Our industry is fraught with interoperability problems, despite being highly digitized. Think about it – when you go from one provider to another - or one hospital to another - unless they use the same EHR vendor, information is typically not readily available for rapid and accurate high-quality clinical decision-making. SMART on FHIR was developed to address this interoperability problem in health care. Substitutable Medical Applications and Reusable Technologies (SMART) was started in 2010 with a grant from the Office of the National Coordinator (ONC) to build an interoperable application platform for health care. Fast Healthcare Interoperability Resources (FHIR) is an open health care data standard from Health Level 7 International (HL7). FHIR provides standards for exchanging data electronically. That standard simplifies implementation without sacrificing information integrity by leveraging existing logical and theoretical models to provide a consistent, easy-to-implement and rigorous mechanism for data exchange.
Data is typically locked into EHRs and not easily exchanged or available for clinical decision making across the care venue. FHIR unlocks data because it makes discrete data elements available in real time through apps like ours. Our apps assimilate clinically relevant data from the EHR and present it to clinicians in a meaningful and actionable way. Data is integrated into workflows and analyzed in real time for compliance with best practices and quality metrics. Our apps also include patient-entered information, so clinicians have immediate access to how patients are feeling and responding to their treatment. Extracting and analyzing data and embedding it into workflows improves efficiency and quality of care. The time patients spend with their care teams is focused on problem solving versus collecting information. For providers, having meaningful data at their fingertips that is auto-populated into their workflows and clinical notes is priceless in terms of efficiencies gained.
The first SMART on FHIR app that xG Health developed is a rheumatology app; this app helps patients by improving their quality of care and outcomes. It promotes data-driven, not gestalt-driven, decision making, along with best-in-class improvements in nationally vetted quality measures. Patients get better faster, and they stay better longer over time. The app also saves patients time – ensuring the right clinician gets the right information at the right time. Patients don’t have to repeat information to multiple care providers - they enter their information into the app, and it is instantly available to the care team.
xG Health is developing a suite of apps based on Geisinger innovation. Other SMART-on-FHIR apps on the roadmap include: those focused on common procedures, such as coronary artery bypass grafting and total knee replacement, chronic diseases such as heart failure and oncology, management of patients in the ED, a provider documentation app that automates the documentation process and improves HCC scores, apps that promote optimal use of high cost pharmaceuticals, and apps that integrate genomics into clinical practice.
Without data integration, data lives in silos and often requires clinicians to hunt and peck for relevant clinical information in disparate data sources. FHIR promotes data liquidity, meaning data can be shared across care venues, thereby promoting continuity of care and informed clinical decision-making.