Tuesday, 13 February 2007

AJAX and Healthcare IT

One of the most important factors in driving users towards higher use of clinical systems is providing an effective user interface. Specifically for web based clinical applications it is quite a challenge to provide an effective user interface. AJAX (Asynchronous JavaScript and Extensible Markup Language) is emerging as an effective solution in providing such a interface

For starters Ajax lets web pages feel active and interactive in real time by exchanging small packets of data behind the scenes so that the entire web page doesn't have to be reloaded each time the user requests new information. Ajax makes web-based applications look and act like desktop applications. Ajax isn’t a technology. It’s really several technologies, each flourishing in its own right, coming together in powerful new ways. Ajax incorporates:

• standards-based presentation using XHTML and CSS;
• dynamic display and interaction using the Document Object Model;
• data interchange and manipulation using XML and XSLT;
• asynchronous data retrieval using XMLHttpRequest;
• and JavaScript binding everything together.

For a more detailed understanding of AJAX Refer to this article http://adaptivepath.com/publications/essays/archives/000385.php

In healthcare IT AJAX can play a big role in simplifying User Interface workflows for end users. For example typically in existing applications scheduling of clinicians in an enterprise requires the clinician details to be searched before slots are associated for performing activities like procedures in different departments. AJAX allows auto-completion of data and it could aid in typing in clinicians names, procedure names, department names instead of remembering the codes associated with it. No popup listing and scanning down a list of values or searching is required.

It is typical while working in departments like Mental and Psychiatric departments large amounts of clinical data needs to be captured in one single form. It is often quite frustrating in web based applications after filling in the data accidental clicking on the wrong icon or page link causes complete loss of data. We can using AJAX we can to persist the values of form fields into the HTTPSession step by step, just incase someone clicks off their page by mistake or loses their work.

AJAX can also be used to navigate huge procedures tree, while retrieving the required element. This enabled us to deliver a much better user interface and lessens the data entry time.

One of the most exciting uses of AJAX can be for developing a UI for quick browsing and selecting of clinical codes. SNOMED-CT is emerging worldwide as the most dominant clinical coding standards. At the moment, most SNOMED-CT browsing is done using a free (but not open source) Visual Basic GUI application called CLUE (see http://www.clininfo.co.uk/clue5/index.htm). Ask any clinician or any organization where CLUE is used they can tell the issues associated with it. AJAX can be used to provide a Web-based SNOMED-CT browser/search facility to provide good interactivity in letting the clinicians browse and choose the correct SNOMED concept. The provision of SNOMED-CT look-up facility using AJAX can be used for both open source and closed source clinical applications. An AJAX based SNOMED browser will enable distribution of codes through a central service or access clinical codes locally. This will enable updating of clinical codes in local systems automatically either by client side polling or by user invoked requests.

One of the major hindrances of a nation wide EHR is the inability to provide an affordable application with a user interface relevant to organizations of different size ranging from a Family Physician office to a Big General Hospital. A web based solution centrally hosted solution is the oft quoted answer for this but it is a known fact that web based solution negates the rich experience of a local client apart from not catering to an individual organization needs. AJAX makes these web based user interfaces much more interactive without requiring the typical submit/post/redraw round-trip of an HTML interface. AJAX uses the “The Web as Platform" paradigm and allows Ajax desktops or personalized UI suiting to the organization.

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