Practical choices for infobutton customization: experience from four sites

Abstract

Context-aware links between electronic health records (EHRs) and online knowledge resources, commonly called "infobuttons" are being used increasingly as part of EHR "meaningful use" requirements. While an HL7 standard exists for specifying how the links should be constructed, there is no guidance on what links to construct. Collectively, the authors manage four infobutton systems that serve 16 institutions. The purpose of this paper is to publish our experience with linking various resources and specifying particular criteria that can be used by infobutton managers to select resources that are most relevant for a given situation. This experience can be used directly by those wishing to customize their own EHRs, for example by using the OpenInfobutton infobutton manager and its configuration tool, the Librarian Infobutton Tailoring Environment.

Figure 1:

Knowledge specifications for an Infobutton Manager. The librarian first decides which resources are generally appropriate for a given clinical task (solid arrows) and then further refines the selection criteria based on specific values of the HL7 context parameters (boxes with dashed lines). Three parameters (in addition to “Task”) are shown; the standard specification includes many others as well.

Figure 2:

Creating a Context-Specific Link in LITE. The user is using LITE to configure OpenInfobutton for a fictitious EHR at the American Medical Informatics Association. The user has chosen to link the resource MedlinePlus Connect to the clinical task “diagnosis list entry”. By clicking on “Sex Information”, “Age Information” or “Information recipient language information”, the user can limit the selection criteria for this resource. In the screen shot, the user has indicated that MedlinePlus Connect should be selected when the EHR user is entering a diagnosis on a problem list and the patient is an adolescent, English-speaking female.