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The HL7 Clinical Decision Support sponsors both the HL7 InfoButton and CDS Hooks specifications. Both of these specifications enable the real-time, in-workflow use of external clinical decision support service. When does it make sense to use one versus the other?

HL7 InfoButton

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).

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.

InfoButton provides hypertext to the clinician.

CDS Hooks

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. 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.

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.

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