EHR vendor Cerner has unveiled a production version of Health Level Seven’s Fast Healthcare Interoperability Resources (FHIR) framework for information sharing based on the latest web standards.
The company’s customers will beta test Substitutable Medical Applications and Reusable Technologies (SMART)—an application programming interface on FHIR applications—in Cerner’s Millennium EHR system, with an initial catalog of SMART on FHIR apps generally available by the end of the year.
Cerner’s initiative is part of a larger effort by the five major EHR vendors to build the SMART application programming interface (API) into releases of their respective products, and to standardize the SMART API in HL7 specifications. Developed with funding from the Office of the National Coordinator for Health IT under the Strategic Healthcare IT Advanced Research Projects (SHARP) program, SMART leverages HL7’s emerging FHIR standards to make it as easy as possible for app developers to get to data and for EHR vendors to implement a common API.
David McCallie, M.D., senior vice president of medical informatics at Cerner, says the company is excited about the prospect of “getting the vendor community to agree to implement a standards-based API that will allow third-party developers to build tools that could then plug into any compliant EHR.” McCallie adds that the vendor is “lining up” third-party developers to deploy apps into Cerner’s EHR system.
The vision for SMART on FHIR is medical apps that integrate into diverse EHR systems at the point of care. McCallie observes that apps on mobile devices—including smartphones—have revolutionized other industries and it was “inevitable” that these tools would eventually get to healthcare.
Kenneth Mandl, M.D., professor of biomedical informatics/pediatrics at Harvard Medical School and director of the Computational Health informatics Program at Boston Children’s Hospital, is the lead and chair of the SMART Advisory Committee. Mandl describes SMART on FHIR— an API between health system data and innovators’ apps—as a “work in progress” to establish open specifications that integrate apps with EHRs and other health IT systems.
According to Mandl, SMART is being adopted in its current form across several major healthcare systems including Boston Children’s Hospital, Geisenger, and Duke, which is implementing SMART on FHIR apps on top of its Epic system. He calls Cerner’s beta program the “tip of the spear” in terms of getting the API out into the clinical practice settings.
“The modus operandi is rapid iteration and evolution of both the API and the apps,” says Mandl. “We define interoperability in terms of substitutability—that an app should be able to be added to or deleted from an EHR as easily as on the iPhone. SMART focuses on promoting one specific property of interoperability—that an app written one time will run anywhere in the healthcare system.”
“It’s not only feasible to do it but actually we’re going to do it,” adds McCallie. His company’s beta program will include Cerner customer Mosaic Life Care in St. Joseph, Missouri, which has already begun to test a clinical decision support system that helps clinicians recognize and diagnose visually presenting conditions. Cerner is starting out with a small number of customer beta sites and will then roll the software out to the company’s broader client base by the end of 2015, he says.
Under the HL7 Argonaut Project, aimed at accelerating development and adoption of FHIR, five EHR vendors—athenahealth, Cerner, eClinicalWorks, Epic, and MEDITECH—are implementing SMART in their next product releases. “Cerner’s is coming out the end of this year. The other vendors may have different time tables,” comments McCallie. “It’s the vendors’ choice to fit it into their development cycles, but by joining and participating in Argonaut they’ve committed to doing it.”
“There’s an excitement in this new world of provider-facing apps, some of which will be embedded within the EHR,” says Micky Tripathi, Argonaut Project manager and president/CEO of the Massachusetts eHealth Collaborative.
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