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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

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  1. Architecture for aWeb-Based Clinical Information System that Keeps the Design Openand 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

  2. 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

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

  4. 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

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

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

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

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

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

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

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

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

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

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

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

  16. Web Server Web Browser 2 patcis.cgi 4 3 Data Entry Session Registry Java script Vital Signs Blood Sugar Logout 5 Data Entry Re-enter Password 1 Review 6 Advice 7 Education CGI Usage Log Link Comments Help 8 9 10 11 Javascript CGI Internet

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

  18. 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

  19. Hypertext Links in PatCIS Instead of:<a href="mydoc.html">Click Here</a> Use:<a href='javascript:parent.titleWin.document.FF.CGI.value="mydoc.html";parent.titleWin.document.FF.submit();'>Click Here</a>

  20. CGI Calls in PatCIS Instead of:<FORM action="myapplication.cgi" name="Click Here" method="post"><INPUT type="SUBMIT" name="SUBMIT" value="My Button"></FORM> Use:<FORM action="patcis.cgi" name="Click Here" method="post"><INPUT type="SUBMIT" name="SUBMIT" value="My Button"><INPUT type="HIDDEN" name="CGI" value="myapplication.cgi"><INPUT type="HIDDEN" name="USER" value="sandcar"><INPUT type="HIDDEN" name="MRN" value="3131313"><INPUT type="HIDDEN" name="SESSION" value="349860623"></FORM>

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

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

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

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

  25. Columbia University NLM Postdoctoral Fellowships in Medical Informatics James Cimino: 212-305-8127 James.Cimino@columbia.edu. Advanced Degrees in Medical Informatics Stephen Johnson: 212-305-1858 Stephen.Johnson@columbia.edu http://www.cpmc.columbia.edu.

  26. Columbia University Faculty Position George Hripcsak, MD Department of Medical Informatics DAP-1310 161 Fort Washington Avenue New York, NY 10032 Columbia University is an equal opportunity and affirmative action employer

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