understanding infobutton standards: how to link ehrs and cds
TRANSCRIPT
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Understanding Infobutton Standards:
How to link EHRs and CDS
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Understanding Infobutton Standards:
How to link EHRs and CDS
HL7 Context-Aware Knowledge
Retrieval System
• HL7 International (Health Level Seven) and its
members provide standards for the integration of
health information
• Eliminate the “wild west” of integrations
• One of these standards is for the “Context-Aware
Knowledge Retrieval, Knowledge Request
Standard”
•Infobutton
• Clinical Decision Support Work Group
• First version was approved in September 2010
• Provides a specific framework and structure for
systems to submit knowledge requests to
resources
Provides clinicians and patients
with relevant resources to meet
your MU2 objectives
Infobutton
§170.314 (a) (8) Clinical Decision Support
§170.314 (a) (15) Patient-Specific Education Resources
• Clinicians need resources to find answers at the
point of care
• Infobutton provides a way to integrate resources
into the EHR or PHR system
• Provides a more efficient way to get to these
resources, so that they may be used more
frequently
1) Context-specific topic to support decisions
2) Specialized by user – Patients, physicians,
pharmacists, nurses
3) Access to authoritative information without
leaving workflow
• Enables interoperability
• Utilizes standard terminologies – ICD-9, ICD-10,
SNOMED, RxNORM, NDC, LOINC, CPT
ICD-10 E10.9
Diabetes Type 1
LOINC 2345-7
Fasting Blood Sugar
LOINC 4548-4 HbA1C
RxNorm 5856 Insulin
Patient Education
Handouts
Secure email
Patient Portal
Retrieves data from EHR and CDS content
Infobutton
Manager Third Party
Content Provider
Third Party
Content Provider
Parameter Value Description
patientPerson.administativeG
enederCode.dn
Male Specifies the display name for this
patient’s gender is male
mainSearchCriteria.v.cs 2.16.840.1.113883.6. 3 Specifies the ICD-10 code system
mainSearchCritera.v.c J15.9 ICD-10 code for unspecified
bacterial pneumonia
age.v.u A Specifies the age unit (a=years)
age.v.v 65 Specifies the age value
subTopic.v.dn Treatment Specifies the subtopic description
URL Representation:
mainSearchCriteria.v.c=J15.9&mainSearchCriteria.v.cs=2.16.840.1.
113883.6.3&mainSearchCriteria.v.csn=ICD10
patientPerson.administativeGenderCode.dn=Male&
Age.v.v=65&age.v.u=a&
subTopic.v.dn=treatment
Generated XML:
-<resourceRequest>
-<mainSearchCriteria>
-
<value code="J15.9"codeSystem="2.16.840.1.113883.6.3"codeSystemName="IC
D10">
<displayName value=""/>
</value>
</mainSearchCriteria>
</resourceRequest>
Example Content Return
BACTERIAL PNEUMONIA
Background › Pathophysiology › Diagnostics › - History › - Physical Exam › - Dx Testing › - Dx Imaging › Differential
Dx › Treatment › - Antibiotics › Disposition › References
Treatment
ABCs
Support O2 & consider Venous access prn
Bronchodilator medications (if wheezing)
Sepsis evaluation if <8 wks old & fever on toxic child
Consider use of antibiotics if bacterial pathogen likely
Empiric antibiotics based on
Age
Season
Clinical factors
Labs
Epidemiology
Antibiotic Recommendations
Outpatient ABx dosages
Inpatient antibiotic therapy
Infobutton Study:
•Needs dependent on context and clinician type
•All clinicians: institution-specific protocols
•MDs: unfamiliar domains
•RNs: physician order rationales
•NPs: Similar to MDs and RNs
•Suggestion: Infobutton should tailor anticipated questions
by clinician type
Collins, Sarah A, Leanne M. Currie, Suzanne Bakken and James J. Cimino. Information Needs, Infobutton Manager Use, and Satisfaction
by Clinician Type: A Case Study. Journal American Medical Informatics Association. 2009 Jan-Feb; 16(1): 140-142
