The classification of clinicians' information needs while using a clinical information system.

The Classification of Clinicians’ Information Needs While Using a Clinical Information System Mureen Allen, MB BS, Leanne M. Currie, RN, MS, Mark Graham, PhD, Suzanne Bakken, RN, DNSc, Vimla L. Patel, PhD, James J. Cimino, MD Department of Medical Informatics, Columbia University, New York, New York, USA Introduction: Information needs are prevalent in clinical practice. They represent a potential source of medical errors. This study seeks to empirically determine the information needs of clinicians while using a clinical information system (CIS), and characterize those needs. In addition this paper will provide the framework necessary for the development of the solutions to these information needs. Methods: Clinicians were observed while using a CIS. They were recorded on audiotape and the computer screen recorded on videotape. The types of question during these interactions were recorded. A classification of the questions provided the conceptual and architectural basis for the development of context-sensitive links to information resources, called infobuttons. Results: There were 154 information needs. The questions were grouped into seven categories. Within these categories we were able to identify eleven specific repeated question patterns, accounting for 72 or 47% of users' questions. Discussion: These findings are applicable to a number of settings and can be generalized to other institutions. The proposed infobuttons based on six categories, will be navigational (‘how-to...’ links), cross-reference (‘what is the…’ links), domain knowledge buttons in the areas of laboratory, pharmacy, diagnosis, and definitions/general information. Using these groups we were able to identify eleven patterns of questions. INTRODUCTION The Institute of Medicine’s seminal report “To Err is Human” sensitized the health care profession 1 to the magnitude of medical errors. The IOM’s report in part stated: “it (technology) can enhance human performance to the extent that the human plus technology is more powerful than either is alone.” Investigators have long been interested in physician information needs and in the provision of appropriate solutions, including technological 2,3,4,5 ones. Providing information, in a timely manner, to physicians (and indeed other health care providers) 6,7 is essential for the decision making process. Whenever clinicians encounter data they often require additional information in order to formulate a decision. It has been estimated that in the inpatient setting there are 5 questions per patient 8 discussed. Potentially, if these information needs are unanswered at the time a physician is making a clinical decision errors may occur. A central theme in medicine is how to take the information available to the clinician (memory, text, journals, and colleagues) and apply that information to a specific patient. Now more than ever there is a need for technological solutions (information systems) that seamlessly supplement the information requirements of the health care provider in a timely manner. With the increased use of clinical information systems (CISs) in clinical practice it is interesting to determine the information needs at that time while the clinician is interacting with the system and how he or she resolves any information need that he may have. It is expected that while using a computer to obtain new data the clinician will have unmet information needs and potentially these needs would be soluble using the same computer. The study of clinician’s information needs in the context of the use of a CIS to our knowledge has not been done before. We are seeking to develop a set of contextspecific functions, called infobuttons (IBs) to anticipate and address the information needs that 9 occur when clinicians use a CIS. In order to do so, we are taking an empirical approach to determining what information needs arise, in a given context, based on factors such as user traits, patient traits, CIS task being performed, and specific data that may be triggering the need. One study is using a survey instrument, together with analyses of system 10 log files. In a parallel study, presented here, we are using direct observation to identify information needs. This study has entailed the collection of video and audio data from clinicians using the CIS in the 9 normal course of their day. We have developed a coding scheme for characterizing the needs that we AMIA 2003 Symposium Proceedings − Page 26 Classification Need for resources internal to WebCIS Need for resources external to WebCIS: e.g. Harrison’s, Up-to-Date, Epocrates, dictionaries etc Navigation Cross-Reference Definition A question about any function in WebCIS (either currently present or could be added at a later date) that that the user is unable to access or use. A response or question, which alludes to the need to add an item to WebCIS or give the user access to another resource, which answers the need. Laboratory Information needs that are related to laboratory domain knowledge. Pharmacy Information needs that are related to the pharmacy domain knowledge. Differential Diagnosis Questions related to alternative causes of a symptom or laboratory or radiology finding. Definition/ Information Questions related to the meaning of words. In addition, general information on a topic. IB Function The IB link would take the user to a resource that tells him how to access the needed information. The IB would access the resource that would solve the problem and present the solution to the user. The IB would provide information about a specific laboratory finding. The IB would provide information about specific medications. IB would provide contextspecific differential diagnoses. IB would provide a definition or general information about a topic/word. Those needs that do not readily translate into patient/institution needs. Table 1: Classification of Information Needs 11 observe and applied the scheme to observational investigator repeated the process, identifying data. In the present study, we examine the instances of information needs. These results were information needs thus identified and attempt to compared with the initial data to determine the characterize them with respect to the types of IBs validity of the collected data. The results of this that will be needed to address them. work served as input data for the current project and are described elsewhere, along with a more METHODS extensive description of the observational techniques 14 The acquisition of users’ information needs used in this study. 12 To provide the conceptual and architectural while using the CIS (WebCIS) has been carried out 13 with a portable usability laboratory (PUL), which framework for the design for the different types of recorded the interaction on videotape and IB that will eventually be constructed, we audiocassettes. The videotape captured the characterized the information needs that had been computer sc (...truncated)