While Health Level 7 International’s Fast Healthcare Interoperability Resources (FHIR) is still emerging as a mature standard, app developers have widely embraced HL7’s FHIR in many current use cases.

Health IT vendors see FHIR as a critical component to solving the complex interoperability challenges that are confronting healthcare organizations. Ultimately, they view their respective efforts as creating an ecosystem of third-party apps that will serve to increase consumer access to their health records through the open FHIR application programming interface.

Brigham and Women's Hospital in Boston
Brigham and Women's Hospital in Boston

Apps leveraging FHIR were prominently featured Monday at the Office of the National Coordinator for HIT’s inaugural Interoperability in Action Day, a virtual event that included presentations and demonstrations from industry highlighting the emerging standard and its ability to advance health information exchange.

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“Patient data remains scattered across many different sources,” said Adam Wong, a senior innovation analyst in ONC’s Office of Standards and Technology. “The digitization of data and the availability of EHRs enable great opportunities for innovation. And standardized APIs allow data to be moved and aggregated by clinicians and patients.”

The lack of interoperability between EHR systems remains a significant obstacle to data sharing. However, the FHIR API enables data to move between vendor systems at different providers and to third-party apps for direct use by consumers.

According to Wong, the agency wants to see more tools in the marketplace that “turn this potential into reality.” Toward that end, ONC has sponsored technology challenges seeking vendor proposals using FHIR to enable consumers to share their personal health information safely and securely with providers, family members and other caregivers.

ONC’s Consumer Health Data Aggregator Challenge, launched last year, is meant to spur the development of third-party consumer-facing apps that use open, standardized APIs such as FHIR to help consumers aggregate their data in one place and under their control. Among the requirements is that final apps submitted to the competition leverage FHIR Draft Standard for Technical Use 2 (DSTU2) and data as specified in the 2015 Edition Common Clinical Data Set, said Wong.

In Phase 2 of the Consumer Health Data Aggregator Challenge, first prize of $50,000 went to PatientLink Enterprises for its MyLinks cloud-based mobile-responsive app that makes it easy to gather, manage and share patient data using several methods, including FHIR and Direct secure messaging. Using the app, patients can also participate in research, monitor data from remote devices, and use interactive tools such as online forums, instant messaging and email.

MyLinks is “designed to make it easy for patients to gather their medical records from all of their providers and share the information from one secure location,” said Debi Willis, founder and CEO of PatientLink. “Patients are given the opportunity to have secure, encrypted, bi-directional communication with physicians, family and friends, and researchers.”

Willis added that the MyLinks app enables patients to view their connected devices, share their health data and import medical records from EHR systems using FHIR. “We’re connected to seven unique EHRs,” she said—those include Allscripts (Professional, Sunrise, and TouchWorks), athenahealth, Cerner, Epic and NextGen.

In addition, the app enables “patients to indicate their desire to participate in research and even gives them the ability to specify research preference like Alzheimer’s, autism or brain cancer” with a search feature that filters results based on illness categories, according to Willis.

A second prize of $50,000 and Connector Award was made to Green Circle Health for an app that leverages FHIR to import patient data into a platform integrating a comprehensive family health dashboard that incorporates patient-generated health data from wearables, sensors, and other connected devices, as well as remote monitoring and reminders.

“Typically, health is a family affair, and usually family members are open to sharing” data, said Dinesh Sheth, founder and CEO of Green Circle Health, who noted that the app can manage a family's healthcare remotely by sharing medical records and vitals with providers, storing lab results, X-rays and other documents, as well as sending alerts and reminders for appointments.

APIs are part of ONC’s 2015 Edition of Health IT Certification Criteria, which requires certified EHRs to demonstrate the ability to provide a patient-facing app access to the Common Clinical Data Set via an API. Sheth pointed out that the Green Circle Health app’s comprehensive family healthcare dashboard covers the Common Clinical Data Set.

Also See: ONC announces phase 2 winners of API challenge

ONC’s Provider User Experience Challenge was also meant to promote the use of FHIR. But, it also focused on demonstrating how data made accessible to apps through APIs can enhance providers’ experience with EHRs by making clinical workflows more intuitive, specific to clinical specialty, and actionable.

Just like the Consumer Health Data Aggregator Challenge, final apps submitted to the Provider User Experience Challenge must leverage FHIR DSTU2 and the 2015 Edition Common Clinical Data Set.

In Phase 2 of the Provider User Experience Challenge, first prize of $50,000 went to Herald Health for its solution that helps clinicians manage the overwhelming flow of alerts and information by allowing them to create highly customizable push notifications, which can be tailored to both individual patients and groups and exported to fellow users.

Brigham and Women’s Hospital“What Herald Health does it connects to sources of data within a hospital and allows providers to customize exactly how they receive that data in a pushed out way—as opposed to having to pull the data out,” said Brad Diephuis, MD, co-founder and CEO of Herald Health.

Diephuis said the customizable clinical alerting system is being piloted by 300 physicians at Brigham and Women’s Hospital in Boston. He added that EHR vendor Cerner and Boston Children's Hospital recently selected Herald Health to support providers in managing alerts, by enabling individual providers to easily customize the alerts to match their own practice needs.

“We are excited to be working with Herald Health,” said David McCallie, MD, Cerner’s senior vice president of medical informatics, in a written statement. “We are not surprised that they also won the ONC award. We look forward to putting a pilot into place in the near future at Boston Children's to test out their system.”

According to Diephuis, the partnership with Cerner is particularly exciting as a way to have Herald Health achieve “deeper EMR integration while using the FHIR standard in their Cerner code platform as a distribution mechanism.”

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