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2018 | Buch

Health Informatics on FHIR: How HL7's New API is Transforming Healthcare

verfasst von: Mark L. Braunstein

Verlag: Springer International Publishing

Enthalten in: Springer Professional "Wirtschaft+Technik" , Springer Professional "Technik" , Springer Professional "Wirtschaft"

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Über dieses Buch

This textbook begins with an introduction to the US healthcare delivery system, its many systemic challenges and the prior efforts to develop and deploy informatics tools to help overcome those problems. It goes on to discuss health informatics from an historical perspective, its current state and its likely future state now that electronic health record systems are widely deployed, the HL7 Fast Healthcare Interoperability standard is being rapidly accepted as the means to access the data stored in those systems and analytics is increasing being used to gain new knowledge from that aggregated clinical data. It then turns to some of the important and evolving areas of informatics including population and public health, mHealth and big data and analytics. Use cases and case studies are used in all of these discussions to help readers connect the technologies to real world challenges.

Effective use of informatics systems and tools by providers and their patients is key to improving the quality, safety and cost of healthcare. With health records now digital, no effective means has existed for sharing them with patients, among the multiple providers who may care for them and for important secondary uses such as public/population health and research. This problem is a topic of congressional discussion and is addressed by the 21st Century Cures Act of 2016 that mandates that electronic health record (EHR) systems offer a patient-facing API.

HL7’s Fast Healthcare Interoperability Resources (FHIR) is that API and this is the first comprehensive treatment of the technology and the many ways it is already being used. FHIR is based on web technologies and is thus a far more facile, easy to implement approach that is rapidly gaining acceptance. It is also the basis for a ‘universal health app platform’ that literally has the potential to foster innovation around the data in patient records similar to the app ecosystems smartphones created around the data they store. FHIR app stores have already been opened by Epic and Cerner, the two largest enterprise EHR vendors.

Provider facing apps are already being explored to improve EHR usability and support personalized medicine. Medicare and the Veteran’s Administration have announced FHIR app platforms for their patients. Apple’s new IOS 11.3 features the ability for consumers to aggregate their health records on their iPhone using FHIR. Health insurance companies are exploring applications of FHIR to improve service and communication with their providers and patients. SureScripts, the national e-Prescribing network, is using FHIR to help doctors know if their patients are complying with prescriptions.

This textbook is for introductory health informatics courses for computer science and health sciences students (e.g. doctors, nurses, PhDs), the current health informatics community, IT professionals interested in learning about the field and practicing healthcare providers. Though this textbook covers an important new technology, it is accessible to non-technical readers including healthcare providers, their patients or anyone interested in the use of healthcare data for improved care, public/population health or research.

Inhaltsverzeichnis

Frontmatter

Perspective

Frontmatter

Chapter 1. A Brief History and Overview of Health Informatics

Abstract

This first chapter provides a brief history of some, but certainly not all, of the key subdomains within the health informatics field and further explains the potential significance of the FHIR standard that will occupy much of the rest of the book. To do this, the chapter begins with a discussion of early electronic records and clinical decision support tools and then shifts gears to introduce the concept of health information exchange. Later, we discuss interoperability challenges that date back decades and the various ways that existing technologies have been used, sometimes with limited success, to simplify and coordinate the sharing of information among providers. The chapter ends with the premise that widespread adoption of modern web technologies (and FHIR in particular) is transforming health informatics. To help illustrate this the chapter ends with a demonstration FHIR app developed by a team of Georgia Tech students did using these emerging technologies to help predict the onset of a life threatening condition in ICU patients.

Mark L. Braunstein

Chapter 2. The US Healthcare System

Abstract

This chapter briefly describes the US healthcare system and some of the most important of its many problems. This is a complex topic that I cannot adequately cover in a short, introductory book, so I have provided a number of suggested supplemental readings. For a very complete and detailed discussion of the topics raised here (and others) I suggest the Institute of Medicine publication The Healthcare Imperative: Lowering Costs and Improving Outcomes: Workshop Series Summary which is available for purchase or free download.

Mark L. Braunstein

Chapter 3. Health Informatics in the Real World

Abstract

In this chapter, we begin a discussion of the key informatics tools needed to power a Learning Healthcare System. These include electronic records for both providers and patients as well as information sharing technologies to bind them together. There are two similar terms used to describe these records. Electronic medical records (EMRs) are best thought of as “the standard medical and clinical data gathered in one provider’s office”. In the early days of clinical information systems, before data sharing was feasible creating the EMR, as defined, was the goal. The newer term is Electronic Health Record (EHR) and it contains a complete record of a patient’s care across all providers. Increasingly, with the growth of mHealth (mobile health), it may also contain data contributed by the patients using mobile apps or wearable or other devices in the home.

Mark L. Braunstein

Beyond Direct Patient Care

Frontmatter

Chapter 4. The Empowered Patient

Abstract

Patient facing health informatics is an increasingly rich and interesting field, particularly because many people now use smartphone apps, wearable and other sensors and mobile devices to monitor and report on their behavior, activity and physiologic parameters. Those new technologies now have a name – mHealth (mobile health) – that will be the topic of a later chapter. In this one, we will address some of the other tools and approaches to patient engagement through informatics. We discuss various examples of personal health records and related tools, the technologies and regulatory incentives that enable them, and the factors that have limited their usefulness and adoption by patients. We also contrast traditional and essentially ‘read-only’ patient portals with an array of newer interactive tools that provide patients with greater ability to gain insights into their own health information to better manage their care. Some of these are old ideas while others are quite new. Changing economics and the new models of payment and care are increasing interest in mHealth based approaches to patient engagement in their own care as well as connecting patients to their providers on a more continuous basis.

