EHR Interoperability 

Data interoperability has become increasingly important as the healthcare industry further moves toward a value-based care model. As patients demand more consumer-friendly, personalized, and data-driven experiences, being able to share clinical records and other patient data among providers and across different systems is key to helping meet the goals of cost-efficient care and better patient outcomes. 

Lucienne Marie Ide, M.D., PH.D., founder and CEO, Rimidi, a leading clinical management platform designed to optimize clinical workflows, enhance patient experiences and achieve quality objectives, has an extensive background with national health IT systems, including the leading Electronic Health Records company, Epic, and has a passion for using data to help tell patients stories and improve clinical care. 

Dr. ide took the time to respond to several questions.

1)  Can you explain the evolution of SMART-on-FHIR technology and where it stands today?

When the 2009 Health Information Technology for Economic and Clinical Health (HITECH) Act was signed into law, it ushered in a widespread and rapid adoption of EHRs in hospitals across the country. While the adoption of EHRs allowed for more patient data than ever before, this also created information silos.

As a first step to break down these silos, Fast Interoperable Health Resources (FHIR) was introduced in 2011 as a data standard that defines the structure of health data in transit. FHIR was designed to ensure that EHRs and third-party applications could speak the same language so that health data could flow more freely and securely between solutions. 

As FHIR was accelerating, the Office of the National Coordinator for Health Information Technology provided funding for a $15 million grant to Boston Children’s Hospital to develop a standard framework for interchangeable healthcare applications, Substitutable Medical Applications, Reusable Technologies (SMART). This defined how users would authenticate to third party applications in the EHR context and how those applications would be visualized. In 2013, the SMART and FHIR initiatives joined forces and SMART-on-FHIR was born. 

Together, SMART-on-FHIR created an open, free, standards-based application programming interface (API) that facilitates the development of applications that can run anywhere within the healthcare system, paving the way for the EHR app marketplace we know today.

Looking forward, SMART-on-FHIR will continue to be the driver for the healthcare industry’s continued shift toward value-based care, in part due to its ability to provide more pathways to integration where user experiences, not just discrete data, can be shared across systems, and thus enabling quicker and more precise implementations.

2) What is your definition of interoperability, and why is it necessary as the healthcare industry continues to evolve?

There are many varying definitions of interoperability. But for me, interoperability is the ability to speak the same language across different applications such that data can flow freely and efficiently. With the complexity of healthcare, most patients receive care across multiple provider organizations and those organizations use multiple technologies in the delivery of care. To make this ecosystem of EHRs, clinical applications, various specialists and generalists work, frictionless data exchange is a must. Otherwise, everyone only knows a portion of the patient story or has access to a fraction of the technology that could benefit patient care.    

3) Why will SMART-on-FHIR be the catalyst for growth in the healthcare app market? What use cases can it be used for?

With technological advances in healthcare and rules mandating integration and access to information, like the Centers for Medicare & Medicaid Services Interoperability and Patient Access final rule, even more apps will be developed to ensure patients can make informed healthcare decisions, while simultaneously minimizing reporting burdens on affected healthcare providers and payers. 

SMART-on-FHIR facilitates the development of applications for a variety of different clinical use cases that can run anywhere in the health system within existing EHR workflows. SMART-on-FHIR apps have a range of use-cases. I think the most exciting are clinical applications that enable better use of data both from the EHR and outside sources like connected devices. For example, with a SMART-on-FHIR-enabled patient survey app, clinicians can collect and interpret Patient Reported Outcomes data in their existing workflow, as opposed to the paper surveys we all receive at the doctor now — which may or may not ever get documented in the digital patient chart.

SMART on FHIR apps can focus on specific clinical conditions like diabetes and provide a single interface in the workflow for clinical data, patient generated health data, and advanced decision support.

4) Describe Rimidi’s composable platform and how it utilizes SMART-on-FHIR technology to achieve optimal patient outcomes and improve clinical workflows. 

SMART-on-FHIR integration enables the Rimidi clinical management platform to work within our clients’ existing EHR workflow and integrate in as little as 1-2 weeks — much faster than a traditional HL7 integration. Specifically, the Rimidi platform:

  • Embeds clinical decision support cards that are easily configurable and mapped to national practice guidelines, protocols, remote monitoring alerts, and more.
  • Creates a comprehensive snapshot of cardiometabolic patients, allowing hospitals and health systems to better manage their population with multiple comorbid chronic conditions.
  • Leverages data from remote patient monitoring devices that are combined with existing clinical data and weighed against provider and patient designated targets to drive clinical insights and actions.
  • Sends questionnaires to patients on their device in real time or in an event-driven context, allowing providers to view responses and incorporate them into the clinical notes, allowing for more personalized patient care.

5) What are the benefits of CDS Hooks, especially as it relates to remote patient monitoring (RPM) continuous glucose monitoring (CGM), and patient-reported outcomes (PRO)?

CDS Hooks is a new specification from SMART-on-FHIR, which allows for information, insights and actions to be driven in the proper patient context at the proper time within a clinician’s EHR workflow. With this, EHR-only users can have insights relevant to the clinical situation and within their EHR workflow based on data sourced outside of it.

FHIR-based APIs enable third-party apps and decision support tools to ingest data from sources other than the EHR like RPM, CGM, and PROs data. The CDS Hooks specification is what enables the insights from these previously disparate data sources to be delivered directly within EHR workflows.