Meeting the electronic health record "meaningful use" criterion for the HL7 infobutton standard using OpenInfobutton and the Librarian Infobutton Tailoring Environment (LITE)

Abstract

Infobuttons are clinical decision support tools that use information about the clinical context (institution, user, patient) in which an information need arises to provide direct access to relevant information from knowledge resources. Two freely available resources make infobutton implementation possible for virtually any EHR system. OpenInfobutton is an HL7-compliant system that accepts context parameters from an EHR and, using its knowledge base of resources and information needs, generates a set of links that direct the user to relevant information. The Librarian Infobutton Tailoring Environment (LITE) is a second system that allows institutional librarians to specify which resources should be selected in a given context by OpenInfobutton. This paper describes the steps needed to use LITE to customize OpenInfobutton and to integrate OpenInfobutton into an EHR.

Figure 1:

Relationships between clinical users working in the context of a particular patient’s care at a particular institution, OpenInfobutton (which uses its knowledge base to create a set of context-specific links to information resources), and the Librarian Infobutton Tailoring Environment (which allows an institutional librarian to create and maintain OpenInfobutton’s knowledge base).

Figure 2:

Sample LITE screen, showing the Context Review page in the Context Specific Link Wizard. By clicking on the various headings, users can alter the parameter settings. In this case, the context settings tell OpenInfobutton to create a link to MedlinePlus Connect if the institution is “Marine Biological Laboratory”, and the task is “patient information review”. OpenInfobutton will select this resource for any patient gender and age.

Figure 3:

The OpenInfobutton testing page. Once a context is defined and published using LITE, the user can test the addition by using this page, which simulates the look and feel of Infobuttons integrated into an imaginary EHR (http://lite.bmi.utah.edu/OpenInfobuttonDemo.html). The user can select an institution, set the age and gender of the fictitious patient and then chose the Infobutton that corresponds to the clinical task in the context being tested. The infobutton link will then evoke OpenInfobutton (see Figure 4) as if it had been called by a real EHR so that the LITE user can verify that the resource was selected properly.

Figure 4:

The OpenInfobutton as it appears when called from the testing page shown in Figure 3. The tester had selected “Veterans Administration” as the institution, specified that patient is an adult female, and clicked on the infobutton icon adjacent to “Haloperidol (Haldol), 5mg, Tablet, Oral”. OpenInfobutton displays a set of links to various resources on the left side, evokes the first link (in this case, “FDA Drug Label”) and displays the result in the main window frame. Note that the Daily Med page displayed is for Haloperidol but that the age and gender information was ignored.