Architecture for a Web-Based Clinical Information System that Keeps the Design Open and the Access Closed James J. Cimino, Soumitra Sengupta, Paul D. Clayton,

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Presentation transcript:

Architecture for a Web-Based Clinical Information System that Keeps the Design Open and the Access Closed James J. Cimino, Soumitra Sengupta, Paul D. Clayton, Vimla L. Patel, Andre Kushniruk, Xiaoli Huang - Department of Medical Informatics, Columbia University Centre for Medical Education, McGill University

Task Create a secure Web-based clinical information system interface for patients (PatCIS) Create an environment that will facilitate the rapid prototyping and simplified integration that is conducive to testing new ideas

Open Architecture Simplify integration Take care of security tasks Track usage Support evaluation

Closed Access Authorization: –One-user, one-patient authorization Authentication: –User ID and password –SecurID token –Secure Socket Layer encryption –Single-use "log on" form –Session ID –Short time-out –Long time-out –Log out

User Interface Design Netscape Navigator 4.x Constant set of main function classes "Sub-buttons" are customizable Low-tech, minimal “flash”

Data Entry Review Advice Education Comments Help Logout patcis.cgi Web Server Web Browser

Data Entry Review Advice Education Comments Help Logout Java script Vital SignsBlood Sugar Data Entry patcis.cgi Web Server Web Browser

Data Entry Review Advice Education Comments Help Logout Vital SignsBlood Sugar Data Entry patcis.cgi Web Server Web Browser Session Registry

Data Entry Review Advice Education Comments Help Logout Vital SignsBlood Sugar Data Entry patcis.cgi Web Server Web Browser Session Registry Request Password

Data Entry Review Advice Education Comments Help Logout Vital SignsBlood Sugar Data Entry patcis.cgi Web Server Web Browser Session Registry Re-enter Password

Data Entry Review Advice Education Comments Help Logout Vital SignsBlood Sugar Data Entry patcis.cgi Web Server Web Browser Session Registry Usage Log Internet CGI

Data Entry Review Advice Education Comments Help Logout Vital SignsBlood Sugar Data Entry patcis.cgi Web Server Web Browser Usage Log Internet Link CGI

Data Entry Review Advice Education Comments Help Logout Vital SignsBlood Sugar Data Entry patcis.cgi Web Server Web Browser Internet Link CGI

Data Entry Review Advice Education Comments Help Logout Vital SignsBlood Sugar Data Entry patcis.cgi Web Server Web Browser Internet Javascript Link CGI

Data Entry Review Advice Education Comments Help Logout Vital SignsBlood Sugar Data Entry patcis.cgi Web Server Web Browser Internet Link CGI

Data Entry Review Advice Education Comments Help Logout Java script Vital SignsBlood Sugar Data Entry patcis.cgi Web Server Web Browser Session Registry Re-enter Password Usage Log Internet Javascript Link CGI 11

Integration of Components Applications linked to "Sub-Buttons" Infobuttons inserted into applications

The Rules 1 - Javascript function handles HREF links 2 - "CGI" hidden variable passed to patcis.cgi 3 - Hidden variables: MRN, USER, SESSION 4 - SYSLOG if accessing clinical database 5 - Open new window where appropriate 6 - Include return code in dynamic documents

Hypertext Links in PatCIS Instead of: Click Here Use: Click Here

CGI Calls in PatCIS Instead of: Use:

Exploitation of Web Resources Patient education sites Newsgroups –Diabetes –PatCIS users Targeted resources –Pubmed –Micromedex Decision support systems –Body mass index calculator –Cholesterol guideline

Evaluation Log-on "Questionnaire of the Day" Usage log Phone interviews Usability laboratory

Experience with Our Design Application integration is easy Maintenance is nontrivial Major revision: blocking parts of the EMR

Mission Accomplished Open Architecture - Integration is simple - Security tasks managed - Tracks usage - Supports evaluation Closed Access - Authorization: modified by MD - Security: continuous authentication

Columbia University NLM Postdoctoral Fellowships in Medical Informatics James Cimino: Advanced Degrees in Medical Informatics Stephen Johnson:

Columbia University Faculty Position George Hripcsak, MD Department of Medical Informatics DAP Fort Washington Avenue New York, NY Columbia University is an equal opportunity and affirmative action employer