Title: Pop Health on FLAT FHIR: A SMART Approach to Universal Healthcare Reporting
Applicant Name: Boston Children’s Hospital
Physical Address: 300 Longwood Ave, Boston, MA 02115-5724
Contact Name: Jamie Chan
Contact Phone Numbers (Voice, fax): 617-919-2729
E-mail address: email@example.com
SMART on FHIR, funded by the Office of the National Coordinator of Health Information Technology (ONC), has defined an application programming interface (API) so apps can be added to or deleted from electronic health records (EHR) as easily as smartphone apps. Building on the success of the SMART API, the 21st Century Cures Act requires certified health IT to publish APIs that allow information “to be accessed, exchanged, and used without special effort . . . including providing access to all data elements of a patient’s EHR to the extent permissible under applicable privacy laws.” A growing ecosystem of apps, many exhibited in our ONC-funded SMART App Gallery, is being developed to leverage this transformational approach to interoperability. Two striking examples are: (1) Apple’s Health app now connects, across the SMART API, to hundreds of hospitals, enabling patients to access their health records in FHIR format; and (2) The CMS new Blue Button 2.0 uses SMART to provision claims data to beneficiaries.
Eight years after our original SMART project under ONC’s Strategic Health IT Advanced Research Projects (SHARP) Program, we propose the next step. We catalyze an ecosystem for accessing and analyzing, without special effort, data on whole populations rather than one patient at a time. We have made real progress toward this vision, working with HL7 and ONC, to define the population health analog to the SMART API—the FHIR Bulk Data Export API. The output is “Flat FHIR,” an easily consumable flat file. Currently, a provider using EHR data to meet reporting requirements on population-level quality or cost measures requires a customized and prohibitively complex process to extract, transform, and load data into a separate analytic engine.
Our vision is seamless data exchange, via an API, between provider organizations and third parties. We propose a use case of exchange of EHR and claims data and derivative metrics between a provider and a payor. Toward this end, we design, develop, and test a substitutable population health analytics app, SMART-PopHealth, which enables a payor to access permitted data and metrics on covered populations, directly through the API. We test it in a real-world Accountable Care Organization.
The immediate benefit is to reduce or eliminate burdens on at-risk providers for reporting performance metrics to payors. But downstream benefits at the health system level are far greater. If our research shows that the Flat FHIR format provides a rich, production-grade substrate for effective, easily reproducible dataset creation, sharing, and analysis, it could become a lingua franca for a learning health system based on apps and analytic engines for uses as diverse as infectious disease surveillance and pragmatic clinical trials. Planning toward this next stage, we propose, in the out years of the project, implementation of federated data structures enabling query across multiple sites for health system-level intelligence. Our extraordinary technical expert panel will guide our design, review our results, and help us identify technical, legal, and policy challenges to the scope and scale of FHIR-based APIs for these purposes.