For several years I have been involved with Health Level Seven (HL7) in the development of the Infobutton standard. In their simplest form, Infobuttons are context-sensitive links from an electronic health record (EHR) system to a knowledge resource. A knowledge resource is typically a website with information for professionals and/or patients; an example would be UpToDate. Infobuttons are designed to make it easier for healthcare providers to answer clinical questions. For example, an Infobutton might appear next to an abnormal lab result. Clicking on this Infobutton might take the clinician directly to information on what this abnormal result means and what further action (treatment, additional tests) is warranted.

Instead of linking from an EHR directly to a knowledge resource website, Infobuttons can be directed to an intermediate Infobutton Manager website, which sits in between the EHR and one or more knowledge resource websites. Infobutton Managers enable users to refine their question and/or select a knowledge resource. For example, after clicking on an Infobutton in an EHR next to a problem or diagnosis, an Infobutton Manager might give the user these options:

• Knowledge Resource #1
  • Diagnosis
  • Treatment
  • Etiology
  • Prognosis
• Knowledge Resource #2
  • Diagnosis
  • Treatment
  • Etiology
  • Prognosis

Alternatively, the Infobutton Manager might choose to group the options by subtopic and then knowledge resource, as in:

• Diagnosis
  • Knowledge Resource #1
  • Knowledge Resource #2
• Treatment
  • Knowledge Resource #1
  • Knowledge Resource #2
• Etiology
  • Knowledge Resource #1
  • Knowledge Resource #2
• Prognosis
  • Knowledge Resource #1
  • Knowledge Resource #2

Each option presented in the Infobutton Manager would be linked to a knowledge resource using a URL that followed the HL7 Infobutton standard. Institutions would maintain their own Infobutton Managers and customize them based on the knowledge resources to which they would like to direct users looking for clinical and/or patient information.

Let’s look at an example of the parameters and values that an Infobutton URL might contain. This one is a request for information on the treatment of benign hypertension in a 65 year old patient. The actual URL would contain parameters and values all strung together, but we will break it out into a table for ease of readability.

As you can see, the use of standard terminologies such as ICD-9-CM is encouraged. When EHR systems, Infobutton Managers and knowledge resources use standard terminologies, they effectively speak the same language, thereby reducing the chance of a mismatch between a data element in the patient’s record and the information provided in the knowledge resource. Nevertheless, free text alone is still permitted by the standard, using the mainSearchCriteria.v.dn parameter.

In a future post I will comment on the ongoing effort to create a standard for implementing Infobuttons as web services.