Stream: cds hooks
Topic: CDS HOOKs versus Infobutton... What´s the better choice?
Paulo Rades (Nov 10 2019 at 11:41):
Hello.
I have a question about Infobutton versus CDS-HOOKs.
Both specifications guide how to use an external clinical decision support service, correct?
What are the advantages and disadvantages if I choose CDS-HOOKs over Infobutton?
Does infobutton require an OID plan? Is it harder to deploy than FHIR CDS-HOOKs?
Any colleagues know of any production implementations of CDS-HOOKs?
I'm in this dilemma ... HOOKs or Infobutton?
Thanks for any guidance
Lloyd McKenzie (Nov 10 2019 at 15:32):
@Isaac Vetter
Isaac Vetter (Nov 11 2019 at 04:29):
Hi @Paulo Rades !
Great question, HL7 InfoButton is a wonderful mechanism to integrate and expose a clinical knowledgebase to a clinician. It has the significant advantages of not communicating PHI (and therefore ignoring security complications), it may be a simple HTTP GET with the optional return of mere html. Overall, it's simple and extremely implementable. Generally an InfoButton integration is manually enacted by the clinician (e.g. the provider has to click a button to access the clinical knowledgebase).
Isaac Vetter (Nov 11 2019 at 04:29):
InfoButton provides hypertext to the clinician. Similarly, CDS Hooks can also provide mere markup text to the clinician; however CDS Hooks integrations are specifically triggered based upon clinical workflow actions. Further, a CDS Hooks service can provide markup, a recommended app, or even specific actions -- represented in FHIR.
Isaac Vetter (Nov 11 2019 at 04:29):
Overall, your choice of InfoButton or CDS Hooks should depend upon the needs and goals of your cds. Are you providing a clinical knowledgebase, are you providing an app or discrete order suggestions? Overall, an InfoButton integration many well be simpler and easier ... and less functional than a CDS Hooks service. You should decide between these two mechanisms based upon the needs and capabilities of your cds.
Isaac Vetter (Nov 11 2019 at 04:29):
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Isaac Vetter (Nov 11 2019 at 04:29):
Does that help?
Paulo Rades (Nov 11 2019 at 19:47):
Hello @Isaac Vetter !!!
Yes, your comments were valuable and of great help !!!
Do you know where I can find a tutorial or starting point for implementing Infobutton (in EHR and the knowledge base?)
Our decision was to pilot CDS-HOOKs and now deploy Infobutton, because what we have is a clinical knowledge base.
Thanks for all the help!
Isaac Vetter (Nov 11 2019 at 21:23):
As far as I know, there isn't a publically available InfoButton sandbox. I think these are the right specs. @Guilherme Del Fiol is the primary author of InfoButton and may have additional guidance.
John Moehrke (Nov 11 2019 at 21:29):
IHE has a Profile on InfoButton https://wiki.ihe.net/index.php/Retrieval_for_Clinical_Knowledge
But, no help as there is not a reference implementation. @Keith Boone says it is trivial to implement
Guilherme Del Fiol (Nov 12 2019 at 01:26):
I agree with @Isaac Vetter 's thoughts. A couple more thoughts:
- The Infobutton URL-based implementation guide is required for Meaningful Use certification and has been adopted by certified EHRs. Most of the popular knowledge resources are also compliant with this specification.
- CDS Hooks is a more general and more powerful standard, with several potential advantages over Infobutton. For example, it allows CDS requests to be automatically triggered based on EHR user events versus triggered on user demand. It also allows a CDS service to query additional data that could be used to refine the content included in an infobutton response.
We did test CDS Hooks in the support of infobutton functionality at one of the previous connectathons and it worked fairly well.
@Paulo Rades , If you want to try this out, the service endpoint for our CDS Hooks-based infobutton service is https://dev-service.oib.utah.edu:443/cds-services . This works with the CDS Hooks sandbox both for patient-view and order-select hooks.
The main caveat is that I don't know if any of the mainstream infobutton knowledge vendors support CDS Hooks at the moment.
Guilherme Del Fiol (Nov 12 2019 at 01:28):
By the way, we do have an open source reference implementation: www.openinfobutton.org
I will be happy to provide details if anyone is interested.
Paulo Rades (Nov 18 2019 at 17:18):
@Guilherme Del Fiol : Thanks a lot for the help...
To deploy infobutton version 2.3, should I first deploy from previous versions?
Is there any instruction.doc more current than what is available on the official infobutton website?
Farhan Ahmad (Dec 04 2019 at 03:51):
If you are thinking of using Infobutton I would highly suggest analyzing the target EHRs' implementations of Infobutton because they are all over the place! Furthermore, practically, I have seen very few EHR vendor support staff that is familiar with their Infobutton implementations so it's hard to get support when implementing. Another factor to consider is whether you will be listing the app on the EHR marketplaces because some EHR vendors will not consider apps that do not use SMART, FHIR, CDS Hooks, etc.
Unfortunately, the biggest hurdle with CDS Hooks is, again, the vendor support, but from the EHR vendor investments and commitments so far it seems like the support is coming relatively quickly.
@Guilherme Del Fiol in your Infobutton CDS Hooks wrapper, are you sending all the problems or somehow only one that a clinician might be interested in?
Guilherme Del Fiol (Dec 04 2019 at 17:20):
We are sending the most recent problem. Less than ideal, but sending all problems and getting cards for each of them would probably be worse.
Farhan Ahmad (Dec 06 2019 at 04:08):
I see. Thanks for that info. Agreed, most recent is better than sending all.
Isaac Vetter (Jan 29 2020 at 19:10):
Per a discussion earlier today on the CDS WG call, I copied some of the above conversation and created this page: CDS Hooks vs InfoButton: Which should I use? on the CDS confluence space.
@Guilherme Del Fiol - would you review/edit as appropriate?
@Bryn Rhodes - fyi and, is this what you had in mind?
Bryn Rhodes (Jan 30 2020 at 19:47):
@Isaac Vetter , yes, that's great, thank you for putting that together!
Last updated: Apr 12 2022 at 19:14 UTC
