Showing papers by "James J. Cimino published in 2002"

Theoretical, empirical and practical approaches to resolving the unmet information needs of clinical information system users.

Abstract: We hypothesize that when clinicians review clinical data in an electronic medical record, the information needs that arise are predictable, based on a number of situational factors. Because our theory does not say, exactly, what those needs are, we are using an empirical approach (observation) to detecting and categorizing them. For each need, we can construct an "infobutton" that links the clinical data to an on-line information resource. We have constructed an Infobutton Manager to match the data being reviewed by clinicians with context-appropriate infobuttons. This paper describes how the theory, observations, and practical solutions can come together to improve clinician decision making by resolving information needs.

Web-based tailoring and its effect on self-efficacy: results from the MI-HEART randomized controlled trial.

Abstract: This paper reports the effects of a tailored Web-based delivery system on self-efficacy as it relates to a patients' response to acute myocardial information (AMI) symptoms. The data reported are from MI-HEART, a randomized trial examining ways in which a clinical information system can favorably influence the appropriateness and rapidity of decision-making in patients suffering from symptoms of acute myocardial infarction. Participants were randomized into one of three groups: tailored Web-based, non-tailored Web-based and non-tailored paper based. A theoretically based behavioral-cognitive model was used to identify key variables upon which to tailor education material. A key variable in the model is self-efficacy, operationalized with a three-dimensional scaling. Results show trends in improved self-efficacy scores for all groups at 1-month follow up, with sustained significant increases in baseline to 3-month scores only in the tailored Web-based group. One possible explanation could be related to "hit-count", which was significantly higher in the tailored group. This study is a first step in quantifying the contribution of Web-based tailoring over non-tailoring in changing key determinants of patient delay to AMI symptoms.

Enriching the structure of the UMLS semantic network.

Abstract: The Unified Medical Language System's (UMLS's) Semantic Network (SN)---consisting of a network of semantic types---has a two-tree structure, where each semantic type has at most one parent semantic type. This arrangement is restrictive because some semantic types are, by their definition, specializations of several parents. As a proposed enhancement to the SN, its semantic types have previously been partitioned into groups, each of which contains semantic types of some specific area. However, some groups of this proposed partition contain forest (i.e., multiple-tree) structures or even isolated semantic types. Both situations imply a disconnected internal structure. Connectivity is actually one way to assess the proposed "semantic validity" principle for partitions. It is a desired, although not required, property. In this paper, we introduce a methodology for identifying "missing" IS-A links and adding them to the SN. This process transforms the SN into a Directed Acyclic Graph (DAG) structure, with semantic types permitted to have multiple parents. A result of our methodology is the transformation of the proposed SN partition into groups satisfying the connectivity property.

Analyzing the Semantics of patient data to rank records of literature retrieval

Abstract: We describe the use of clinical data present in the medical record to determine the relevance of research evidence from literature databases. We studied the effect of using automated knowledge approaches as compared to physician's selection of articles, when using a traditional information retrieval system. Three methods were evaluated. The first method identified terms and their semantics and relationships in the patient's record to build a map of the record, which was represented in conceptual graph notation. This approach was applied to data in an individual's medical record and used to score citations retrieved using a graph matching algorithm. The second method identified associations between terms in the medical record, assigning them semantic types and weights based on the co-occurrence of these associations in citations of biomedical literature. The method was applied to data in an individual's medical record and used to score citations. The last method combined the first two. The results showed that physicians agreed better with each other than with the automated methods. However, we found a significant positive relation between physicians' selection of abstracts and two of the methods. We believe the results encourage the use of clinical data to determine the relevance of medical literature to the care of individual patients.

Linking molecular imaging terminology to the gene ontology (GO).

