Healthcare IT Interoperability, EHR interoperability, Hospital Interoperability

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New FHIR App Developments Support Health Data Search on EHRs

New developments of an i2b2 repository built on a FHIR format shows promise to expanding health data queries and interoperability.

- A research team has successfully developed a system which supports patient data in Integrating Biology and the Bedside (i2b2) repositories over the SMART on FHIR format, helping to boost health data interoperability between disparate technologies.


In a study published in the Journal of the American Medical Informatics Association (JAMIA), a research team explained that i2b2 repositories allow physicians to search for health data through a system that runs parallel to the EHR on which it is installed. When physicians query the system, the repository delivers to them a copy of the EHR data.

By developing the interface to have i2b2 run on the FHIR platform, the researchers have made the repositories somewhat like an app, meaning that they have expanded the functions of the EHR on which the i2b2 repository is installed.

The same apps that run in the EHR context could also run on a “sidecar” such as i2b2 supporting the SMART-on-FHIR API. SMART Health IT transforms an EHR or its sidecar into an iPhone-like platform. Smartphone platforms support an ecosystem of applications that extend the capability of the phone beyond the core software. Similarly, SMART Health IT supports an “app store for health” of substitutable apps constructed around core services and is intended to drive down health care technology costs and spur innovation, by fostering market competition for the evolution of applications that better support care provider needs.

Following development, the researchers found they could use the i2b2 system to successfully retrieve demographics, medications, lab results, and diagnosis for a set of fake test patients. This indicates that their i2b2 FHIR app is fully functioning.

“We successfully retrieved the demographics, medications, labs, and diagnoses for fake test patients,” the research team reported. “The developed SMART app ran successfully, demonstrating a dashboard to summarize data.”

This tool is specifically helpful in research settings. Because of its quick and effective search for patient data, the i2b2 tool helps researchers find the information they are looking for without having to sift through the EHR. The researchers did, however, report one limitation, stating that as of present the information is only available in read-only format.

That said, their developments are a step forward in facilitating better research queries.

“The i2b2 client is used to interactively query the repository to identify patient cohorts for hypothesis testing,” the team explained. “I2b2 software has evolved to provide a secure and scalable environment for such research operations. Another advantage of this approach is that the EHR system is not overloaded by research operations, allowing the EHR to focus on clinical operations.”

Going forward, the researchers predicted that their developments will inspire further innovation, allowing for even more efficient search for health data over interoperable systems

“We were able to successfully retrieve the demographics, medications, labs, and diagnoses for random patients in a demonstration i2b2 instance, and were able to successfully run SMART apps to show a dashboard summary for these patients,” the team said. “The SMART-on-FHIR cell will facilitate i2b2 sites in providing simplified but secure data access in FHIR format, and will spur innovation and interoperability.

These developments are vital for health data interoperability because they continue to support FHIR, an open API format which many healthcare experts say has promise in helping the industry see nationwide interoperability.

Because of that hope, FHIR plays an integral role in several industry groups’ efforts toward better interoperability. ONC, for instance, is hosting an interoperable app development challenge, which will be hosted on FHIR interfaces. Other interoperability pushes, like those within the new MACRA legislation, advocate a widespread use of APIs.

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