Mark L. Braunstein

Chapter 5. Health Information Exchange

Abstract

In the previous chapter we discussed how health information technology is being used to help patients better manage their own care. In this chapter, we will focus on main impediments to interoperability and provide examples of how those impediments have been overcome, at least in part.

Mark L. Braunstein

Chapter 6. Payer Applications of FHIR

Abstract

Earlier we discussed how the Utah Health Information Network (UHIN) began as a secure, standards-based approach to exchange health insurance claims information. Today, the interaction between health care providers and payers is often retrospective when it could be done in real time. It is often episodic and it could be a far more efficient process if provider and payer information systems were able to share data electronically. This is yet another opportunity for interoperability and payers have begun to appreciate and act on the potential of FHIR to transform their business processes, particularly as they connect with providers.

Mark L. Braunstein

Interoperability Essentials

Frontmatter

Chapter 7. Data and Interoperability Standards

Abstract

Data and interoperability standards are the virtually ubiquitous plumbing that underlie most contemporary health informatics systems and tools. We’ve already gotten a glimpse of that when we encountered LOINC codes in the lab test HL7 V2 message.

Given the complexity of healthcare, it should not be surprising that this is a complicated topic, so we will divide it into three chapters. In this initial chapter, we will first discuss the evolution of standards and then we will focus on standards for representing health data. In the next chapter, we will discuss how that data is packaged, transported and shared using interoperability standards developed before FHIR. In the third chapter, we will cover FHIR in some detail.

Mark L. Braunstein

Chapter 8. Pre-FHIR Interoperability and Clinical Decision Support Standards

Abstract

In the last chapter, we looked at the evolution of standards and examined the key health data standards. For use in actual patient care, standardized clinical data, typically along with other non-standardized data such as free text notes, must be packaged into a useful and usable form and sent using widely accepted data sharing standards and approaches. Many people feel that these standards and approaches will increasingly be FHIR APIs but FHIR is still being developed and the first ‘normative’ version isn’t expected until late 2018 so for some time into the future earlier standards will continue to be used. We will look at FHIR in the next chapter, while in this one we will look at the standards for packaging and sharing data that predate it.

Mark L. Braunstein

Chapter 9. FHIR

Abstract

In 2011, Australian HL7 standards guru, Grahame Grieve, proposed a new interoperability approach he called “Resources for Health (RFH)”. He said it would define a set of objects to represent granular clinical concepts for use on their own or aggregated into complex documents. As a result, it would be ‘composable’ – so that, unlike with complex C-CDA documents, developers could request only the information needed for their particular use case. In part, because of that, he said that this flexibility could offer “coherent solutions for a range of interoperability problems”.

Mark L. Braunstein

Chapter 10. SMART on FHIR

Abstract

A universal health app platform to support informatics-based innovations in care delivery, no matter what the underlying EMR, was a long-held dream of the academic health informatics community. In 2010, the ONC awarded $15 million to the Boston Children’s Hospital Computational Health Informatics Program and the Harvard Medical School Department of Biomedical Informatics to create and initially develop just such an app platform.

Mark L. Braunstein

New Frontiers

Frontmatter

Chapter 11. mHealth

Abstract

Many of us can think back to a key role a teacher played in shaping our world-view or our career. In my case, one such person was Dr. Hiram Curry, a general practitioner who retrained in neurology and then founded the first academic Family Medicine Department. Its clinic has many of the characteristics we now associate with a patient centered medical home. He introduced me to Dr. Larry Weed’s seminal book Medical Records, Medical Education and Patient Care and through it I became an advocate of his idea of a Problem Oriented Medical Record. I joined Dr. Curry’s effort and led the development of one of the first ambulatory EHR systems. Dr. Curry taught me many things but one in particular is relevant to this topic. He used to caution his residents that they would see patients for a few minutes every so often and think that what they did in those few brief encounters would make all the difference. He was fond of saying that what the patients did between those encounters would actually make that difference.

Mark L. Braunstein

Chapter 12. Public and Population Health

Abstract

In the clinical setting, the focus is traditionally on individual patients after they become sick or injured. In contrast, public and population health focus on groups of patients or the public at large. These can be as small as a local neighborhood, or as big as an entire country or region or the world. Instead of diagnosis and treatment of individuals, the goal may well be prevention of disease, identification of risk or protective factors, or promotion of the health of communities as a whole. We will begin this chapter with a discussion of public health and then shift to population health.

Mark L. Braunstein

Chapter 13. Analytics and Visualization

Abstract

This book is not about how to do analytics. Rather, we will explore the specialized infrastructures and tools that support research on and exploration of health data at scale. Generally, this involves aggregating at least the clinical part of that data from a large number of digital health records. This introduces the interoperability issues and technologies we have been discussing throughout the book. It is good to think back to the proposed FHIR Bulk Data Protocol we discussed in the population health section. We referred then to research as another future application of FHIR once that access method becomes available.

Mark L. Braunstein

Backmatter

Titel: Health Informatics on FHIR: How HL7's New API is Transforming Healthcare
verfasst von: Mark L. Braunstein
Verlag: Springer International Publishing
Electronic ISBN: 978-3-319-93414-3
Print ISBN: 978-3-319-93413-6
DOI: https://doi.org/10.1007/978-3-319-93414-3