One aim of the 21st Century Cures Act recently passed by Congress is to make digital health data more accessible, emphasizing the use of APIs in healthcare to increase EHR interoperability and improve patient records matching. Aligning closely with the SMART Health IT focus on creating a app ecosystem for healthcare, the act states that a year from now, open APIs will be necessary for EHR system certification.
“… that the entity has in place data sharing programs or capabilities based on common data elements through such mechanisms as application programming interfaces without the requirement for vendor-specific interfaces;
[…] publish application programming interfaces and associated documentation, with respect to health information within such records, for search and indexing, semantic harmonization and vocabulary translation, and user interface applications; and
[…] demonstrate to the satisfaction of the Secretary that health information from such records are able to be exchanged, accessed, and used through the use of application programming interfaces without special effort, as authorized under applicable law.”
“As the country orients toward alternative payment models, measuring individual health outcomes and disparities among vulnerable populations is crucial for driving innovation toward outcomes that matter most to individual lives.”
“Simply building APIs into EHR products so that data can be called by external applications will improve the current state. But the most important goal is that—as in an “app store”—an app written once will be able to run anywhere in the health care system and that a decision support service will be able to be created once and be called from any care point in the system. “
Read the Discussion Paper On Information Technology Interoperability and Use for Better Care and Evidence
President Obama’s Cancer Panel defines connected health as “the use of technology to facilitate the efficient and effective collection, flow, and use of health information.” In their 2016 report to the President, the panel highlights the benefits of using the SMART On FHIR open-access API for development of health applications.
“The Precision Cancer Medicine (PCM) app was designed to present patients’ genomic test results to oncologists in real time as a component of clinical practice, as well as provide links to external knowledge bases that otherwise would be unavailable through the native EHR system. PCM was piloted at Vanderbilt University and integrated into that institution’s EHR system. However, because the app was developed based on an open-access API (Substitutable Medical Applications and Reusable Technology, or SMART) and uses the emerging HL7 Fast Healthcare Interoperability Resources standard, it could easily be deployed for other compatible EHR systems.”
“The Panel urges all stakeholders—health IT developers, healthcare organizations, healthcare providers, researchers, government agencies, and individuals—to collaborate in using connected health to reduce the burden of cancer through prevention and improve the experience of cancer care for patients and providers.”
Improving Cancer-Related Outcomes with Connected Health: A Report to the President of the United States from the President’s Cancer Panel. Bethesda (MD): President’s Cancer Panel; 2016.
As part of a broader survey of 1,300 physicians covering digital health tools, the SMART Health IT Project and the American Medical Association collaborated on a set of questions to better understand how providers wish to discover, evaluate and purchase apps that connect with their EHR system.
One important finding for app creators is that 81% of physicians ranked integration with their EHR as a very important or important requirement for digital health tools. Additionally, more than half of the physicians indicated that they are extremely likely or very likely to purchase apps that extend their EHR system’s capabilities and securely integrate into the EHR workflow.
We’re looking for a senior developer to work full time on the open source SMART on FHIR project!
The Boston Children’s Hospital Computational Health Informatics Program (http://www.chip.org), a Harvard Medical School affiliate, is seeking an experienced full stack web developer to join the SMART Health IT team.
The platform is REST-based, incorporates OAuth2 and related technologies on the security layer and can use JSON and XML serialization formats. The team you will be joining writes services, applications and frameworks for web and mobile platforms in various programming languages and likes to give the latest and greatest technology a try.
The ideal candidate:
Has a Bachelors or Masters in Computer Science or equivalent industry experience, plus at least 3 years of experience in real-world software development
Lives and breathes full stack web development using open-source development and tools, can discuss the pros and cons of various web application toolkits
Writes quality code: source control, testing, and clear documentation are all musts
Has experience with at least one web framework
Is comfortable doing basic system administration in a Linux environment
Bonus points if:
You have experience with Python or the JVM
You’re familiar with both statically and dynamically typed languages
You can share a link to your work on GitHub
Please submit a cover letter describing your background, a resume and a code sample that represents your best work to: firstname.lastname@example.org
Today is the last day of the comment period for CMS’s MACRA and MIPS proposed rules. Below, we share a comment we submitted promoting the use of APIs for patient and provider access alike.
CMS states that priorities for “Advancing care information” are patient engagement, electronic access, and information exchange:
> These measures have a focus on patient engagement, electronic
> access and information exchange, which promote healthy behaviors
> by patients and lay the ground-work for interoperability.
… but nothing in CMS’s proposed MIPS measurement strategy in fact places an emphasis on these goals. Consider patient API access through third-party apps, which falls squarely in the intersection of these focus areas. Under the proposed scoring rubrics, a provider can earn 100% full marks on “advancing care information” while making API access available only to a single patient!
