By far the hottest ticket at the AMIA Symposium on Monday, Nov. 17, was the SMART on FHIR session, where the leaders of the SMART project highlighted some projects and vendors lending momentum to the apps platform concept in healthcare.
SMART on FHIR implements an open architecture to support interchangeable Web applications that can be “plugged in” to any compliant EHR or health data container. Part of the allure is that the effort can get away from document-centric approaches and expose discrete data elements as services. During the session, speakers such as David McCaille, M.D., vice president of medical informatics at Cerner Corp., and Stan Huff, M.D., chief medical informatics officer of Intermountain Healthcare, showed off pilots of how apps initially created at Boston Children’s Hospital could easily be plugged into other health system EHRs.
SMART Co-Director Kenneth Mandl, M.D., M.P.H., a professor at Harvard Medical School, told the overflow audience at the AMIA presentation that last year at HIMSS there were four or five demonstrations of SMART apps. “By the next HIMSS we expect to have many more demonstrations involving real patients.” Organizations working with SMART include Cerner, Geisinger, Duke Medicine, Epic, HCA, Surescripts, The Advisory Board, and CMS.
McCaille noted that Cerner increasingly hears from its health system customers that EHRs are becoming a commodity platform and that the winners in the market will be those that make their platforms open and extensible. Health systems want vendor independence with few proprietary entanglements, he added. He co-chaired the ONC JASON Task Force, which recently recommended that ONC focus its efforts on open application programming interfaces and FHIR profiles. Apps, he said, can extend EHRs’ functionality and plug right into the clinical workflow. SMART and FHIR can make it happen, he said. The effort at Cerner is still in pilot mode as it waits for more advanced work on FHIR profiles, but McCaille added that he expects production work to begin sometime in 2015.
In a separate session, a new nonprofit organization, the Healthcare Services Platform Consortium (HSPC) introduced itself as an effort to promote the HL7 FHIR model for data access to enables the EHR integration of SMART apps.
HSPC’s primary strategy is to establish a middle tier of standards-based services for data access, privacy and role-based authentication of users along with other capabilities to support business process management and decision support, explained Intermountain’s Stan Huff. The HSPC has adopted the HL7 FHIR model for data access. FHIR profiles are based on standardized detailed clinical models that are tightly bound to LOINC, SNOMED CT, and RxNORM. The success of the venture will depend on persuading commercial EHR vendors to support the standards-based services as part of their infrastructure, he noted. “We want to get to a point where we can share applications and data across platforms. We want to create an apps store environment,” Huff said. He said HSPC has strong support for the concept from from vendors such as Epic, Cerner and Siemens, but the vendors need a business case to work on this model. “That comes from customers saying this would provide value and we would pay to support it,” he said.