Architecture for a Web-Based Clinical Information System that Keeps the Design Open and the Access Closed

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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

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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

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User Interface Design

• Netscape Navigator 4.x
• Constant set of main function classes
• "Sub-buttons" are customizable
• Low-tech, minimal flash

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Web Server
Web Browser
patcis.cgi
Logout
Data Entry
Review
Advice
Education
Comments
Help
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Web Server
Web Browser
patcis.cgi
Data Entry
Java script
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
Review
Advice
Education
Comments
Help
10
Web Server
Web Browser
patcis.cgi
Data Entry
Session Registry
Vital Signs
Blood Sugar
Logout
Data Entry
Request Password
Review
Advice
Education
Comments
Help
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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
12
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
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Web Server
Web Browser
patcis.cgi
Data Entry
Vital Signs
Blood Sugar
Logout
Data Entry
Review
Advice
Education
Usage Log
CGI
Link
Comments
Help
CGI
Internet
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Web Server
Web Browser
patcis.cgi
Data Entry
Vital Signs
Blood Sugar
Logout
Data Entry
Review
Advice
Education
CGI
Link
Comments
Help
Internet
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Web Server
Web Browser
patcis.cgi
Data Entry
Vital Signs
Blood Sugar
Logout
Data Entry
Review
Advice
Education
CGI
Link
Comments
Help
Javascript
Internet
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Web Server
Web Browser
patcis.cgi
Data Entry
Vital Signs
Blood Sugar
Logout
Data Entry
Review
Advice
Education
CGI
Link
Comments
Help
Internet
17
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
Usage Log
CGI
Link
Comments
Help
8
9
10
11
Javascript
CGI
Internet
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Integration of Components

• Applications linked to "Sub-Buttons"
• Infobuttons inserted into applications

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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

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Hypertext Links in PatCIS

• Instead oflta href"mydoc.html"gtClick Herelt/agt
• Uselta href'javascriptparent.titleWin.document.
  FF.CGI.value"mydoc.html"parent.titleWin.docume
  nt.FF.submit()'gtClick Herelt/agt

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CGI Calls in PatCIS

• Instead ofltFORM action"myapplication.cgi"
  name"Click Here" method"post"gtltINPUT
  type"SUBMIT" name"SUBMIT" value"My
  Button"gtlt/FORMgt
• UseltFORM action"patcis.cgi" name"Click Here"
  method"post"gtltINPUT type"SUBMIT" name"SUBMIT"
  value"My Button"gtltINPUT type"HIDDEN"
  name"CGI" value"myapplication.cgi"gtltINPUT
  type"HIDDEN" name"USER" value"sandcar"gtltINPUT
  type"HIDDEN" name"MRN" value"3131313"gtltINPUT
  type"HIDDEN" name"SESSION" value"349860623"gtlt/
  FORMgt

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Exploitation of Web Resources

• Patient education sites
• Newsgroups
• Diabetes
• PatCIS users
• Targeted resources
• Pubmed
• Micromedex
• Decision support systems
• Body mass index calculator
• Cholesterol guideline

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Evaluation

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

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Experience with Our Design

• Application integration is easy
• Maintenance is nontrivial
• Major revision blocking parts of the EMR

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Mission Accomplished

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

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Columbia University NLM Postdoctoral Fellowships
in Medical Informatics James Cimino
212-305-8127 James.Cimino_at_columbia.edu. Adva
nced Degrees in Medical Informatics Stephen
Johnson 212-305-1858 Stephen.Johnson_at_columb
ia.edu http//www.cpmc.columbia.edu.
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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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