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Product Brief - Context-Aware Knowledge Retrieval (Infobutton)

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Product Name - HL7 Version 3 Standard: Context-aware Information Retrieval (Infobutton), Release 1

  • HL7 V3 Standard: Context-Aware Information Retrieval (Infobutton) Knowledge Request, Release 1


Topic of Clinical Decision Support Domain


Topics

Standard Category

  • Health Information Exchange Standards

Integration Paradigm

  • Web Services

Type

Normative, ANSI Standard

Releases

ANSI/HL7 V3 INFOB, R1-2010

Summary

Clinicians face numerous knowledge needs during the course of patient care and the majority of these needs are not met, compromising the quality of care. Likewise, in order to be partners in the decision making process, patients need to be well-informed about their health and health care options. Online health knowledge resources that are capable of solving clinicians’ and patients’ knowledge needs are now widely available, but a series of barriers hinder a more effective and frequent use of these resources to support decision-making. Context-aware knowledge retrieval into clinical information systems (CIS), such as electronic health record (EHR) and personal health record (PHR) systems, is an increasingly promising approach for delivering relevant clinical knowledge to the point of care as well as patient-tailored educational material to support patient-centered care. These kinds of knowledge retrieval tools have been known as "Infobuttons." For example, an infobutton displayed in the context of a patient’s problem list may allow a user to view directly educational material regarding the evaluation and treatment of a specific disease without having to leave the CIS and look up the knowledge elsewhere.

To support the integration of knowledge resources into CISs, the Clinical Decision Support Work Group (CDS WG) has been developing a set of standard specifications for context-aware knowledge retrieval. The first of these specifications, entitled Context-Aware Knowledge Retrieval (Infobutton), Knowledge Request Standard, was approved in September 2010 as a normative ANSI/ISO HL7 standard. This specification provides a standard mechanism for clinical information systems to submit knowledge requests to knowledge resources. In addition, a URL-based implementation guide has been developed to specify knowledge request implementations using the HTTP protocol.

Description

The core artifact of the Infobutton, Knowledge Request is an information model (Refined Message Information Model, or simply RMIM) that defines the structure and semantics of a context-aware knowledge request. In essence, the RMIM provides a standardized representation of the context of an interaction between a user and a CIS. Context is represented in the RMIM in terms of the following dimensions: patient (e.g., gender, age, main primary concept of interest), user (e.g., patient vs. provider, discipline), care setting (e.g., inpatient, outpatient), and CIS task (i.e., order entry, lab results review). Knowledge resources that implement this standard become context-aware in the sense that they are able to receive, process, and make inferences over the context in order to retrieve relevant, context-specific knowledge content in any particular context.

The RMIM is technology agnostic. For implementation purposes, two representation mechanisms have been defined: URL-based representation and XML. The RMIM automatically generates an XML schema that can be used by implementers to create and validate knowledge requests.

The Context-Aware Knowledge Retrieval (Infobutton), Knowledge Request Standard can be implemented through the following representation and transport mechanisms:

  • As a URL using HTTP GET or POST (see Context-Aware Knowledge Retrieval, URL-Based Implementation Guide for details)
  • As a Web Service

The Context-Aware Knowledge Retrieval, URL-Based Implementation Guide and the Context-Aware Knowledge Retrieval, Service-Oriented Architecture Implementation Guide provide these implementation details.

Business Case (Intended Use, Customers)

  • Clinical information system developers
  • Clinical knowledge resource publishers
  • Clinical decision support developers
  • Health care organizations


Benefits

Enables the integration of contextually relevant, patient-specific knowledge resources into clinical information systems, helping providers meet their patient care knowledge needs. To support patient-centered care by enabling patients to be partners in the decision-making process.



Implementations/ Case Studies (Actual Users)

Resources

Work Groups

Clinical Decision Support

Education

Relationship to/ Dependencies on, other standards

Links to current projects in development

Product Name - HL7 V3 IG: URL-Based Implementations of the Context-Aware Information Retrieval (Infobutton)

  • HL7 V3 Implementation Guide: URL-Based Implementations of the Context-Aware Information Retrieval (Infobutton) (Topic of Clinical Decision Support Domain)

Type

Informative (IG)

Releases

HL7 V3 INFOBUTTON, R1

  • HL7 Version 3 Implementation Guide: URL-Based Implementations of the Context-Aware Information Retrieval (Infobutton) Domain, Release 1 - 2/1/2007
  • HL7 Version 3 Implementation Guide: URL-Based Implementations of the Context-Aware Information Retrieval (Infobutton) Domain, Release 2 - 6/2/2008
  • HL7 V3 Implementation Guide: URL-based Implementations of the Context-Aware Information Retrieval (Infobutton) Domain; Infobutton Request, Release 3 (Jan 2010)

Summary

The approach outlined in this implementation guide allows Infobutton knowledge requests to be converted represented in a URL-based format. The URL parameter names are derived from element names used in the Infobutton, Knowledge Request XML schema based on a simple set of rules.

