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OpenInfobutton

OpenInfobutton. Guilherme Del Fiol, MD, PhD Department of Biomedical Informatics University of Utah. Background. Resources: answer >90% of questions. 1 question out of every 1-2 patients seen (Del Fiol, 2012). “What is the dose of Pediazole for this child?”

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OpenInfobutton

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  1. OpenInfobutton Guilherme Del Fiol, MD, PhD Department of Biomedical Informatics University of Utah

  2. Background Resources: answer >90% of questions 1 question out of every 1-2 patients seen (Del Fiol, 2012) • “What is the dose of Pediazole for this child?” • “Where is the hospital pain management protocol” • “I need a diabetes patient education handout” • “What is this patient’s most recent HbA1c?” Context EHR i > 60% of questions left unanswered

  3. Top 10 question Types 80/20 rule 30% about drug treatment Source: Ely et al. , BMJ 2000; 321:429-32.

  4. Topics Resources

  5. Context • Patient • Provider • Setting • EHR task

  6. Impact of Infobuttons • Answers to over 85% of questions • Decision enhancement or learning in over 62% of infobutton sessions • Median session time: 35 seconds • High user satisfaction • Usage uptake in medications and lab results • 1 million sessions at Partners Healthcare in 2011 Maviglia et al. J Am Med Inf Assoc, 2006. Cimino JJ. J Am Med Inf Assoc. 2009. Del Fiol et al. J Am Med Inf Assoc, 2008.

  7. Architecture Azithromycin Female 81 years User: MD Order entry Resource 1 HL7 EHR Resource 2 i HL7 HL7 Infobutton Manager Resource 3 HL7 HTML

  8. OpenInfobutton • VA Innovations Project (2010) • Portland VAMC • David Douglas, Clayton Curtis (PIs) • Open source infobutton manager • VA system wide infobutton manager • HL7 reference implementation • Fosteradoption& innovation • Integrated with 34 knowledge resources(8 HL7 compliant) http://www.OpenInfobutton.org

  9. HL7 Context Dimensions Patient User Patient vs. provider Discipline / specialty • Gender • Age group • Concept of interest • Secondary observations Organizational Goal • Care setting • Service delivery location • Location of interest • Task (e.g., order entry, problem list entry, lab results review)

  10. VA[representedOrganization.id.root=1.3.6.1.4.1.3768] • Problem list review [taskContext.c.c=PROBLISTREV] • Diabetes Mellitus Type 2 [mainSearchCriteria.v.c=250.00&mainSearchCriteria.v.cs=2.16.840.1.113883.6.103&mainSearchCriteria.v.ot=Diabetes+Mellitus+type+2] • Female[patientPerson.administrativeGenderCode.c=F] • 65 years old [age.v.v=65&age.v.u=a] • ED[encounter.c.c=EMER] • Health care provider [performer=PROV] • Patient recipient [informationRecipient=PAT] • Patient Spanish speaker [informationRecipient.languageCode.c=es] Medline Plus OpenInfobutton Discharge handout EHR Mayo VA content

  11. Medline Plus OpenInfobutton Discharge handout EHR <feed> <title type="text">MedlinePlus</title> <subtitle type="text">type 2 Diabetes Mellitus </subtitle> <updated>2013-03-26T12:13:12.013-06:00</updated> <category scheme="mainSearchCriteria.v.c" term="250.00"/> <category scheme="mainSearchCriteria.v.cs" term="2.16.840.1.113883.6.103"/> <category scheme="mainSearchCriteria.v.dn" term="type 2 Diabetes Mellitus "/> <category scheme="informationRecipient" term="PAT"/> <entry> <title>Diabetes Type 2</title> <link href="http://www.nlm.nih.gov/medlineplus/diabetestype2.html" rel="alternate"/> <summary type="html">&lt;p&gt;&lt;a href="http://www.nlm.nih.gov/medlineplus/diabetes.html"&gt;Diabetes&lt;/a&gt; means your blood glucose, or blood sugar, is too high. With type 2 diabetes, the more common type, your body does... </summary> </entry> </feed> Mayo VA content

  12. <aggregateKnowledgeResponse> <feed> <title type="text">VA patient education</title> … </feed> <feed> <title type="text">MayoClinic</title> <subtitle type="text">type 2 Diabetes Mellitus </subtitle> <updated>2013-03-26T12:13:12.013-06:00</updated> <category scheme="taskContext.c.c" term="PROBLISTREV"/> <category scheme="mainSearchCriteria.v.c" term="250.00"/> <category scheme="mainSearchCriteria.v.cs" term="2.16.840.1.113883.6.103"/> <category scheme="mainSearchCriteria.v.dn" term="type 2 Diabetes Mellitus "/> <entry> <title type="text">Patient education</title> <link href="http://www.google.com/search?hl=en&amp;btnI=Im+Feeling+Lucky&amp;q=type 2 Diabetes Mellitus +site:www.mayoclinic.com/health/&amp;"/> </entry> </feed> <feed> <title type="text">MedlinePlus</title> … </feed> </aggregateKnowledgeResponse> Medline Plus OpenInfobutton Discharge handout EHR Mayo VA content

  13. AViVA Prototype: Problem List

  14. Software Environment • Deployment environment • Any Java application server (tested with Tomcat) • Any SQL DB (tested with MySQL) • UMLS license for terminology access • Development • Source code in public GitHub repository • Eclipse + plug-ins

  15. Ongoing Collaborations • VA • Live within HMP (pilot at San Diego VA) • University of Utah • Integration with Epic • Intermountain Healthcare • Live within problem list • Duke University • Medical library search page • University of Washington • Pharmacogenomics CDS – feasibility (PhD project) • New York University • Nortwestern University • eMERGE network

  16. Under development • OpenInfobutton • Compliance with latest versions of HL7 specification • Implementations with other terminology servers (3M Health Data Dictionary) • Infobutton responder • Allow local content to be indexed and searched through HL7 compliant API

  17. Resources • Project site • www.openinfobutton.org • OSEHRA • http://code.osehra.org/journal/browse/publication/33# • Source repository • https://github.com/VHAINNOVATIONS/Innovation-182/

  18. Acknowledgements • Funding source • VHA CHIO Innovation Project #182 • AHRQ grant 7K01HS018352-03 • HL7 Clinical Decision Support WG • Portland VAMC • David Douglas (PI), Clayton Curtis (PI), Saad Aziz • University of Utah • Andrew Iskander, Aditya Kalluri • NIH Clinical Center & NLM • Jim Cimino, Xia Jing

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