Use, Usability, Usefulness and Impact of an Infobutton Manager

James J. Cimino, M.D.

Department of Biomedical Informatics

Columbia University College of Physicians and Surgeons

2006 AMIA Fall Symposium

Evaluating the Infobutton Manager

• What are Infobuttons?

• What is the Infobutton Manager?

• How do we study it (modalities)?

• What did we learn?– How is it used?– How usable is it?– How useful is it?– What is its impact?

Infobuttons vs. Infobutton Manager

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Hyperlinks

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InfobuttonManager

Context

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CPMC Infobutton Managers Deployed:

• New York Presbyterian Hospital’s WebCIS

• New York Presbyterian Hospital’s Eclipsys

• New York State Psychiatric Institute’s PSYCKES

• Regenstrief Medical Record System

• Crystal Run Healthcare’s NextGen

Evaluation of InfobuttonsRosenbloom ST, Geissbuhler AJ, Dupont WD, et al. Effect of

CPOE user interface design on user-initiated access to educational and patient information during clinical care. JAMIA. 2005;12(4):458-73.

• 105 house officers studied over 11 months• 278 uses• Findings: 15-fold increased use of resources

Maviglia SM, Yoon CS, Bates DW, Kuperman G. KnowledgeLink: impact of context-sensitive information retrieval on clinicians' information needs. JAMIA. 2006;13(1):67-73.

• 359 users over 12 months• 7,972 uses• Findings: 84% found answers to their question,

positive impact on patient care 15% of the time

Evaluation Modalities

• System log files

Mar 5 06:46:03|xxx9017|156.145.18.47|lab^524732|view

Mar 5 06:46:33|xxx9017|156.145.18.47|healthresource|view

Mar 5 06:46:35|xxx9017|156.145.18.47|url^http://www.crlonline.com

Mar 5 06:47:21|xxx9017|156.111.245.19|LabDetail|ibutt^35776

Mar 5 06:47:24|xxx9017|156.111.245.19|LabDetail|Infomgr^70^35776

What does the CPMC Lab Manual say about the Serum Ferritin test?

Evaluation Modalities

• System log files

• Pop-up surveys

Evaluation Modalities

• System log files

• Pop-up surveys

• On-line feedback

Evaluation Modalities

• System log files

• Pop-up surveys

• On-line feedback

• E-mail surveys

1) How often do you use Infobuttons __ Once a month or less __ A few times a month __ A few times a week __ A few times a day-----------------------------------------------------------2) Infobuttons are easy to use: __ Strongly Agree __ Agree Somewhat __ Neither Agree nor Disagree __ Disagree Somewhat __ Strongly Disagree------------------------------------------------------------3) When I click on an Infobutton in WebCIS, the

question I am interested in is: __ Almost never on the list __ Usually not on the list __ Is only on the list about half the time __ Usually on the list __ Almost always on the list------------------------------------------------------------4) Compared to the way I usually get answers to

my questions, the Infobuttons are: __ Much slower __ Somewhat slower __ About the same speed __ Somewhat faster __ Much faster------------------------------------------------------------

5) When I click on a question on the question list __ I almost always get a helpful answer __ I usually get a helpful answer __ I get a helpful answer about half the time __ I usually do not get a helpful answer __ I almost never get a helpful answer------------------------------------------------------------6) Which statement most accurately describes your

experience with Infobuttons? __ Infobuttons almost always have a negative effect on

my patient care decisions __ Infobuttons sometimes have a negative effect on

patient care __ Infobuttons have no effect (positive or negative) on

my patient care decisions __ Infobuttons sometimes have a positive effect on my

patient care decisions __ Infobuttons almost always have a positive effect on

my patient care decisions------------------------------------------------------------7) Please tell us about a time that Infobuttons

improved a patient care decision (please do not include any information that would identify a patient)

------------------------------------------------------------8) Please tell us about a time that Infobuttons hindered

a patient care decision (please do not include any information that would identify a patient)

