From HITECH to SMART-on-FHIR: where does the health apps ecosystem stand?

A little over a decade ago, less than 10% of hospitals used electronic health records (ESD). But then healthcare officially entered the digital age when the Health Information Technology for Economic and Clinical Health (HITECH) Act of 2009 was signed into law, ushering in the widespread and rapid adoption of EHRs in hospitals nationwide.

While EHRs are ubiquitous today and contain more patient data than ever before, these systems can often create silos of information. These technological barriers can make it difficult to share data with stakeholders, from patients and providers to payers and the research community.

These limitations are no longer acceptable. Healthcare providers expect the same ease of use and interoperability in healthcare applications that they know with online banking or online shopping. And as our industry moves away from the fee-for-service status quo, healthcare services can be improved if providers have all the data they need at their fingertips, helping them make more informed decisions and to provide better care and greater patient value and outcomes.

To break down these silos, EHRs must interact with each other and a host of diverse applications created by healthcare innovators. The first step towards this goal was the 2011 introduction of Fast Interoperable Health Resources (FHIR), a data standard that defines the structure of health data in transit. FHIR ensures that EHRs and third-party applications can speak the same language, so healthcare data can flow freely and securely between EHRs and other digital solutions. About the same time came Substitutable medical applications, reusable technologies (SMART). With a $15 million grant from the Office of the National Coordinator of Health Information Technology (ONC), SMART supported the development of a standard framework that enabled the development of interchangeable healthcare applications . This innovation paved the way for the EHR application markets we know today.

The two standards have been brought together to create SMART-on-FHIR, an open, free, standards-based application programming interface (API) that facilitates the development of applications that can run anywhere in the system. health. Essentially, what FHIR is to data integration, SMART is to workflow integration. SMART-on-FHIR then enables the creation of third-party applications for a variety of use cases that clinicians can launch into their existing EHR workflow. These apps will work with EHRs, enabling single sign-on and eliminating the need to switch between additional tabs, windows, or portals.

In fact, two recent federal rules mandate these standards to advance the adoption of value-based care:

SMART-on-FHIR is the inflection point to drive the shift to value-based care. The reason: it offers another path to integration where user experiences, not just discrete data, are shared across systems, enabling lightning-fast implementation. The reality of quick and painless onboarding gives healthcare systems the flexibility to choose, test and adopt the right solution for them, rather than struggling with the sunk cost of a long and costly implementation phase. . Maintaining the user experience is further centralized by the application, relieving healthcare system IT staff of the heavy burden of managing multiple systems. Finally, the agility of the FHIR specification and its built-in adherence breaks the pattern of data silos too often found when specialized applications are involved. Finally, we have a fully integrated mechanism to democratize innovation in the health record.

Supporting the evolution of value-based care with SMART-on-FHIR

SMART-on-FHIR will ultimately be the catalyst for the growth of the healthcare application market. In “The ecosystem of applications and software integrated with certified health information technology,” Posted in Journal of the American Medical Informatics Association, ONC reports that in 2021, there was a 20% year-over-year increase in the number of applications integrating with certified EHRs. About 38% of apps were for clinical uses, including performing automated tasks, population health, telehealth, and clinical decision support. Other applications, according to the research, have focused on care management, patient engagement, and research.

Between rules mandating integration and access to healthcare information and technological innovation in use cases, I predict that we will start to see many new applications that support the evolution of healthcare based on value and help reduce costs for patients, providers and payers. . These applications will further address aspects of healthcare, such as remote patient monitoring, precision medicine, integration of personal fitness trackers with EHRs, medication adherence monitoring, chronic disease patients and the collection of patient-reported outcomes, to name a few.

Apps can also be valuable to the research community, giving them better access to more patient population data as they explore cures for diseases or uncover opportunities to link patients to clinical trials. that could improve their quality of life or lead to the development of life-saving treatments. . I see a particular opportunity for applications that support clinical studies, as they can connect a single web application to multiple centers via SMART-on-FHIR. This allows EHR users to access a unified experiment, data set, patient set and database, framed within their individual EHR via SMART-on-FHIR, and automatically read and write data via FHIR integration.

There is so much data being generated in healthcare today, and it will only continue to grow exponentially from here. SMART-on-FHIR is the spark our industry needs to warm up in the app ecosystem, which will be important in supporting innovative use cases in long-term value-based care.

Photo: DrAfter123, Getty Images

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