Specialized Resources
Pediatric Dosing
Calculator
Nursing Considerations,
Patient Teaching AHFS Spanish education
handout
Parameter Value Description
informationRecipient
PAT
Specifies the intended recipient is
a patient
performer.languageCode.c en Specifies the language of the user
(en=English)
informationRecipeint.languag
eCode.c
es Specifies the language of the
patient is Spanish (es=Spanish)
Performer.healthCareProvide
r.c.dn
Registered Nurse Display name of the performer is
RN
mainSearchCriteria.v.cs 2.16.840.1.113883.6.69 Specifies the NDC code set
mainSearchCriteria.v.c 49502-693-03 NDC code for Albuterol sulfate
inhalation solution 1.25 mg
URL Representation:
informationRecipient=PAT&
Performer.languageCode.c=en&
informationReciient.languageCode.c=es&
Performer.healthCareProvider.c.c=160W00000X&performer.health
Careprovider.c.dn=Registered Nurse&
mainSearchCriteria.v.c=49502-693-
03&mainSearchCriteria.v.cs=2.16.840.1.113883.6.9&mainSearchCri
tiera.v.dn=Albuterol+sulfate&mainSearchCriteria.v.ot=Albuterol+Sulf
ate+inhalation_solution+1.25mg
HTTP POST example: <input
name="InfobuttonEventNotification"value=”infobuttonEventNotification.effectiveTi
me.v=20060706001023&holder.assignedEntity.n=OrganizationUsername&holder.as
signedEntity.certificateText=organizationpassword&patientPerson.administrative
GenderCode.c=F&patientPerson.administrativeGenderCode.dn=Female&age.v.v
=8&age.v.u=a&ageGroup.v.c=D002648&ageGroup.v.cs=2.16.840.1.113883.6.177&
taskContext.c.c=MEDLISTREV&performer=PROV&informationRecipient=PAT&p
erformer.healthCareProvider.languageCode.c.c=en&informationRecipient.patien
tPerson.languageCode.c=es&performer.healthCareProvider.c.c=163W00000X&p
erformer.healthCareProvider.c.dn=RegisteredNurse&mainSearchCriteria.v.c=495
0269303&mainSearchCriteria.v.cs=2.16.840.1.113883.6.69&mainSearchCriteria.v.
dn=Abuterol+sulfate&mainSearchCriteria.v.ot=Albuterol+sulfate+inhalation+solution
+1.25+mg”/>
Example Content Return – Patient
NOMBRE GENÉRICO: Albuterol Print
¿PARA CUÁLES condiciones o enfermedades se prescribe este medicamento?
Albuterol se usa para prevenir y tratar síntomas como resoplo (silbido al respirar), respiración entrecortada y
contractura toráxica, provocados por enfermedades pulmonares como el asma y la enfermedad pulmonar obstructiva
crónica (COPD por su sigla en inglés; un grupo de enfermedades que afectan al pulmón y a las vías aéreas).
Pertenece a una clase de medicamentos llamados broncodilatadores. Funciona al relajar y abrir los bronquios,
permitiendo el paso normal de aire a los pulmones, facilitando la respiración.
¿CÓMO se debe usar este medicamento?
Albuterol viene envasado en forma de tabletas, como jarabe, y como tabletas de liberación lenta (acción prolongada)
para tomar por vía oral. Por lo general las tabletas y el jarabe se toman 3 ó 4 veces al día. Las tabletas de liberación
lenta por lo general se toman 1 vez cada 12 horas. Tome este medicamento alrededor de las mismas horas todos los
días. Siga cuidadosamente las instrucciones en la etiqueta del medicamento y pregúntele a su doctor o farmacéutico
cualquier cosa que no entienda. Use el medicamento exactamente como se indica. No use más ni menos que la
dosis indicada ni tampoco más seguido que lo prescrito por su doctor. Tome las tabletas de liberación lenta enteras,
con un vaso de agua o de otro líquido. No las parta, mastique ni aplaste. Su doctor podría comenzar con una dosis
baja del medicamento y aumentarla de manera gradual. Albuterol puede ayudar a controlar los síntomas pero no
cura su condición. Continúe usando este medicamento aunque se sienta bien. No deje de tomar albuterol sin antes
conversar con su doctor. Llame a su doctor si sus síntomas empeoran o si siente que el albuterol ya no los controla.
