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CC BY-NC-ND 4.0 · Appl Clin Inform 2022; 13(05): 1163-1171
DOI: 10.1055/s-0042-1758736
Case Report

Integrating a Patient Engagement App into an Electronic Health Record-Enabled Workflow Using Interoperability Standards

David F. Lobach
1   Elimu Informatics, El Cerrito, California, United States
,
Aziz Boxwala
1   Elimu Informatics, El Cerrito, California, United States
,
Nitu Kashyap
2   Yale New Haven Health, New Haven, Connecticut, United States
,
Krysta Heaney-Huls
3   NORC at the University of Chicago, Bethesda, Maryland, United States
,
Andrew B. Chiao
3   NORC at the University of Chicago, Bethesda, Maryland, United States
,
Thomas Rafter
2   Yale New Haven Health, New Haven, Connecticut, United States
,
Edwin A. Lomotan
4   Center for Evidence and Practice Improvement, Agency for Healthcare Research and Quality, Rockville, Maryland, United States
,
Michael I. Harrison
4   Center for Evidence and Practice Improvement, Agency for Healthcare Research and Quality, Rockville, Maryland, United States
,
Chris Dymek
4   Center for Evidence and Practice Improvement, Agency for Healthcare Research and Quality, Rockville, Maryland, United States
,
James Swiger
4   Center for Evidence and Practice Improvement, Agency for Healthcare Research and Quality, Rockville, Maryland, United States
,
Prashila Dullabh
3   NORC at the University of Chicago, Bethesda, Maryland, United States
› Author Affiliations Funding This work is based on research conducted by NORC at the University of Chicago under contract to the Agency for Healthcare Research and Quality (AHRQ), Rockville, Maryland, United States (contract no.: HHSP233201500023I).
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Abstract

Background Patient use of mobile health applications is increasing. To promote patient-centered care, data from these apps must be integrated into clinician workflows within the electronic health record (EHR). Health Level 7 Fast Healthcare Interoperability Resources (FHIR) offers a standards-based application programming interface (API) that may support such integration.

Objective We aimed to use interoperability standards to integrate a patient mobile application (coronavirus 2019 [COVID-19] Tracker) with an EHR. The COVID-19 Tracker engages patients by sending introductory and reminder text messages, collecting vital signs and symptom data from COVID-19 patients, and providing actionable guidance if concerning issues are identified. This case report explored the use of FHIR APIs to integrate the app into EHR-enabled clinical workflows.

Methods The authors used notes from project meetings and from semistructured discussions among the application development team to track the design and implementation processes. Seven points of integration between the application and the EHR were identified, and approaches using FHIR to perform these integrations were delineated.

Results Although this clinical decision support integration project benefited from its standards-based approach, many challenges were encountered. These were due to (1) partial implementation of the FHIR standard in the EHR, particularly, components needed for patient engagement applications; (2) limited experience with the adoption of FHIR standards; and (3) gaps in the current FHIR standard. Alternative approaches, often not based on interoperability standards, were developed to overcome these limitations.

Conclusion Despite the challenges encountered due to the early stages of FHIR development and adoption, FHIR standards provide a promising mechanism for overcoming longstanding barriers and facilitating the integration of patient engagement apps with EHRs. To accelerate the integration of apps into clinical workflows, additional components of the FHIR standard must be implemented within the EHR and other clinical systems. Continued expansion of available FHIR resources will help with tighter workflow integration.

Keywords

clinical decision support - interoperability standards - patient-generated health data

Authors' Contributions

All authors made substantial contributions to the conception, design, and execution of this research. All authors participated in drafting the manuscript or revising it critically for important intellectual content and gave final approval of the version published.


Data Availability Statement

The data underlying this article are available in the article.


Protection of Human and Animal Subjects

The study was performed in compliance with the World Medical Association Declaration of Helsinki on Ethical Principles for Medical Research Involving Human Subjects and was reviewed by the NORC and Yale New Haven Health System Institutional Review Boards.




Publication History

Received: 13 April 2022

Accepted: 29 September 2022

Article published online:
14 December 2022

© 2022. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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