EHR Plug And Play Possible Thanks To FHIR

By Megan Williams, contributing writer

Open source EHR technology might not be very far away. The SMART project (started in 2010 with a $15 million grant from the Office of the National Coordinator for Health IT, ONC) has resulted in an open, standards-based app platform. The acronym “SMART” stands for “Substitutable Medical Applications & Reusable Technologies.” Josh Mandel of Boston Children’s Hospital, the architect for the collaborative platform, explains the thought process behind SMART, “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. Over the last year and a half, we've been building out a set of open standards to do it.”

SMART At HIMSS15
Mandel demoed SMART on the FHIR standards framework at the HIMSS15 Interoperability Showcase. He was accompanied by representatives from athenahealth, Duke Medicine, and Cerna, all of whom presented EHR apps featuring plug-and-play interoperability that integrated with clinical workflows. All of the apps share the same set of platform specifications.

As Healthcare IT News reports, the SMART on FHIR specs give developers and healthcare organizations access to a secure patient context where they can access sensitive clinical data — that includes anything from lab results, to medications, to patient demographics. All this is done through a well-defined web API with pre-specified vocabularies.

Mandel continued, “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. You can go and build it yourself.”

Current Apps
The platform currently features apps including:

• Crimson Care manager from The Advisory Board, an app that centralizes management decisions and allows care plan sharing
• Meducation by Polyglot, an app that translates patient-facing medication instructions into 16 languages
• a point-of-care medication adherence app by Surescripts designed to improve communication between pharmacy benefit management companies and clinicians.

Mandel also made sure to emphasize a rheumatology app from the Geisinger Health System that pulls structured EHR data and guides physicians through detailed data collection. After that’s complete, it creates a complete clinical note including exam findings that can be added 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.”

Going Deeper
To learn more about FHIR and the potential it has for healthcare data and communication, please read “FHIR Could Change How Health Data Is Transferred.”