An effort to develop technology to enroll a portion of the 1 million volunteers in the White House's Precision Medicine Initiative is placing a spotlight on one possible solution to interoperability and in the meantime creating unprecedented collaboration.
Six prominent developers of electronic health record systems, the health informatics program at Boston Children's Hospital, and the Office of the National Coordinator for Health Information Technology at HHS are all working to produce the needed software applications. The goal is to ease participation in the PMI, a national longitudinal healthcare research project.
They're trying to adapt the technology of an existing, public-private interoperability effort called SMART on FHIR. The goal would be to have the volunteers' medical records and other healthcare information transferred from their healthcare providers EHRs to the PMI database.
SMART stands for Substitutable Medical Apps, Reusable Technology, a healthcare mobile application development project at Boston Children's. Those efforts over the past couple of years have been paired with FHIR, Fast Healthcare Interoperability Resources, overseen by Health Level Seven, a healthcare standards development organization.
The ONC's Deputy National Coordinator Dr. Jon White said he thinks some volunteers will be able to use the technology to enroll in PMI later this year.
The PMI was announced by President Barack Obama in his 2015 State of the Union address. It aims to create a database for clinical research of the medical records of 1 million or more participants.
The initial six participating EHR developers are Allscripts, athenahealth, Cerner Corp., drchrono, Epic Systems Corp. and McKesson Corp.
Their efforts will likely enroll about 300,000 volunteers, said Dr. Josh Mandel, a research scientist at Harvard Medical School's Department of Biomedical Informatics and the school's leader on the Synch for Science project.
The other 700,000 are expected to come from seven large, participating healthcare provider organizations, Mandel said.
The Harvard team is working with the six vendors to build SMART of FHIR technology into their patient portals.
“It's sort of like a team effort,” said Daniel Kivatinos, co-founder and chief operating officer of drchrono, a developer of web-based EHR and practice management systems. “All of the vendors, even the big guys, they're all collaborating.”
Kivatinos said he's been the IT market for 8 years and has never before seen such a tight-knit effort.
His company has been using application programming interfaces (APIs) like those in FHIR for years, so their plan is to keep those APIs, Kivatinos said.
Kivatinos said his company, which is a provider of revenue cycle management services for physicians, is also committed to educating its clients on applications that are already on FHIR.
Eric Helsher, vice president of client services for Epic Systems, Verona, Wis., said it's a great example of taking on an existing profile with committed standards like FHIR and broadening the use cases for them. “It's one more thing, but a big thing with a big impact.”
The only caveat, Helsher said, is that “There are many new initiatives that want to leverage FHIR, but it's still a standard in its infancy.” That leaves room for variations in how it might be implemented by its users, he said.