Example Content Return – Pharmacist
Albuterol (Systemic, Oral Inhalation)
Class: 12:12.08.12 Selective beta-2-Adrenergic Agonists
AccuNeb®, Combivent®, DuoNeb®, ProAir® HFA, Proventil®, Proventil® HFA, Ventolin® HFA, VoSpire® ER,
Introduction
Bronchodilator; relatively selective, short-acting β2-adrenergic agonist.(j)
Uses
Bronchospasm in Asthma
Symptomatic management or prevention of bronchospasm in patients with reversible, obstructive airway disease
(e.g., asthma).(132)(139)(154)(181)(241)(249)(255)(282)
Exercise-induced Bronchospasm
Prevention of exercise-induced bronchospasm.(132)(181)(249)
Chronic Obstructive Pulmonary Disease
Albuterol sulfate in fixed combination with ipratropium bromide: Symptomatic management of reversible
bronchospasm associated with COPD in patients who continue to have evidence of bronchospasm despite regular
use of an orally inhaled bronchodilator and who require a second bronchodilator.(233)(250)(251)(252)
Albuterol sulfate: Symptomatic management of reversible bronchospasm associated with COPD† when given on an
as-needed or regular (e.g., 4 times daily) basis, either alone or concomitantly with other inhaled
bronchodilators.(181)(206)(251)(266)(267)(268)(269) Regular use of a selective, short-acting inhaled β2-adrenergic
agonist (e.g., albuterol) in the management of COPD, in contrast to that in asthma, does not appear to be
detrimental.(206)(247)(250)(251)
Example Content Return – Physician
ALBUTEROL
Adult Dosing
Acute Bronchospasm
0.5 mL of 0.5% solution (2.5 mg) nebulized q6hr
Inhaler: 2 puffs q4-6hr
Tabs 2-4 mg PO TID/QID
Severe bronchospasm
0.5 mL of 0.5% soln (2.5 mg) nebulized q20min or continuous x1 hr
Exercise-induced Bronchospasm: 180 mcg (2 puffs) inhaled 15-30 min before exercise; up to 12 puffs/24hr
Administration
Inhaler should be shaken well & test-sprayed into the air before initial use or if it has not been used for a prolonged time
Place inhaler well into the mouth, lips firmly closed around it
Extended release tablets should not be chewed, crushed or mixed with food
See also combo with ipratropium (Combivent/DuoNeb)
Pediatric Dosing
Inhaler
>4 yo: as adult
Nebulizer
2-12 yo, >15 kg: 0.63-2.5 mg TID/QID
Adjust flow rate of albuterol delivery over period of 5-15 min
Tabs
• Use observation studies and clinical context
information to guide use of Infobuttons
• Usage logs showing use of context-specific
information resources
• What is hypothetically useful vs. what is
empirically useful?
Cimino, JJ. The Contribution of Observational Studies and Clinical Context Information for Guiding the Integration of Infobuttons into
Clinical Information Systems. AMIA Annual Symposium Proceedings. 2009 Nov 14;2009:109-13.
- Problem List
- Medication List
- Medication Allergy List
- Demographics
- Lab Tests and Values/Results
- Vital signs
Provide patients with
information to manage
and maintain their own
health
- Problem List
- Medication List
- Lab Results
What to look for when choosing a content
provider
• Standardized terminology - improves retrieval results of
Infobutton content
• Both clinician and patient information
• Evidence-based medicine; unbiased drug data
• Strategic partnership
Hypertensive Emergency
Pathophysiology
1. Mechanism
• Systolic blood pressure (SBP) ≥
180 mmHg and/or diastolic blood
pressure (DBP) ≥ 120 mmHg
• Usually asymptomatic, but
some may experience
headaches or anxiety
• Hypertensive urgency indicates
that BP is high enough to cause
serious risk of sudden, life-
threatening events but not
currently occurring
• Could quickly develop
them if blood pressure not
quickly brought under
control
2. Etiology/Risk Factors
• 90% risk of developing HTN in
(even if normotensive at 55 yo)
• Two types based on cause
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Jenna Reynolds
Director, Business Development
PEPID