2018 LEAP in Health IT Projects

Pop Health on FLAT FHIR: A SMART Approach to Universal Healthcare Reporting

Project Overview

The Office of the National Coordinator for Health Information Technology’s (ONC) Cures Act Final Rule requires certified health information technology (health IT) developers to publish application programming interfaces (APIs) that allow information to be accessed, exchanged, and used without special effort. 

Substitutable Medical Applications, Reusable Technologies on Fast Healthcare Interoperability Resources (SMART on FHIR®) has defined an API so that mobile applications (apps) can be added to or deleted from electronic health records (EHRs) systems as easily as smartphone apps. A growing ecosystem of apps—many of which are exhibited in the SMART App Gallery—is leveraging this transformational approach to interoperability. 

The team built upon the success of the SMART on FHIR API and prototyped an app, called SMART-PopHealth, that demonstrates the power of a shared view of EHR data between healthcare provider organizations and payors (Medicare, Medicaid, and private insurers). Through an app like this one, hospitals can demonstrate performance and value, via a constantly updated view. The model of shared payor-provider data made possible with SMART-PopHealth could create a new basis for pay-for-performance, assessment of value-based care, and approaches to quality management. The SMART-PopHealth app is an open source prototype that the community can build upon. 

This project addresses the Leading Edge Acceleration Projects (LEAP) in Health IT fiscal year 2018 special area of interest 1: Expanding the Scope, Scale, and Utility of Population-Level Data-Focused APIs. 

Project Dates

This project began in 2018 and is estimated to be completed in 2023.

Project Goals

The goals of this project are to:

• Catalyze an ecosystem for accessing and analyzing, without special effort, data on whole populations rather than one patient at a time. 
• Continue to define the FHIR Bulk Data Export API, the population health analog to the SMART API. 
• Test a use case of exchange of EHR and claims data and derivative metrics between a provider and a payor. 
• Design and develop a substitutable population health analytics app, SMART-PopHealth, to enable a payor to access permitted data and metrics on covered populations, directly through the API. 
• Test SMART-PopHealth in a real-world accountable care organization. 

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Mobilizing a Million Hearts: Leveraging Health IT Architecture to Advance Clinical Knowledge and Care Coordination

Project Overview

Understanding how to successfully prompt clinicians at the point of care is a complex problem. For example, there are many clinical decision support (CDS) tools that provide the ability to calculate and display a patient’s updated atherosclerotic cardiovascular disease risk estimate. However, like most risk calculators, these stand-alone tools require clinician activation and do not support coordination of care across providers.

Leveraging Substitutable Medical Applications, Reusable Technologies on Fast Healthcare Interoperability Resources (SMART on FHIR®), MedStar Health Research Institute (MHRI) is working to close the gap between the tremendous promise of data-driven infrastructure supporting clinical knowledge and the current limitations of realized benefits.

MHRI advances clinical knowledge at the point of care by transforming the American College of Cardiology’s (ACC) Million Hearts Longitudinal Atherosclerotic Cardiovascular Disease (ASCVD) risk estimator into an open, standards-based application (app) that seamlessly and securely run across health information technology (health IT) platforms and provider organizations to optimize clinical workflow, improve care coordination, and support patient engagement.

The work represents a multidisciplinary approach that tackled technological and design components of health IT architecture while understanding end-user needs (e.g., cognitive support), workflow, and data integration.

This project addresses the Leading Edge Acceleration Projects (LEAP) in Health IT fiscal year 2018 special area of interest 2: Advancing Clinical Knowledge at the Point of Care.

Project Dates

This project began in 2018 and completed in 2020.

Project Goals

The goals of this project are to:

• Leverage health IT architecture that transforms the Million Hearts® suite of calculators into active cross-platform surveillance CDS that integrates into clinician workflow.
• Address technical challenges associated with shortcomings of current CDS tools, policy challenges, and socio-technical challenges.
• Inform health IT development, research, implementation, and policy by:
  • Supporting evidence-based cognitive support,
  • Serving as a proof of concept, and
  • Facilitating communication and coordination among providers and between providers and patients.
• Build and deploy a SMART on FHIR application (“Mobilizing Million Hearts”) that uses the risk factors of the Million Hearts® Model ASCVD Risk Estimator and incorporates clinician workflow and user needs.

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