Implementations of the HL7 Context-Aware Knowledge Retrieval ("Infobutton") Standard: challenges, strengths, limitations, and uptake

Abstract

To support clinical decision-making, computerized information retrieval tools known as "infobuttons" deliver contextually-relevant knowledge resources into clinical information systems. The Health Level Seven International (HL7) Context-Aware Knowledge Retrieval (Infobutton) Standard specifies a standard mechanism to enable infobuttons on a large scale.

Objective: To examine the experience of organizations in the course of implementing the HL7 Infobutton Standard.

Method: Cross-sectional online survey and in-depth phone interviews.

Results: A total of 17 organizations participated in the study. Analysis of the in-depth interviews revealed 20 recurrent themes. Implementers underscored the benefits, simplicity, and flexibility of the HL7 Infobutton Standard. Yet, participants voiced the need for easier access to standard specifications and improved guidance to beginners. Implementers predicted that the Infobutton Standard will be widely or at least fairly well adopted in the next 5 years, but uptake will depend largely on adoption among electronic health record (EHR) vendors. To accelerate EHR adoption of the Infobutton Standard, implementers recommended HL7-compliant infobutton capabilities to be included in the United States Meaningful Use Certification Criteria for EHR systems.

Limitations: Opinions and predictions should be interpreted with caution, since all the participant organizations have successfully implemented the standard and over half of the organizations were actively engaged in the development of the standard.

Conclusion: Overall, implementers reported a very positive experience with the HL7 Infobutton Standard. Despite indications of increasing uptake, measures should be taken to stimulate adoption of the Infobutton Standard among EHR vendors. Widespread adoption of the Infobutton Standard has the potential to bring contextually relevant clinical decision support content into the healthcare provider workflow.

Figure 1

URL-based infobutton implementation architecture. The solid lines (steps 1 and 2) represent standard knowledge requests according to the URL-based implementation guide. Dashed lines (step 3) represent non-standard knowledge responses, typically HTML. Knowledge requests can be mediated by an infobutton manager, which may communicate with several knowledge resources (steps 1 and 2); or be submitted directly to a knowledge resource (step 1). The callout provides a simplified sample knowledge request in which a physician, reviews a male, 77 year-oldpatient’s problem listwith bacterial pneumoniaand the patient has been admitted to aninpatient setting. The physician requests specific knowledge content related to therapy.