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

OBJECTIVES: To support a pragmatic, electronic health record (EHR)-based randomized controlled trial, we applied user-centered design (UCD) principles, evidence-based risk communication strategies, and interoperable software architecture to design, test, and deploy a prognostic tool for children in emergency departments (EDs) with pneumonia. METHODS: Risk for severe in-hospital outcomes was estimated using a validated ordinal logistic regression model to classify pneumonia severity. To render the results usable for ED clinicians, we created an integrated SMART on Fast Healthcare Interoperability Resources (FHIR) web application built for interoperable use in two pediatric EDs using different EHR vendors: Epic and Cerner. We followed a UCD framework, including problem analysis and user research, conceptual design and early prototyping, user interface development, formative evaluation, and postdeployment summative evaluation. RESULTS: Problem analysis and user research from 39 clinicians and nurses revealed user preferences for risk aversion, accessibility, and timing of risk communication. Early prototyping and iterative design incorporated evidence-based design principles, including numeracy, risk framing, and best-practice visualization techniques. After rigorous unit and end-to-end testing, the application was successfully deployed in both EDs, which facilitated enrollment, randomization, model visualization, data capture, and reporting for trial purposes. CONCLUSION: The successful implementation of a custom application for pneumonia prognosis and clinical trial support in two health systems on different EHRs demonstrates the importance of UCD, adherence to modern clinical data standards, and rigorous testing. Key lessons included the need for understanding users' real-world needs, regular knowledge management, application maintenance, and the recognition that FHIR applications require careful configuration for interoperability.

A regional health information exchange: architecture and implementation.

The MidSouth eHealth Alliances health information exchange in Memphis, Tennessee provides access to data on almost 1 million individuals. The effort is the product of a comprehensive, integrated approach to technology and policy that emphasizes patient-centered use, low-cost, flexibility, and rigorous privacy and confidentiality policies and practices It is used in emergency departments and other major clinical settings. This paper provides a high-level overview of the system and its use. The early anecdotal success of this effort and preliminary formal clinical and financial evaluation suggest that health information exchanges can improve care at relatively low cost.

Reducing HIE costs through real-time data feed visualizations.

Reliable and cost-effective health information exchanges require real-time monitoring of data sources, especially during implementation and deployment. MidSouth eHealth Alliance developers created a tool for real-time visualization of data feed logs which summarizes activity over multiple time windows and across different components, sources, and event types. This representation allows maintainers to differentiate between expected patterns and events that require rapid intervention to ensure reliable data handling, supporting efficient monitoring of and response to anomalous activity.