CMS should take actions to ensure that the “priority goals” are in fact met. One clear way to fix this issue would be to define a scoring function where patient API access is a hard line. For example, MIPS could require providers to offer API access to all patients in order to be eligible for the “base score”. This special-priority treatment is already given to one objective (“Protect Patient Health Information”); it should be extended to other priority items including patient API access. Otherwise, these “priorities” can, in fact, be entirely ignored by MIPS EPs, given the elaborate structure of bonus points and the “ceiling effect” of earning just 100 points out of a possible 131 points.
CMS should also add an explicit requirement for APIs that be used by healthcare providers as well as patients. Current meaningful use requirements focus on patient API access; MACRA should expand access to clinicians as well. To be concrete in advancing interoperability, MIPS could award points for clinicians who run at least one third party application against their EHR data (for example, see the SMART on FHIR open app platform specifications at http://docs.smarthealthit.org/) and at least one third party decision support service (for example, see the SMART CDS Hooks specifications at http://cds-hooks.org/).
Following a competitive process, the U.S. Department of Health and Human Services, Office of the National Coordinator for Health Information Technology has awarded SMART Health IT, a project of Boston Children’s Hospital Computational Health Informatics Program and the Harvard Medical School Department of Biomedical Informatics, the “Discovery Infrastructure for Clinical Health IT Apps” funding opportunity.
Under this agreement, SMART Health IT will study the healthcare app ecosystem, enhance the SMART App Gallery (https://gallery.smarthealthit.org) with additional functionality, and expand the sample data available to users and developers through the SMART Sandbox. To achieve these goals, SMART Health IT has partnered with organizations that include FHIR.org, HL7, the American Medical Association, American Nursing Association, as well as consultants from world-class market research firms and design companies.
FHIR is laying a framework for digital disruption to occur. A big part of FHIR’s popularity is that it’s vendor-neutral and free to use, which allows innovators to do things that couldn’t easily be done before. […] The SMART on FHIR app platform and app gallery are great examples. Think of SMART on FHIR like the app store on a smartphone. Some of the apps are designed for physicians to use, such as the Growth Chart app developed by Boston’s Children’s Hospital. The app plots a child’s height and weight against growth charts published by the World Health Organization and U.S. Centers for Disease Control and Prevention (CDC) so that physicians can track a child’s growth over time and communicate this to the child’s caregivers.
Other apps in the SMART on FHIR gallery are patient-facing, such as the ClinDat application, which makes it easier for rheumatoid arthritis patients to document which joints are normal, tender, or swollen. These data are captured electronically and sent back to the medical record in real-time to support the clinical care patients receive. The beauty of SMART on FHIR is the apps are vendor neutral and can be ‘plugged-in’ to EHRs and other tools used on multiple devices (particularly mobile devices) that are already integrated into clinicians’ workflows.
I’m deeply excited about the Precision Medicine Initiative. With Cohort Program grant deadlines approaching in a matter of hours, I thought it might be time for a brief distraction with this blank verse reflection on the funding opportunity announcements:
Precision Medicine Initiative:
a blank verse summary and overview.
Recruit a million volunteers across
the country, spanning age, geography,
ethnicity and race, the ill and well,
a cohort of participants engaged
as partners for a long-term effort to
transform our understanding of the links
that bind genetics, our environment,
disease and health: a cohort big enough
for wide association studies of
diverse and non-prespecified effects.
We’ll weave a network joining scientists
from academia and industry,
and someone’s loft or basement or garage
to generate hypotheses, compare
results and methodology, and share
interpretations with participants.
We’ll gather physical exam reports
from EHRs and clinics, collate SNPs
and genomes, track activity from phones
and wearables, and questionnaires to learn
as much as each participant will share.
And how to organize a study with
The cast of characters includes at least
* Enrollment Centers (seven) to recruit
one hundred thousand people each, and build
a pipeline for transmitting data to…
* Coordinating Center (one) composed
of interlocking Cores for Data (with
facilities to scale analysis),
Research Support (including phenotype
selection algorithms, software tools,
and science help desk), plus a centralized
Administrative Core to oversee
the project and collaborations with…
* Participant Technologies, to build
a suite of mobile applications that
engage participants through questionnaires,
acquire sensor data (GPS
and wearables) and share research results.
* A central Biobank for specimens
collected from the cohort, offering
facilities to handle, process, store,
prepare, and ship to labs upon request.
A cohort of one million volunteers
will chart a course across the next five years.
Jump in and grab the helm — but science steers:
discoveries ho! Let’s sail to new frontiers.