Health Level Seven (HL7), a not-for-profit, ANSI-accredited standards development organization with more than 2,300 members, is continually developing a framework and standards for the information exchange, integration, sharing and retrieval to improve clinical practice and the management, delivery, and evaluation of health services.
To standardize integration between clinical decision support (CDS) tools and electronic health records (EHRs), HL7 developed the context-aware knowledge retrieval (Infobutton) standard, which has subsequently been included in the standards certiﬁcation criteria for the meaningful use of EHR systems.
Infobuttons are becoming 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. 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 clinical information system (CIS) and look up the knowledge elsewhere.
Catholic Health Partners (CHP), one of the largest non-profit health systems in the U.S., based in Cincinnati, Ohio, has begun to successfully integrate these Infobuttons into critical areas of the patient chart, including Problem List, Health Maintenance, Clinician Order Entry and Chief Complaint. CHP clinicians can access context-speciﬁc information within seconds, says Stephen Beck, M.D., chief medical informatics officer (CMIO) at CHP.
CHP uses the Verona, Wis.-based Epic for its EHR software, which integrates with UpToDate, a physician-authored CDS tool from the Waltham, Mass.-based Wolters Kluwer Health. Beck says that getting the build completed is the first step, and having an EHR vendor seamlessly incorporate the third-party content allows for far greater efficiency. “Now, with a click, you are able to view the information,” he says. “It’s really as seamless as possible to gather information.”
Beck explains there are occurrences when a doctor may know the diagnosis, but it could be something they don’t treat very often, so he or she is able to use the Infobutton to quickly call up and edit the problem list. “With a simple right click on the problem list of that diagnosis that I’ve already entered, I can get the query on that topic to get as much detail and information as I want about recent treatments and protocols,” he says.
Regarding content, Beck feels the Infobutton is particularly exciting because it facilitates a context-based search for data. He says that based on the content and topic searches he has been able to review, he has found that providers are looking for information that they might not have seen for a while.
“For a new diagnosis or a diagnosis where doctors are looking for the most up-to-date information on treatment, they can get that knowledge immediately when they do those searches off the problem list,” he says. So the question might be, “What is my ideal treatment or what is the latest antibiotic for those given conditions? Rather than typing into a Google search what you can do, this information is sent directly over through a discrete search. Physicians are smart, but they have a limited amount of time to get to bottom of what they’re looking for. One of the things I like to say about providers is this type of tool makes smart providers smarter.”
Undoubtedly, integrating Infobuttons into clinician workflow can present challenges, and Beck says education is the most critical piece. “We have been working proactively when we enroll new users to educate them on the Infobutton and how they can access it. When we roll out new technology, we have instruction sheets available, but with the Infobutton, we have been a bit more proactive because we see it as a big win for the providers.”
That education piece is still ongoing, admits Beck, who knows that being an integrated health system with 15 live inpatient facilities and roughly 1,500 ambulatory providers in about 250 locations can result in a lengthy process.
“Between testing and implementation, the build didn’t take us much time,” Beck says. “The actual training, however, has been the biggest challenge to overcome. Again, we have it available in production for any provider, and even for nurses. I believe that one of our great accomplishments is making nurses aware they can use the Infobutton in their day-to-day care. So when we go back around (to all the locations) for refresher education, the Infobuttons have been a big thing that we’re discussing one-on-one with providers. When we do that, satisfaction tends to improve.”
Concerned about provider satisfaction, Beck says CHP sent out surveys a little more than a year ago to get a better sense on whether or not they knew the functionality was out there, whether it was successful or not, and whether it changed their practice.
The data showed that a lot of the doctors didn’t understand the technology, but for those that did, the satisfaction was high, Beck says. “Further, providers were satisfied with the results they received based on their searches, and the national stats on how this information changes practice was pretty much mimicked by our internal surveys.”
And while Beck admits there are not yet quantifiable results in terms of improved quality of care, he feels that the level of provider satisfaction confirms—or in some cases, can modify—their current treatment plan. “We’re making a judgment, but in theory, it draws to the conclusion that Infobuttons are improving care,” he says. “They provide a great opportunity to match technology with quality and improved outcomes.”