title: Context-sensitive decision support (infobuttons) in electronic health records: a systematic review.
abstract: OBJECTIVE
  Infobuttons appear as small icons adjacent to electronic health record (EHR) data (e.g., medications, diagnoses, or test results) that, when clicked, access online knowledge resources tailored to the patient, care setting, or task. Infobuttons are required for "Meaningful Use" certification of US EHRs. We sought to evaluate infobuttons' impact on clinical practice and identify features associated with improved outcomes.
  
  
  METHODS
  We conducted a systematic review, searching MEDLINE, EMBASE, and other databases from inception to July 6, 2015. We included and cataloged all original research in any language describing implementation of infobuttons or other context-sensitive links. Studies evaluating clinical implementations with outcomes of usage or impact were reviewed in greater detail. Reviewers worked in duplicate to select articles, evaluate quality, and abstract information.
  
  
  RESULTS
  Of 599 potential articles, 77 described infobutton implementation. The 17 studies meriting detailed review, including 3 randomized trials, yielded the following findings. Infobutton usage frequency ranged from 0.3 to 7.4 uses per month per potential user. Usage appeared to be influenced by EHR task. Five studies found that infobuttons are used less often than non-context-sensitive links (proportionate usage 0.20-0.34). In 3 studies, users answered their clinical question in > 69% of infobutton sessions. Seven studies evaluated alternative approaches to infobutton design and implementation. No studies isolated the impact of infobuttons on objectively measured patient outcomes.
  
  
  CONCLUSIONS
  Weak evidence suggests that infobuttons can help providers answer clinical questions. Research on optimal infobutton design and implementation, and on the impact on patient outcomes and provider behaviors, is needed.
authors: Knowledge Delivery Center, Mayo Clinic College of Medicine, Rochester, MN, USA.|Mayo Clinic Online Learning, Mayo Clinic College of Medicine, Rochester, MN, USA.|Department of Medicine, Mayo Clinic, Rochester, MN, USA.
authors: David A
authors: DA
authors: Cook
authors: Department of Medicine, Mayo Clinic, Rochester, MN, USA.
authors: Miguel T
authors: MT
authors: Teixeira
authors: Department of Biomedical Informatics, University of Utah, Salt Lake City, UT, USA.
authors: Bret Se
authors: BS
authors: Heale
authors: Informatics Institute, School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA.
authors: James J
authors: JJ
authors: Cimino
authors: Department of Biomedical Informatics, University of Utah, Salt Lake City, UT, USA.
authors: Guilherme
authors: G
authors: Del Fiol
mesh_terms: D001292:Attitude to Computers; D020000:Decision Support Systems, Clinical / Q000706:statistics & numerical data; D057286:Electronic Health Records; D016247:Information Storage and Retrieval / Q000379:methods; D014584:User-Computer Interface
keywords: clinical; decision support systems; hospital information systems; infobutton; medical informatics applications