Evaluation

• Log file analysis

• On-line survey

• Popup questionnaires

• E-mail survey

• Log file analysis: 32 months of data

Results: System Log Files

• March 2004-October 2006:– IM: 3,009 users, 29,541 times

Infobutton Manager (IM) Usage

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Resource Use by Context

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3000 Laboratory Results Review

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100Microbiology Sensitivity Results

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300Diagnosis List

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120Inpatient Lab Order Entry

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200Inpatient Drug Order Entry

Health Resources Infobutton Manager

Results: System Log Files

• March 2004 - October 2006:– IM: 3,009 users, 29,541 times

• October 2006:– IM: 281 users, 1,022 times (33/day)– HR: 708 users, 5,744 times (185/day)

– HR: 3,609 users, 155,718 times

Resource Use by Context - October

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LabResults

InpatientDrugs

OutpatientDrugs

OrderEntry

Infobuttons

HealthResources

Finding a Resource or Question

• Users chose questions 48.7% of the time

Diagnosis list: 10.5-24.3%

Outpatient drug order review: 23.0-63.3%

Inpatient drug order review: 63.3-78.7%

• Users chose at least one resource from HR page 92.4% of the time (82.6-93.7%, depending on user type and context)

Evaluation

• Log file analysis

• On-line survey

• Popup questionnaires

• E-mail survey

• Log file analysis: 32 months of data

• On-line survey: 108 comments

Results: On-line Feedback

• 108 questions or topics submitted by users– 54 (50%) in Laboratory Results Review context

• 30 were about test interpretation– 22 (20%) in Inpatient Drug Order Review

• 15 were about side effects, dosage, cost, trade names, and interactions

Evaluation

• Log file analysis: 32 months of data

• On-line survey: 108 comments

• Popup questionnaires:

• E-mail survey• Popup questionnaires: 195/~3,642 (5.4%)

Pop-up Survey Responses

Q1: Easy to useQ2: Got answerQ3: Helpful

Evaluation

• Log file analysis: 32 months of data

• On-line survey: 108 comments

• Popup questionnaires:

• E-mail survey• Popup questionnaires: 195/~3,642 (5.4%)

• E-mail survey: 73/1,228 (5.8%)

E-mail Survey Responses

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Q2: Infobuttons are easy to useQ3: Presence of question on the listQ4: Speed of answerQ5: Helpful answerQ6: Positive effect on patient care decisions1 (strongly positive) to 5 (strongly negative)

Results: Pop-Up and E-Mail Surveys

Pop-Up E-Mail

Easy to use 83% 92%

Question on list >50% of time 89%

Answered question 69%

Useful 77%

Helpful >50% of time 90%

Positive effect on care 74%

Specific cases of improved care 14

(40% of negative responses due to Lab Manual)

(Students were the least positive)

Summary of Impact

• Over 29,000 additional accesses to resources (19%)

• Positive impact at least half the time: 74%

• 14 respondents identified one or more specific situations in which patient care improved

Lessons Learned

• Use of the IM has been more gradual than desired

• User fails to select a question half the time

– Is the IM failing to anticipate the information need?

– Example - questions sugested during lab review:Housestaff did not select a question 57.8% of timeOnline survey: 4/11 dealt with reference rangesIM almost always provides a link to lab manual

– Is the user unable to find questions on the IM page?

• Solutions:– Education– Add questions– User interface

Conclusions

1. Context-specific access to health knowledge resources has been successfully accomplished

2. Impact on patient care decisions has been positive

3. Need to improve user interface for navigation

4. Increased resource use should result in clinicians making better informed patient care decisions

Acknowledgments

• This work is supported by NLM grant R01LM07593• Evlauation plan:

– Vimla Patel– Sue Bakken– Leanne Currie– Beth Friedman

• Programming: Jianhua Li• Log files: Rick Gallagher

Questions?

www.dbmi.columbia.edu/cimino/amia06-app.pdf