Abstract: The rapidly developing domain of molecular imaging represents the merging of current advances in the fields of molecular biology and imaging research. Despite this merger, an information gap continues to exist between the scientists who discover new gene products and the imaging scientists who can exploit this information. The Gene Ontology (GO) Consortium seeks to provide a set of structured terminologies for the conceptual annotation of gene product function, process and location in databases. However, no such structured set of concept-oriented terminology exists for the molecular imaging domain. Since the purpose of GO is to capture the information about the role of gene products, we propose that the mapping of GO's established ontological concepts to a molecular imaging terminology will provide the necessary bridge to fill the information gap between the two fields. We have extracted terms and definitions from an already published molecular imaging glossary as well as molecular imaging research articles, and developed molecular imaging concepts. We then mapped our molecular imaging concepts to the existing gene ontology concepts as a method to comprehensively represent molecular imaging.

The cognitive demands of an innovative query user interface.

Abstract: Too often, online searches for health information are time consuming and produce results that are not sufficiently precise to answer clinicians' or patients' questions. The PERSIVAL project is designed to circumvent this problem by personalizing and tailoring searches and presentation to the demands of the user and the particular clinical context. This paper focuses on a cognitive evaluation of one component of this project, a Query User Interface (QUI). The study examines the system's ability to allow users to easily and intuitively express their information needs. We performed several analyses including a cognitive walkthrough of the interface and quantitative estimations of cognitive load. The paper also presents a preliminary analysis of usability testing. The analyses suggest that there are features in the QUI that contribute to a greater cognitive load and result in greater effort on the part of the subject. The results of usability testing are consistent with these findings. However, subjects found it to be relatively easy and intuitive to generate well-formed queries using the interface. This study contributed to the iterative design of the interface and to the next generation of the PERSIVAL system.

Improving Clinical Communication with a Virtual Whiteboard

Abstract: Effective clinical communication among health care providers is essential to provide high-quality care for patients Poor communication has been recognized as a significant source of medical errors To help facilitate clinical communication between physicians and nurses, we have developed a virtual whiteboard extension to our clinical information system, WebCIS The virtual whiteboard can be used to identify other health care providers associated with the users patients, and facilitate exchange of brief asynchronous communications among those providers

Issues in Developing Clinical Applications for the Wireless Environment

Abstract: The use of wireless technology in the clinical setting is increasing. There are a growing number of clinical applications being developed to run on mobile devices and communicate wirelessly. There are numerous issues that arise when developing for the wireless environment and a number of options available. At New York Presbyterian Hospital (NYPH), many of these issues were dealt with for the implementation of a wireless clinical application called PalmCIS (Palm-based Clinical Information System).

Using Patient Data to Rank Records of Literature Retrieval.

Abstract: Introduction. Several studies have assessed the needs of clinicians for access to information pertinent to clinical practice. 2 Increasing importance is being given to the use of the best current evidence in clinical practice and health services. Special attention has also been given to the assessment of medical errors and other adverse events in health care. Studying the incidence of medical errors and other adverse events, researchers have shown that most of the failures can be related to impaired access to information. Our goal is to improve the way retrieved medical literature is presented by identifying critical information in the individual medical record that is useful for determining the relevance of literature data.

Knowledge Acquisition of Generic Queries for Information Retrieval

Abstract: Several studies have identified clinical questions posed by health care professionals to understand the nature of information needs during clinical practice. To support access to digital information sources, it is necessary to integrate the information needs with a computer system. We have developed a conceptual guidance approach in information retrieval, based on a knowledge base that contains the patterns of information needs. The knowledge base uses a formal representation of clinical questions based on the UMLS knowledge sources, called the Generic Query model. To improve the coverage of the knowledge base, we investigated a method for extracting plausible clinical questions from the medical literature. This poster presents the Generic Query model, shows how it is used to represent the patterns of clinical questions, and describes the framework used to extract knowledge from the medical literature.

Design of a Web-based Care Team Scheduler for PalmCIS

Abstract: We are building an extension of the existing Web-based clinical information system at Columbia-Presbyterian Medical Center (CPMC) that enables providers to communicate in a virtual environment. We call it a Virtual Whiteboard1. We intend to export the features of this application to a wireless PDA (PalmCIS). One of the elements required for this system is accurate information about which providers are covering each patient at any given time. This paper outlines our effort to build a web-based interface that captures the schedule information of clinicians. The application will automatically provide this information for display in the Virtual Whiteboard.