HL7 Infobutton API Proposal - Health Level Seven International
HL7 Infobutton Standard API Proposal
Prepared By:
Guilherme Del Fiol[1], MD, MS; Roberto Rocha[2], MD, PhD; James J. Cimino[3], MD
(DRAFT December 5th, 2003)
Revisions
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|Date |Comments |
|3-26-02 |Search parameters were classified according to context dimensions wherever applicable |
| |Implied Boolean operators whenever a parameter is repeatable |
| |Section on HTTP request creation and processing was added |
|12-5-03 |Coded concept struture was changed from codedConcept^terminology^surfaceForm to codedConcept^surfaceForm^terminology (to |
| |match HL7’s convention) |
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Contents
1. Introduction 4
1.1 Proposal Background 4
1.2 Scenarios 5
1.3 Requirements/Scope Summary 6
2. Draft proposal 6
2.1 HTTP request parameters 6
2.2 HTTP request formulation and processing 9
2.3 Examples 9
3. References 9
Introduction
1 Proposal Background
Infobutton is a point-of-care information retrieval application that automatically generates and sends queries to digital libraries using patient data extracted from the electronic medical record. Cimino proposed the concept of an Infobutton Manager (IM) as a software component that supports the implementation of Infobuttons in an institution and application independent fashion1. In a nutshell, the IM is called by a Clinical Information System, receiving a set of query parameters, and then generates an HTML document containing a set of natural language queries (clinical questions), each of which is a hyperlink (following the syntax of the target content source) that is used to run a query on the available target content sources. Currently, though, there are two major problems that complicate the integration between Clinical Information Systems and IMs and then between IMs and a set of available content sources (Figure 1):
o Currently, there are several content sources available in the market providing an API that allows Infobutton searches to be performed. On the other hand, each of these APIs has its own proprietary syntax and vocabularies, requiring the development of additional pieces of software for each content source that is to be made available to an Infobutton.
o On the other side, several clinical information systems in the same institution may implement calls to an IM (e.g., Order Entry, Medical Record, Nurse charting application, Lab Results). Since many of these applications are provided by vendors, additional software would be necessary for each IM that the vendor would like to link to.
The focus of this proposal is to address the two problems above by developing a standard for (Figure 2):
o Syntax of the search API calls to be implemented by content resources.
o Syntax of the Infobutton API calls to be implemented by IMs and called by Clinical Information Systems.
[pic]
Figure 1 - Current problem: multiple Clinical Information Systems, multiple IMs, and multiple content sources.
[pic]Figure 2 - Proposed standard
2 Scenarios
Scenario 1 (steps in bold are the ones where the proposal applies)
o A clinical information system (CIS) presents patient data to the user (a medication, for example) with an Infobutton linked to it
o The user clicks on the Infobutton. The CIS calls an IM API passing information about the context (medication, patient age and gender, as well as a username, password, and user institution to authenticate the user against the IM)
o The IM creates an html page with a set of questions (the way the IM creates this page varies from implementation to implementation). The questions contain hyperlinks (should be based on the standard that results from this proposal) to the content sources that most likely will have the answer to each of the questions.
o The user clicks on the hyperlink to one of the available content sources. The user is taken to the content source web site, the query is run and the results are displayed.
Scenario 2 (steps in bold are the ones where the proposal applies)
o A clinical information system (CIS) presents to the user a link to an “electronic resources” page
o The user clicks on that link. The CIS passes to the IM API: user name / password (authenticates against the IM), user role, and institution
o The IM dynamically builds the list of available sources that are applicable to the user’s role and institution and presents it as a set of hyperlinks (again, based on the standard that results from this proposal) to the user.
o The user clicks on one of the hyperlinks and is taken directly to the content source search page (automatically authenticated). The user navigates and builds searches using the content source UI.
3 Requirements/Scope Summary
The main requirements of this proposal are:
1) The standard should be based on HTTP requests (post and get methods).
2) The request should include data required for authentication within the IM and Content Sources
3) Enable queries with different levels of sophistication (e.g., from non-structured free-text searches to structured, coded, context enabled searches)
4) Include context information. The following context dimensions should be part of the standard: age, gender, user role, and associated clinical conditions.
