Tool for augmenting patients' records with information from NLM resources  
Table of Contents

Project Members:
Dina Demner-Fushman, George Thoma

Collaborators:
NIH Clinical Center Nursing and Patient Care Services (NPCS):
Clare Hastings, Gwen Wallen, Cheryl Fisher

NIH Clinical Center Department of Clinical Research Informatics (DCRI)

Charlotte Seckman, Lincoln Farnum

Introduction

The NLM InfoBot is a prototype system that enables a medical institution to automatically augment a patient's Electronic Medical Record (EMR) with pertinent patient-specific information from NLM's evidence-based resources and resources provided by the institution.

The prototype explores possibilities to automatically extract patients' problems and planned interventions from clinical notes and query evidence-based resources using the extracted terms. Our prototype implementation uses RIDeM services to extract clinical terms from free text, to find UMLS definition, to conduct MEDLINE® searches, and for article summarization.

Information provided to a medical institution is customized according to the institution's requirements. The requirements define the EMR fields that are provided to InfoBot and the knowledge sources to be mined for information provided by InfoBot. Each set of requirements for a specific clinical task and user group is called a Ruleset. Medical institutions can define as many rulesets as are needed to support their daily practice with evidence.

InfoBot Dashboard

Figure 1 illustrates the InfoBot Evidence Dashboard for the ruleset defined by the NIH Clinical Center to support the Interdisciplinary Team care plan development.

InfoBot Processes

Overview of Processes: text

Overview of Processes: table

Overview of Processes: slideshow

Process specifications: text and tables

Overview of Processes: diagram

Evaluation

Prototype evaluation status

The second version of the CRIS prototype was deployed for evaluation at the NIH Clinical Center in February 2011.

Past prototype evaluation

The first life EBP InfoBot prototype was deployed as the EBP-InfoBot tab in the NIH Clinical Center system CRIS in August 2009.

An offline protoype system was evaluated in 2008.
Using 4,335 de-identified interdisciplinary team notes for 525 patients, the system automatically
extracted biomedical terminology from 4,219 notes and linked resources to 260 patient records.
Sixty of those records (15 each for Pediatrics, Oncology & Hematology, Medical & Surgical,
and Behavioral Health units) have been evaluated by 16 Clinical Center nurses for quality of
automatically proactively delivered evidence and its usefulness in development of care plans.

Publications

  • Bodenreider O, Demner-Fushman D. Investigating drug classes in biomedical terminologies from the perspective of clinical decision support. Proceedings of the 2010 Annual Symposium of the American Medical Information Association (AMIA 2010), Washington, DC, November 2010.
  • Jao CS, Fung KW, Demner-Fushman D. Identifying indications for drugs in drug package inserts. Proceedings of the 2010 Annual Symposium of the American Medical Information Association (AMIA 2010), Washington, DC, November 2010.
  • Apostolova E, Tomuro N, Demner-Fushman D. Identifying Contextual Information in Clinical Texts: A Study of Two Domains. 4th International Symposium on Semantic Mining in Biomedicine (SMBM 2010). Oct 25-26; Hinxton, Cambridge, UK
  • Mork JG, Bodenreider O, Demner-Fushman D, Dogan RI, Lang FM, Lu Z, Neveol A, Peters L, Shooshan SE, Aronson AR. Extracting Rx information from clinical narrative. J Am Med Inform Assoc. 2010 Sep-Oct;17(5):536-9.
  • Demner-Fushman D, Chapman WW, McDonald CJ. What can natural language processing do for clinical decision support? J Biomed Inform. 2009
  • Demner-Fushman D, Seckman C, Fisher C, Hauser SE, Clayton J, Thoma GR. A Prototype System to Support Evidence-based Practice.
    Proceedings of the 2008 Annual Symposium of the American Medical Information Association (AMIA 2008), Washington, DC, November 2008
  • Seckman C, Demner-Fushman D, Fisher C, Hauser SE, Thoma GR. InfoBot: A prototype system to support evidenced based practice
    Building Connections for Patient Centered Records. University of Maryland School of Nursing 18th Annual Summer Institute in Nursing Informatics. July 2008. Baltimore, MD