Browsing by Subject "Health Information Exchange"

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    Opening the Duke electronic health record to apps: Implementing SMART on FHIR.
    (International journal of medical informatics, 2017-03) Bloomfield, Richard A; Polo-Wood, Felipe; Mandel, Joshua C; Mandl, Kenneth D
    Recognizing a need for our EHR to be highly interoperable, our team at Duke Health enabled our Epic-based electronic health record to be compatible with the Boston Children's project called Substitutable Medical Apps and Reusable Technologies (SMART), which employed Health Level Seven International's (HL7) Fast Healthcare Interoperability Resources (FHIR), commonly known as SMART on FHIR.We created a custom SMART on FHIR-compatible server infrastructure written in Node.js that served two primary functions. First, it handled API management activities such rate-limiting, authorization, auditing, logging, and analytics. Second, it retrieved the EHR data and made it available in a FHIR-compatible format. Finally, we made required changes to the EHR user interface to allow us to integrate several compatible apps into the provider- and patient-facing EHR workflows.After integrating SMART on FHIR into our Epic-based EHR, we demonstrated several types of apps running on the infrastructure. This included both provider- and patient-facing apps as well as apps that are closed source, open source and internally-developed. We integrated the apps into the testing environment of our desktop EHR as well as our patient portal. We also demonstrated the integration of a native iOS app.In this paper, we demonstrate the successful implementation of the SMART and FHIR technologies on our Epic-based EHR and subsequent integration of several compatible provider- and patient-facing apps.
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    Safe Interorganizational Health Information Exchange During the COVID-19 Pandemic.
    (Journal of the American Medical Directors Association, 2020-12) Wong, Serena P; Jacobson, Heather N; Massengill, Jennifer; White, Heidi K; Yanamadala, Mamata
    Accurate and timely transmission of medical records between skilled nursing facilities and acute care settings has been logistically problematic. Often people are sent to the hospital with a packet of paper records, which is easily misplaced. The COVID-19 pandemic has further magnified this problem by the possibility of viral transmission via fomites. To protect themselves, staff and providers were donning personal protective equipment to review paper records, which was time-consuming and wasteful. We describe an innovative process developed by a team of hospital leadership, members of a local collaborative of skilled nursing facilities, and leadership of this collaborative group, to address this problem. Many possible solutions were suggested and reviewed. We describe the reasons for selecting our final document transfer process and how it was implemented. The critical success factors are also delineated. Other health systems and collaborative groups of skilled nursing facilities may benefit from implementing similar processes.