Data interoperability has long been a challenge that becomes increasingly important as healthcare evolves towards a value-based care model. Being able to share clinical records and other patient data between providers and across disparate systems is key to helping achieve cost-effective care goals and better patient outcomes.
But do current standard applications tie medical records, patient-generated data, and clinical decision support (CDS) tools into one continuous workflow for the benefit of providers and their patients?
Find solutions to data access problems with FHIR integration
Before we delve into the subject, let’s see how far we’ve come. In 2016, the 21st Century Cures Act brought access to medical data into law by addressing some of the ongoing challenges in data interoperability and electronic health records (EHR). It requires certified EHRs to support patient-facing APIs to improve data access, transparency, and interoperability between disparate vendors and third-party applications. It also eliminates “data blocking” that ensures access to EHR data.
Implementation of the law led the Office of the National Health IT Coordinator (ONC) and the Centers for Medicare and Medicaid Services (CMS) to issue a final rule in 2020 specifying HL7’s Rapid Healthcare Interoperability Resources (FHIR) as the preferred protocol for application programming interface (API) based data exchange.except its RESTful API, man Provides standards for packaging health data into their resources, providing a broad but loosely prescribed foundation upon which EHRs, practice management systems, digital health applications, and consumers can seamlessly exchange large amounts of structured health information . Alternative Medical Applications and Reusable Technology (SMART) adds a technology layer to FHIR to provide the security and workflow standards that FHIR needs to support EHR-connected applications.
One of the challenges with FHIR-based APIs is that they are almost entirely “read-only”. This means they are best suited for workflows and user actions initiated in other systems, such as FHIR applications that require EHR data. Therefore, actions in the third-party solution prompt the FHIR API to call the EHR and return the data needed to complete the workflow in real time. It usually doesn’t work in the opposite direction, which leaves important patient and other data in different platforms and isn’t always taken into account when the EHR is the primary source of information.
CDS Hooks: Creating Continuous Loops of Patient Information
The CDS Hooks API is a new specification from the SMART group that builds on FHIR and describes how the EHR can automatically invoke external platforms or applications. Invoking the FHIR application for the first time through CDS Hooks, EHR-only users can gain clinically relevant insights in their EHR workflow based on data from external sources.
This is a particularly exciting prospect for healthcare IT companies connected to healthcare data stores such as Remote Patient Monitoring (RPM) Continuous Glucose Monitoring (CGM), Patient Reported Outcomes (PRO) data, etc. – in EHR outside the range. Now, with CDS Hooks, this vital information can be provided automatically and directly in the EHR workflow.
Eliminate data silos in healthcare workflows
CDS Hooks is largely an academic exercise. But it is gaining more and more support in the EHR, and I believe now is the time to adopt it in the wider business world.
Because of their near-universal adoption, 95% of healthcare data resides in EHRs. However, with the advent of increasingly sophisticated consumer apps, devices like Apple Watches and Fitbits, and other healthcare tools like blood pressure cuffs and continuous glucose monitors, the data silos that store the rest of the data continue to grow in size and importance , and more generally remote patient care.This The adoption of these technologies and devices is growing exponentiallymany of whom take measurements every few minutes, leading to an increase in patient-generated data that could soon dwarf data in the EHR.
CDS Hooks can be a powerful way to ensure that all patient data is accessible through the EHR. Importantly, it provides a timely way to enter clinical workflows for massive home data storage. Thus, when an action is taken in the EHR (such as a doctor prescribing a prescription), CDS Hooks-enabled platforms can be notified and access household-generated data and respond appropriately. This clinical decision support can help ensure that patients receive optimal treatment, taking into account all known variables, regardless of where the data resides.
Overcome Alert Fatigue by Integrating FHIR and CDS Hooks
Alert fatigue is another problem that is becoming very common as more and more patient health data is generated. With devices taking measurements frequently throughout the day, it’s easy for medical records and providers to get overwhelmed and “call out” if they are notified of every reading.However, clinical insights from these data can be important and useful If useful and appropriate in the context of clinical workflow.
This CDS Hook Specifications It is envisaged that three different types of CDS cards can be presented to the user: information cards, advice cards or application link cards that will launch the FHIR application. Each of these card types can be used to support isolated health data issues. First, the CDS card can notify the clinician that some patient-generated health data needs to be reviewed when the patient chart is opened. For example, a patient on a continuous glucose monitor was in the very low blood sugar range more than 5% of the time in the past two weeks. This will be an information card. In addition, the CDS card can allow direct launching of the SMART application to visualize supporting data in more detail (application launch card) or order new prescriptions to address outstanding issues (advice card).
Despite the best efforts of earlier standards and now FHIR, the challenge of working with patient data silos has become increasingly important as the increasing complexity and clinically relevant sources of patient-generated data operating outside traditional EHRs many. Now is the time to consider CDS Hooks to complement FHIR and bridge this gap to ensure patient data from third-party systems and home data stores is incorporated into EHR workflows and made actionable. By automatically presenting patient data in the EHR workflow at the right time, providers will gain a more complete picture of an individual’s health and clinical status and be able to make better decisions faster and more efficiently, leading to improved outcomes.
Photo: Filograph, Getty Images
