Beyond One-Off Integrations: A Commercial, Substitutable, Reusable, Standards-Based, Electronic Health Record-Connected App.

The Substitutable Medical Apps and Reusable Technology (SMART) Health IT project launched in 2010 to facilitate the development of medical apps that are scalable and substitutable. SMART defines an open application programming interface (API) specification that enables apps to connect to electronic health record systems and data warehouses without custom integration efforts. The SMART-enabled version of the Meducation app, developed by Polyglot, has been implemented at scores of hospitals and clinics in the United States, nation-wide. After expanding their product's reach by relying on a universal, open API for integrations, the team estimates that one project manager can handle up to 20 simultaneous implementations. The app is made available through the SMART App Gallery, an open app store that supports discovery of apps and, because the apps are substitutable, market competition. This case illustrates how a universal open API for patient and clinician-facing health IT systems supported and accelerated commercial success for a start-up company. Giving end users a wide and ever-growing choice of apps that leverage data generated by the health care system and patients at home through a universal, open API is a promising and generalizable approach for rapid diffusion of innovation across health systems.

Beyond compliance with the 21st Century Cures Act Rule: a patient controlled electronic health information export application programming interface.

OBJECTIVE: The 21st Century Cures Act Final Rule requires that certified electronic health records (EHRs) be able to export a patient's full set of electronic health information (EHI). This requirement becomes more powerful if EHI exports use interoperable application programming interfaces (APIs). We sought to advance the ecosystem, instantiating policy desiderata in a working reference implementation based on a consensus design. MATERIALS AND METHODS: We formulate a model for interoperable, patient-controlled, app-driven access to EHI exports in an open source reference implementation following the Argonaut FHIR Accelerator consensus implementation guide for EHI Export. RESULTS: The reference implementation, which asynchronously provides EHI across an API, has three central components: a web application for patients to request EHI exports, an EHI server to respond to requests, and an administrative export management web application to manage requests. It leverages mandated SMART on FHIR/Bulk FHIR APIs. DISCUSSION: A patient-controlled app enabling full EHI export from any EHR across an API could facilitate national-scale patient-directed information exchange. We hope releasing these tools sparks engagement from the health IT community to evolve the design, implement and test in real-world settings, and develop patient-facing apps. CONCLUSION: To advance regulatory innovation, we formulate a model that builds on existing requirements under the Cures Act Rule and takes a step toward an interoperable, scalable approach, simplifying patient access to their own health data; supporting the sharing of clinical data for both improved patient care and medical research; and encouraging the growth of an ecosystem of third-party applications.

A landscape survey of planned SMART/HL7 bulk FHIR data access API implementations and tools.

The Office of National Coordinator for Health Information Technology final rule implementing the interoperability and information blocking provisions of the 21st Century Cures Act requires support for two SMART (Substitutable Medical Applications, Reusable Technologies) application programming interfaces (APIs) and instantiates Health Level Seven International (HL7) Fast Healthcare Interoperability Resources (FHIR) as a lingua franca for health data. We sought to assess the current state and near-term plans for the SMART/HL7 Bulk FHIR Access API implementation across organizations including electronic health record vendors, cloud vendors, public health contractors, research institutions, payors, FHIR tooling developers, and other purveyors of health information technology platforms. We learned that many organizations not required through regulation to use standardized bulk data are rapidly implementing the API for a wide array of use cases. This may portend an unprecedented level of standardized population-level health data exchange that will support an apps and analytics ecosystem. Feedback from early adopters on the API's limitations and unsolved problems in the space of population health are highlighted.

Push Button Population Health: The SMART/HL7 FHIR Bulk Data Access Application Programming Interface.

The 21st Century Cures Act requires that certified health information technology have an application programming interface (API) giving access to all data elements of a patient's electronic health record, "without special effort". In the spring of 2020, the Office of the National Coordinator of Health Information Technology (ONC) published a rule-21st Century Cures Act Interoperability, Information Blocking, and the ONC Health IT Certification Program-regulating the API requirement along with protections against information blocking. The rule specifies the SMART/HL7 FHIR Bulk Data Access API, which enables access to patient-level data across a patient population, supporting myriad use cases across healthcare, research, and public health ecosystems. The API enables "push button population health" in that core data elements can readily and standardly be extracted from electronic health records, enabling local, regional, and national-scale data-driven innovation.