integration of health information resources into electronic health records using hl7 guilherme del...
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Integration of Health Information Resources into Electronic Health
Records Using HL7
Guilherme Del Fiol, MD, MSBiomedical Informatics Department, University of Utah
Intermountain Healthcare, Salt Lake City, UT
James J. Cimino, MD Department of Biomedical Informatics, Columbia
University, New York, NY
Saverio Maviglia, MD, MScPartners Healthcare System, Boston, MA
Outline
• Background• HL7 infobutton standard• Demonstration participants
– Infobutton Managers– Information resource providers
• Live demonstration
Infobuttons
Background
?MRSA
Information for Decision-Making
Addressing Information Needs with Infobuttons
• Clinical information systems evoke information needs
• Clinician’s computer has access to resources
• Context can be used to predict need• Context can be used to automate
retrieval
Context-Dependent Information Needs
Age Sex TrainingRole DataTask
Context
? !
Institution
Infobuttons vs. Infobutton Manager
Pageof
Hyperlinks
InfobuttonClinical System Resourc
e
InfobuttonManager
ContextQuery
KnowledgeBase
s
Overview
Infobutton standard
Why do we need a standard?
• There is not a common integration language– Parameter names– Terminologies used for content
search retrieval
• Hundreds of resources available– Not designed for infobutton
integration: suboptimal results– Labor intensive integration: just a few
are actually used
http://resource1.com/search = “azithromycin AND dose”
What is the dose of azithromycin ?i
Multiple ways of “asking” the same question
http://resource3.com/
searchConcept = 3333 ^ azithromycin
filter = 11 ^ dosage
http://resource2.com/
query = "azithromycin"[MeSH Terms] AND dose[All Fields]
Resource 3
Resource 1
Resource 2InfobuttonManager
API
API
API
API
No standard in place
Clinical Information
System i
http://resource1.com/search.cgi? search = “azithromycin AND dose”
http://www.resource3.com/search.cgi? searchConcept = 3333 ^ azithromycin filter = 11 ^ dosage
http://resource2.com/
query = "azithromycin"[MeSH Terms] AND dose[All Fields]
ElectronicHealthRecord i
Resource 3
Resource 1
Resource 2
HL7
HL7
HL7
HL7
Standard-based integration
Intermountain
Columbia
Partners
HL7
HL7
HL7
Key points
• XML and URL-based syntax• Recommends adoption of a set of
standard terminologies (e.g., RxNorm, LOINC, SNOMED-CT, MeSH)– Aligned with national initiatives
• Flexible requirements to allow faster adoption
Example
• The user is looking at a problem list of a female, 94 years-old patient with Heart Failure. The user clicks on an infobutton that presents a series of questions. The user selects “How do I treat Heart Failure?”
<informationRecipient><patient> <language code=“eng"/><patient>
<informationRecipient>
<gender code=“F" displayName=“Female"/>
<age value=“94" unit=“a"/>
<taskContext code=“PROBLISTREV"/>
<mainSearchCriteria code="428“ codeSystem="2.16.840.1.113883.6.103"
displayName=“Heart Failure"/><subTopic code="Q000628"codeSystem="2.16.840.1.113883.6.177" displayName="therapy"/>
<mainSearchCriteria code="428“ codeSystem="2.16.840.1.113883.6.103"
displayName=“Heart Failure"/>
<patientContext> <gender code=“F" displayName=“Female"/> <age value=“94" unit=“a"/> <taskContext code=“PROBLISTREV"/>
<mainSearchCriteria code="428" codeSystem="2.16.840.1.113883.6.103" displayName=“Heart Failure"/><subTopic code="Q000628" codeSystem="2.16.840.1.113883.6.177" displayName="therapy"/>
URL-based message
• Simpler implementation– Support industry backwards
compatibility– Faster adoption
• Rules for automated conversion– URL can be automatically derived
from XML model
taskContext.c.c=LABRREV
mainSearchCriteria.c.c=2823-3mainSearchCriteria.c.cs=2.16.840.1.113883.6.1mainSearchCriteria.c.dn=Serum potassiummainSearchCriteria.c.ot=K
interpretationCode.c.c=L
administrativeGenderCode.c=F
age.v=56age.u=a
http://www.e-resource.com/api?patientPerson.administrativeGenderCode.c=Fage.v=56&age.u=a
taskContext.c=LABRREV
mainSearchCriteria.c=2823-3mainSearchCriteria.cs=2.16.840.1.113883.6.1mainSearchCriteria.dn=Serum potassiummainSearchCriteria.c.ot=K
Demonstration
Participants
Content providers
• ACP PIER• Clin-eguide (Wolters Kluwer Health)• Dynamed (Ebsco)• Lexicomp• Micromedex (Thomson Healthcare)• UpToDate
Infobutton Managers
• Intermountain Healthcare– First production version in 2001– Infobutton Manager since 2005– Medication order entry, problem list,
lab results– 1,000+ users per month– Knowledge base: resources and
questions configured in XML files
Infobutton Managers
• Columbia University– Concept of interest translated into
controlled terminology– Related concepts identified– Topics/questions matched to concept
classes and other context parameters– XML table of topics (along with
javascript) returned to the user– Links are initiated from user’s browser
Infobutton Managers• Columbia University – usage
– Infobuttons available since 1996– Infobutton manager version 1 2002– Available in:
• WebCIS: lab results, micro results, sensitivity results, inpatient drugs, outpatient drugs, problem list
• Eclipsys: lab orders, drug orders, nursing orders• Regenstrief Medical Records System: drug orders• NY State Psych Institute: drug orders• NextGen: lab results
– 700+ users per month– 2100+ uses per month
Infobutton Managers
• Columbia University – benefits– Easy to use: 92%– Question on list >50% of time: 89%– Answered question: 69%– Useful: 77%– Helpful >50% of time: 90%– Positive effect on care: 74%
Infobutton Managers
• Partners Healthcare– Live since 2002– Medication order entry, problem list,
lab results (8 clinical apps)– Federated search engine for 2 library portals– 50K sessions by 5K unique users per month
• 60% RN, 15% MD, 11% PharmD• 1-50% of patient encounters• 90% medication queries• Median session duration under 15 seconds!• 85-90% success rate
– Resources and context triggers configured in SQL/Access – no terminology or lexical analysis
http://www.hl7.org/v3ballot/html/welcome/environment/index.htm