'Any system that wants to implement these open specs can run these apps in any way they like'

Public APIs getting ready for prime time

By Neil Versel
11:15 AM
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At the American Medical Informatics Association's annual symposium today, developers and backers of public application programming interfaces talked about how the standard could speed interoperability with add-on apps to enterprise EHRs, and help make those bulky systems more nimble.

In a recent draft of its 10-year roadmap toward interoperability, the Office of the National Coordinator for Health IT adopted a recommendation from its JASON task force that Stage 3 of meaningful use include public APIs. The first such API likely would be Fast Healthcare Interoperability Resources, or FHIR (pronounced "fire"), a standard being developed by Health Level Seven International.

[See also: Interoperability's 'game-changer']

On Tuesday at AMIA's annual conference, fans of FHIR discussed a federally funded test implementation of the standard, and what it might mean for moving the needle on interoperability.

Widespread adoption of FHIR could make the EHR a "potentially open platform," much like Facebook or Salesforce.com, said David McCallie Jr., MD, director of the Cerner Medical Informatics Institute, and a co-chair of the ONC JASON task force. "This notion of a platform is something we’re very comfortable with now."

[See also: Go easy on Stage 3 MU, says JASON group]

Apps built on an open API would extend the platform, he explained.

"It's also, for this crowd, a new channel," McCallie said to this meeting of medical informatics professionals. It would be an alternative to manipulating the source code of an EHR, which he said few CMIOs get to do these days anyway.

McCallie quoted the CEO of an unnamed integrated delivery network  one he said was not a Cerner customer  who said he wanted an open, extensible platform because EHRs were becoming commodities. If a system vendor doesn't work out, proprietary APIs can cause "vendor entanglement" McCallie said, in what may have been a dig at Epic Systems.

McCallie and other panelists then demonstrated "SMART on FHIR," a vendor-neutral implementation developed with the help of a $15 million ONC Strategic Health IT Advanced Research Projects, or SHARP, grant.

The SMART – for Substitutable Medical Apps and Reusable Technology – platform architecture consists of a user interface to "allow 'iPhone-like substitutability for medical apps based upon shared basic components," according to the project's website, as well as a collection of scaleable data capture, storage, retrieval and analytics apps. Apps can launch directly from an EHR when a clinician clicks on an alert.

"Current app stores are not that good for healthcare," McCallie said of public ones such as iTunes and Google Play. SMART on FHIR is meant to replicate those stores, but with a much narrower focus.

"Any system that wants to implement these open specs can run these apps in any way they like," explained Josh Mandel, MD, lead architect for the SMART Platforms team at Boston Children Hospital's and Harvard Medical School.