Geisinger sets SMART apps on FHIR

US healthcare provider, Geisinger Health System, has unveiled an EnrG suite of interoperable software applications, able to link to multiple electronic health records, using common standards.

Geisinger and xG Health Solutions, a technology company founded by Geisinger, have used the new Fast Healthcare Interoperability Resources (FHIR) draft standard developed by international standards organization Health Level 7 to connect a rheumatology app to a number of EHRs.

Earl Steinberg, chief executive officer of xG Health Solutions, told the HIMSS 2015 show in Chicago that Geisinger had great innovations and best practice; but no easy way of disseminating them.

“The big breakthrough came with SMART on FHIR, developed jointly with Boston Children’s Hospital and Intermountain, with funding from the ONC (Office of the National Coordinator).”

SMART [Substitutable Medical Applications, Reusable Technologies] is an initiative to exposing structured patient-level data through an open application programming interface.

FHIR, pronounced ‘fire’, is a draft HL7 standard describing data formats and elements – known as ‘resources’ – and an API for exchanging information with EHRs.

The web-based interoperable SMART container and the corresponding HL7 FHIR interface can exchange information in real-time with any SMART-using FHIR-enabled EHR.

Geisinger told Chicago that FHIR-enabled rheumatology app, EnrG Rheum [YouTube clip], uses 11 FHIR resources, and has been shown to be able to exchange data between EHRs from Athenahealth, Epic and Cerner.

Dr Eric Newman, Geisinger’s director of the department of rheumatology, who developed the app, explained that it integrates data streams from patients, doctors and nurses – together with patient supplied data.

He added: “The system enables us to automatically auto fill 90% of the record and focus on consultation – then push back to our EMR.”

D. Glenn Steele, Geisinger Health System’s CEO, said: “This is a pivotal moment for healthcare.  We are approaching interoperability in a completely different way. We are taking data and workflow from EHR to EHR. We are among the first to do this.”

Geisinger has a suite of further EnrG SMART and FHIR enabled apps for common procedures and chronic diseases.  Other apps in beta testing include apps for medicines reconciliation, discharge planning and transitions of care.

Dr Stan Huff, chief medical information officer of Intermountain Healthcare, and chair of HL7 commented: “SMART a wonderful technology, but as the technical people know there is a need to have more than just FHIR resources. We also need agreement on terminology. 

“So my plea is that we work together in standards process to achieve full interoperability. If we are not careful we could make different profiles and still be using SMART and FHIR and not be interoperable.”

Jonathan Bush, CEO of Athenahealth, urged providers and software suppliers not to lock themselves away, and take so long to agree standard profiles, that nobody uses them.

“Don’t co-operate too much with HL7, as it’s been too slow in the past.  Share what you are doing. Publish and stay open.  Don’t go into some outward-bound huddle.  If it doesn’t work nobody will follow.”