Integrating a Patient Engagement App into an Electronic Health Record-Enabled Workflow Using Interoperability Standards

Abstract

Background Patient use of mobile health applications is increasing. To promote patient-centered care, data from these apps must be integrated into clinician workflows within the electronic health record (EHR). Health Level 7 Fast Healthcare Interoperability Resources (FHIR) offers a standards-based application programming interface (API) that may support such integration. Objective We aimed to use interoperability standards to integrate a patient mobile application (coronavirus 2019 [COVID-19] Tracker) with an EHR. The COVID-19 Tracker engages patients by sending introductory and reminder text messages, collecting vital signs and symptom data from COVID-19 patients, and providing actionable guidance if concerning issues are identified. This case report explored the use of FHIR APIs to integrate the app into EHR-enabled clinical workflows. Methods The authors used notes from project meetings and from semistructured discussions among the application development team to track the design and implementation processes. Seven points of integration between the application and the EHR were identified, and approaches using FHIR to perform these integrations were delineated. Results Although this clinical decision support integration project benefited from its standards-based approach, many challenges were encountered. These were due to (1) partial implementation of the FHIR standard in the EHR, particularly, components needed for patient engagement applications; (2) limited experience with the adoption of FHIR standards; and (3) gaps in the current FHIR standard. Alternative approaches, often not based on interoperability standards, were developed to overcome these limitations. Conclusion Despite the challenges encountered due to the early stages of FHIR development and adoption, FHIR standards provide a promising mechanism for overcoming longstanding barriers and facilitating the integration of patient engagement apps with EHRs. To accelerate the integration of apps into clinical workflows, additional components of the FHIR standard must be implemented within the EHR and other clinical systems. Continued expansion of available FHIR resources will help with tighter workflow integration.

Advances in Clinical Decision Support Systems: Contributions from the 2022 Literature

“…Most studies were single-site, retrospective in nature, and focused on provider-facing CDS. Two out of the 11 best paper candidates [7,12] had a patient-facing application. Lobach et al explored the integration of a patient engagement application (for monitoring and managing COVID-19 symptoms) into the electronic health record using Health Level 7 (HL7) Fast Health Interoperability Resources (FHIR) standards, including contemporary services such as CDS Hooks [12].…”

“…Two out of the 11 best paper candidates [7,12] had a patient-facing application. Lobach et al explored the integration of a patient engagement application (for monitoring and managing COVID-19 symptoms) into the electronic health record using Health Level 7 (HL7) Fast Health Interoperability Resources (FHIR) standards, including contemporary services such as CDS Hooks [12]. Wu et al conducted an implementation effectiveness trial for examining the clinical impact of patient-oriented and provider-facing CDS report for health risk assessment [7].…”

User-Centered Design and Implementation of an Interoperable FHIR Application for Pediatric Pneumonia Prognostication in a Randomized Trial

“…22 Lobach et al provide another useful example of how future investigators can evaluate and report the viability of FHIR app integration in an EHR environment during application design. 23 Finally, the FHIR standard, while robustly designed for customizability, still has gaps in the US Core profile (as demonstrated by the amount of effort needed to model oxygenation) that adds substantial complexity when using the standard. In short, FHIR applications are not simply plugand-play and require informaticians and developers with expertise in the FHIR standard, local EHR and FHIR configuration, and local custom development resources for successful interoperability.…”

Harnessing the Power of Mobile Phone Technology: Screening and Identifying Autism Spectrum Disorder With Smartphone Apps

“…Moreover, they empower families with a sense of agency, allowing them to actively contribute to their loved one's care plan. This engagement is essential for fostering a collaborative and patient-centered approach to ASD management, enhancing the overall quality of care [ 82 ].…”