EMR Integration using FHIRPresented by Marcus Walters

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Overview

Part 1• Introduction• FHIR: Trends, Capabilities, and Standards• Da Vinci project• FHIR Considerations• Iguana’s Integral Role• Q&A

IntroductionQuestion: What category does your organization fall under?

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Providor

Payer

Government

Consultant

Patient

Interoperability

Vendor

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Interoperability

“enables the secure exchange of electronic health information with, and use of

electronic health information from, other health information technology without

special effort on the part of the user” -- ONC

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Interoperability challenges

EHR’s:• Don’t show doctors health information that would promote cost effective care

• Use Electronic based versions of paper records

• Are not Patient-centered

Information blocking:• Activity that (except for lawful reasons) limits efficient access of Electronic

Health information (EHI).

• Examples: EHI fees, Time delays

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ONC’s Proposed Rule

Implement parts of the 21st Century Cures Act:

• Certification to ensure no information blocking

New amendments for Patients:

• Access EHI via smartphones by using Application Programming Interfaces (APIs)

• No Cost

New Amendments for Providers:

• New tools that allow for more choice in care

FHIR Trends, Capabilities, and Standards

Question: What standard facilitates this rule perfectly?

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Fast Healthcare Interoperability Resources (FHIR)

Defines• Data formats (Resources):

• Patient• Medications• Encounters• etc.

• Application Programming Interface (API) that exchanges the Resources • FHIR has gone through 4 revisions (version 1 to version 4)

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FHIR Trends, Capabilities, and Standards

• 32% of health IT (HIT) developers published that they are using FHIR Release 2

• Is this enough?

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FHIR Trends, Capabilities, and Standards

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FHIR Trends, Capabilities, and Standards

• 32% of HIT developers account for 80% of FHIR usage across hospitals

• Examples

• Epic’s App Orchard (21%)

• Cerner’s Ignite API’s for Millenium (20%)

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Epic: App Orchard

• Application store

• Includes FHIR Apps

• MUSE NX (GE Healthcare)

• View ECG Data

• 21% of market share

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Cerner: Ignite APIs for Millenium

• FHIR API

• Developed apps end up in App Gallery

• Supports FHIR ver. 2

• Adding r4 support

• 21% of market share

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FHIR Trends, Capabilities, and Standards –The Takeaway

• FHIR is a dominant standard

• 3rd Party Applications are on the rise

• Interoperability has more means

• Quality initiative?

Da Vinci Project

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Da Vinci Project

What is it?• Private sector Initiative • Empowers providers with the knowledge to make the best clinical decisions

Why?• Promotes value based care (VBC)

How?• Utilizes use cases to facilitate the workflows required to promote VBC via

standards including:• FHIR• SMART

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Substitutable Medical Applications, Reusable Technologies (SMART)

• Authentication Framework

• Connects 3rd party Applications to an EMR/EHR

• Utilizes Oauth2 and openID (Token and ID Authentication)

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Da Vinci Project: Use Cases

eHealth Record Exchange: Clinical Data Exchange (CDex)• Defines combinations of exchange methods (push, pull, subscribe, etc.)• Focuses on both provider and payer information exchange

eHealth Record Exchange: Payer Data Exchange (PDex)• Defines combinations of exchange methods (push, pull, subscribe, etc.)• Focuses on the exchange of mainly payer information

Coverage Requirements Discovery (CRD)• Using FHIR based API to view real-time payer coverage information

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Da Vinci Project: Why FHIR?

• FHIR has the robustness, presence, and staying power

• Allows for extremely fast communication between crucial stakeholders

• Allows for SMART on FHIR apps to be implemented

• SMART on FHIR apps make interoperability more seamless

FHIR Considerations

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FHIR Considerations

• FHIR is not a security protocol

• A proper security subsystem should be considered to manage:

• Authentication: confirmation of identity

• Authorization: access control management

• Auditing: Tracking access of resources

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FHIR considerations: Security Subsystem Workflows

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FHIR considerations: Authentication, Authorization and Auditing

Authentication• Smart (OpenID oAuth2)

Authorization• Role-Based Access Control (RBAC)• Attribute-Based Access Control (ABAC)

FHIR Auditing:• AuditEvent resource: Via FHIR Server• Iguana SMART FHIR Apps: via Iguana’s custom logging feature

Iguana’s Integral Role

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Iguana’s Integral Role

• Iguana supports all FHIR versions

• SMART on FHIR applications can be built within Iguana

• SMART on FHIR Iguana Apps can connect to any EMR/EHR

• Applications can authenticate according to SMART standards (i.e. openID or oauth2)

• SMART on FHIR Apps made in Iguana can be made to adhere to Davinci use cases

EMR Integration using FHIR: End

Questions?