Context-Aware Knowledge Delivery into Electronic Health Records

A main cause of errors in the health care system is gaps in information available to providers, particularly at the point of care. When providers have access to the best and most up-to-date information at the time when that knowledge is needed, they can give patients optimal care. Such information is also essential to clinicians presenting care options and enables patients and providers to make better decisions.

This project identified clinicians’ information needs and designed, developed, implemented, and evaluated a knowledge-delivery prototype to help clinicians meet those needs.

The specific aims of this project were to:

• Build a knowledge base of providers’ knowledge needs.
• Design and develop a scalable, standards-based knowledge-delivery service.
• Conduct a pilot evaluation of a prototype knowledge-delivery tool that automatically summarizes contextually relevant information from multiple online resources.

The project team conducted a systematic literature review of MEDLINE, CINAHL, and Scopus on clinician’s information needs. The review was guided by four primary questions: how often do clinicians raise information needs; how often do clinicians pursue information needs they raise; how often do clinicians succeed at meeting the information needs that they pursue; and what types of questions are asked? The project team observed the care of complex older adults by audio-recording providers during all activities related to a patient visit, including preparing for a visit, interacting with the patient, and concluding the visit. Following the visits, clinicians were interviewed regarding information needs that had arisen. The literature review showed that out of 20 patients seen in a primary care practice, clinicians raise 12 information needs, pursue six, and successfully meet four of the needs. In the care of complex aging patients, clinicians raised two information needs per patient seen and 60 percent of these needs were not met.

This work led to the development of the HL7 Context-Aware Knowledge Retrieval Standard, also known as the Infobutton Standard, which enables the integration between online health knowledge resources and EHR systems. A cross-sectional study was conducted to evaluate the challenges, strengths, limitations, and uptake of this standard. In order to help disseminate Infobutton capabilities in health care organizations, the project team developed OpenInfobutton, a standards-based, open-source Web service. Finally the team developed and evaluated a prototype knowledge-delivery intervention that automatically summarizes contextually relevant information from multiple online resources.

The HL7 Infobutton Standard has been widely adopted and became a requirement for EHR certification in the Meaningful Use Program. OpenInfobutton has been deployed at several health care organizations, including Intermountain Healthcare, the Veterans Health Administration, the University of Utah, and Duke University.