5) Search modifiers (e.g., treatment, diagnosis, complications, prognosis)
Draft proposal
1 HTTP request parameters
The following parameters should be passed in the HTTP request from a Clinical Information System to an IM and from an IM to a Content Source.
|Parameter |Data type |Required |Repeatable |Vocabulary domain |
|username |String |No |No |N/A |
|password |String |No |No |N/A |
|applicationContext |String |No |No |Examples: |
| | | | |Problems, Meds, Labs, Radiology, |
|searchConcept |Coded concept |No |Yes (AND Boolean |Examples: |
| |(codedConcept^surfaceForm^term| |operator is |Problems = MeSH, ICD-9CM, Snomed, DRG |
| |inology) | |implied) |Meds = NDC, FDB, Multum |
| | | | |Lab tests = LOINC |
|Patient context |
|patientAge (in years, to the nearest 1/10th) |Float |No |No |N/A |
|patientGender |String |No |No |Male, Female |
|associatedCondition |Coded concept |No |Yes (AND Boolean | |
| |(codedConcept^surfaceForm^term| |operator is | |
| |inology) | |implied) | |
|User context |
|userRole |String |No |Yes (OR Boolean |Examples: |
| | | |operator is |physician, nurse, medical student, patient, researcher, |
| | | |implied) |pharmacist |
|Care setting context |
|careSetting |String |No |Yes (OR Boolean |Examples: |
| | | |operator is |inpatient, outpatient, emergency room |
| | | |implied) | |
|Institution |String |No |No |N/A |
|Other |
|ContentTarget |String |No |No |Patient vs provider |
|QueryModifier |String |No |No |Subset of MeSH modifiers (subheadings) |
2 HTTP request creation and processing
o Sender should formulate the most complete query as possible (e.g., coded concepts whenever possible, all context dimensions). All coded concepts should be followed by their correspondent surface forms in such a way that the target source can process.
o Target resources should process only the parameters that they understand and are able to process. For example, if a target resource doesn’t support coded search concepts, it should use just the correspondent surface forms to run the queries.
o These directives allow a caller application and an Infobutton manager to create generic queries that would run on any target resource, regardless of the sophistication level of the API in the target resource.
3 Examples
a) Runs a search for D018410 (MeSH), on the problems section of the knowledge source, and with focus on provider content (the fragment in bold is part of the standard, the fragment in normal font is fixed and specific to the knowledge source).
Pneumonia&terminology=MeSH&contentTarget=provider
b) Runs a free-text search for “azythromycin” and “bacterial pneumonia”, for a patient with 75 years old, and with focus on care provider technical content.
Pneumonia&terminology=&searchConcept=&surfaceForm=azythromycin&terminology=&patientAge=75&contentTarget=provider
References
1. Cimino JJ, Li J, Bakken S, Patel VL. Theoretical, Empirical and Practical Approaches to Resolving the Unmet Information Needs of Clinical Information System Users. Proceedings of the American Medical Infomatics Association. 2002; 170-174.
2. Reichert JC, Glasgow M, Narus SP, Clayton PD. Using LOINC to Link an EMR to the Pertinent Paragraph in a Structured Reference Knowledge Base. Proceedings of the American Medical Infomatics Association. 2002; 652-656.
3. Price SL, Hersh WR, Olson DO, Embi PJ. SmartQuery: Context-Sensitive Links to Medical Knowledge Sources from the Electronic Patient Record. Proceedings of the American Medical Infomatics Association. 2002; 627-631.
4. Baorto DM, Cimino JJ. An "Infobutton" for Enabling Patients to Interpret On-line Pap Smear Reports. Proceedings of the American Medical Infomatics Association. 2000; 47-50.
5. Cimino JJ. Linking Patient Information Systems to Bibliographic Resources. Meth Inform Med.1996;122-126.
-----------------------
[1] Intermountain Health Care, Salt Lake City, Utah.
[2] Department of Medical Informatics, Columbia University, New York.
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