control• Mammography Guideline - screening
• The Medline Button - understand conditions• Pharmacy Infobutton - review and teach• Cholesterol Guideline - dietary planning• Dxplain Button - understand findings• QingCIS - problem-oriented views• PatCIS - patient education• Lab Infobutton - patient information• Microbiology Infobuttons - infection control• Mammography Guideline
EMR and Decision Support
- screening• Pap Smear Infobutton - screening
Summary• Decision making requires high-quality, up-
to-date, timely information• The EMR generates information needs• The EMR can help satisfy information needs• The Web makes the rest easy• Further study needed:
– When do users 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?
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