EHR plug-and-play capabilities emerging from SMART on FHIR apps
Have a great idea for a new way to interact with EHR data? An emerging platform enables you to build your own app or use another from an open community.
The name says it all when it comes to an open, standards-based app platform called SMART — Substitutable Medical Applications & Reusable Technologies.
The SMART project was started in 2010 with a four-year, $15 million grant from the Office of the National Coordinator for Health IT, in broad terms to build an app platform for healthcare.
"The idea is that we wanted to support apps that could be chosen by clinicians. The app could plug into their existing EHR system, and then if a better app came along, you could get rid of the old one and swap the new one in," explained Josh Mandel of Boston Children's Hospital, the architect for the collaborative SMART platform team.
"Over the last year and a half, we've been building out a set of open standards to do it," he continued. Those standards include OAuth specifications for security and FHIR for clinical data exchange.
Mandel led a demonstration of SMART on FHIR capabilities at the HIMSS15 Interoperability Showcase on Monday. Representatives from Duke Medicine, Cerner and athenahealth also participated in showing a set of EHR apps that could plug-and-play interoperably, integrated with clinical workflow.
All the apps use the same underlying set of platform specifications.
The SMART on FHIR specs provide access to a secure patient context in which health care organizations or developers can access discrete clinical data — things like medications, problems, lab results, immunizations and patient demographics — and access those through a well-defined web API, with vocabularies that are specified ahead of time.
"The big message about a platform like this is that if you've got someone who has a bright idea for a better way to interact with the data in an EHR system, you don't need to wait for an EHR vendor to adopt that idea," said Mandel. "You can go and build it yourself."
Current apps up and running on the platform include Crimson Care Manager from The Advisory Board, which centralizes where care management decisions get made and allows sharing of care plans; Meducation from Polyglot, which translates patient-facing medication instructions into 16 languages; and a point-of-care medication adherence app from Surescripts, which helps ensure better communication between pharmacy benefit management companies and clinicians (e.g., a contraindication alert for a specified drug).
Mandel also highlighted an innovative rheumatology app from the Geisinger health system. It pulls structure data from the EHR for patient rheumatology workflow and guides physicians through detailed data collection. At the end of that process, it produces a ready-to-go clinical note with exam findings that can be posted back to the EHR.
"This is one of the first examples of an application that can not only read data from the EHR using the SMART on FHIR interface, but it can begin to write data back into the EHR as well. We're very excited about digging in more deeply there," concluded Mandel.