Description

This implementation guide provides a specification for URL-based implementations of the Context-aware knowledge retrieval (Infobutton) standard. The intent of this specification is to support the majority of knowledge retrieval implementations that offer URLs as the primary or exclusive communication protocol. The ultimate goal is to enable a stepwise transition from URL-based implementations to a services-oriented approach. This implementation guide was successfully balloted as a Draft Standard for Trial Use in January 2008. Since then, a large number of implementations became available, allowing the specification to be thoroughly validated and tested. In January 2010, an updated specification was balloted and approved as an HL7 International standard.

Business Case (Intended Use, Customers)

  • Vendors: Health Care IT,
  • Vendors: Decision Support

Benefits

The primary goal of this implementation approach is to support compatibility with most EHR and knowledge resource implementations, which exclusively support URLs as a communication protocol.

Implementations/ Case Studies (Actual Users)

This implementation has received wide adoption in the United States. Most large knowledge publishers have implemented this specification. Most of the large EHR vendors also have at least some level of compliance to the URL-based specification. More advanced implementations are available at institutions with home-grown systems, such as Intermountain Healthcare, Partners Helathcare, Columbia University, and the Veterans Health Administration. Yet, more recently, EHR vendors have been starting to provide more advanced knowledge retrieval / infobutton applications.

Resources

Work Groups Clinical Decision Support

Relationship to/ Dependencies on, other standards

  • Infobutton
  • The URL-based representation is derived directly from the Infobutton message model RMIM.

Links to current projects in development


Product Name - HL7 V3 Implementation Guide: Context-Aware Knowledge Retrieval (Infobutton) - Service-Oriented Architecture Implementation Guide

  • HL7 V3 Implementation Guide: Context-Aware Knowledge Retrieval (Infobutton) - Service-Oriented Architecture Implementation Guide, Release 1;

Type

DSTU ballot 2011Jan

Releases

Summary

The present specification complements the previous ones by enabling the implementation of context-aware knowledge retrieval applications through a Service-Oriented Architecture (SOA) based on the SOAP (Simple Object Access Protocol) protocol and the REST (Representational State Transfer) software architecture style.

Description

This specification includes:

  • Functional requirements for SOA context-aware knowledge retrieval implementations;
  • Context-aware knowledge retrieval implementations based on the SOAP protocol;
  • Context-aware knowledge retrieval implementations based on the REST software architecture style;
  • Knowledge response service payload for the SOAP and RESTful implementation options listed above. The knowledge response service payload is an extension over the Atom content syndication standard maintained by IETF.

The DSS-based implementation is a constraint over the HL7 DSS Service Functional Model Specification; Draft Standard for Trial Use - Release 1 and the OMG DSS Technical Specification; Adopted Beta 2 Specification. Version 1.0. The DSS Standard provides a generic framework for the implementation of clinical decision support (CDS) capabilities over a SOA. The advantage of using a common generic framework for CDS capabilities, including but not limited to knowledge retrieval, is that a variety of these capabilities (e.g., drug interaction checking, infobuttons, chronic disease mangement) can be accessed through a common standard mechanism.

An alternative knowledge retrieval implementation is based on the REST software architecture style, in which implementers have the following implementation alternatives:

  • URL knowledge request, according to the URL-Based Implementation Guide; or or XML knowledge request according to the Knowledge Request Standard XML schema.
  • Non-standard HTML knowledge response; or XML knowledge response according to the knowledge response standard defined in the Infobutton SOA implementation guide.

Business Case (Intended Use, Customers)

  • Clinical information system developers
  • Clinical knowledge resource publishers
  • Clinical decision support developers
  • Health care organizations

Benefits

  • Enables a service-oriented implementation approach for context-sensitive knowledge retrieval
  • Enables knowledge resources to produce standard knowledge responses that can be computed and rendered by a receiving application

Implementations/ Case Studies (Actual Users)

Resources

Work Groups Clinical Decision Support

Relationship to/ Dependencies on, other standards

  • Infobutton
  • DSS

Links to current projects in development

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