MAY 2014 Open Platform Architecture Based Upon SMART Apps Platform and the HL7 FHIR® (DSTU) Demonstrated at HIMSS14 By David Kreda, Translation Advisor, and Joshua Mandel MD, Lead Architect, SMART Platforms Project Harvard Medical School/Children’s Hospital Boston www.smartplatforms.org During the HIMSS14 Annual Conference (Feb- ferent internal architectures ruary 23-27, 2014 in Orlando, Florida), several and technologies, they healthcare IT exhibitors presented an eye-open- were nonetheless able to ing example of the potential of HL7’s newest supply the data via FHIR standard, FHIR® (Fast Healthcare Interoperabil- API calls made by the suite David Kreda ity Resources). The list of exhibitors included of SMART Apps that were Cerner, Intermountain Healthcare, Hewlett Pack- installed on their systems. ard, and Harris Corporation. They presented the Harris Corporation then SMART on FHIR Open Platform Architecture, demonstrated its services which combines FHIR and the open source, web- oriented architecture (SOA) standards based technology stack created by the service, which accepted SMART Platforms Project, a research effort based same FHIR API queries at Harvard Medical School and Children’s Hos- from the SMART apps, fed- pital Boston that enables real-time integration of erated queries to the same substitutable medical apps, or SMART apps, on EHR systems holding the EHR systems. patient data, and synthe- Josh Mandel, MD sized a cross system, longi- Three sophisticated EHR systems, including tudinal patient record, which was returned to the Cerner Millennium, HELP2 from Intermountain requesting SMART app. Healthcare, and VistA from the Veterans Health Administration, were each independently FHIR- Hewlett Packard, which engineered the SMART enabled in less than six weeks. With vastly dif- on FHIR implementation on top of VistA, de- scribed its implementation effort this way: Proof of concepts using the [SMART] platform funded by the [ONC] have been developed dem- onstrating how light-weight appli- cations can be rapidly developed, adopted and implemented using a predictable architecture, consistent API specifications and standards such as HL7’s new interoperabil- ity standard called [FHIR]. In less than three weeks, HP integrated two SMART applications (Blood Pressure Centiles and Cardiac Risk) with VA VistA platform in HP’s Ad- vanced Federal Health Innovation Lab (AFHIL). Josh Mandel, Lead Architect of SMART and a key member of the The SMART on FHIR® Open Platform Architecture FHIR Management Group (shown (HIMSS14 Handout) continued on next page ® Health Level Seven, HL7, CDA and FHIR are registered trademarks of Health Level Seven International, registered in the US Trademark Office HL7 NEWS May 14 COVER.indd 1 4/30/14 10:57:14 AM In This Issue... Open Platform Architecture, continued from page 1 Open Platform Architecture Based in the photograph to the Upon SMART Apps Platform & the right talking to Grahame HL7 FHIR DSTU............................. 1-2 Grieve, one of the origina- tors of FHIR, at HIMSS14), HL7 International and AEGIS.net, recounted his experience in Inc. Partner to Launch HL7 Conformance Testing Program....... 3 incorporating the FHIR API into SMART’s technology Update from Headquarters.......... 4-6 model. “It was something we could do quite quickly, What is Draft Standard for because FHIR and SMART Trial Use (DSTU)?.......................... 6 are remarkably similar in FHIR Connectathon........................ 7 how they focus on granu- lar data access. FHIR has Trillium Bridge Project............... 8-9 the advantage of a larger data vocabulary for many European Patient Summary real-world needs and, of Guidelines............................... 10-11 course, being a community Upcoming International Events.... 11 adopted standard.” Josh Mandel and Grahame Grieve at HIMSS14 Why I Became a Certified SMART on FHIR is EHR vendor-agnostic on technology holds the promise of materially Professional................................... 12 the application side. All SMART apps pre- increasing the value of their systems by mak- What is Your Definition of a sented at HIMSS14 were only coded once and ing them open to the inclusion of apps and Clinician?...................................... 13 make identical FHIR calls to all EHR platforms. services developed by providers, researchers, Of course, vendors were free to expose any of and others. Early History of HL7, Part 2.... 14-15 the SMART apps in any manner they elected. In one example, the vendor screened patient The SMART Platforms team now believes UML Profile for MIF Static context so that the SMART app would launch Models.................................... 16-18 that the accelerated adoption of HL7’s FHIR only if appropriate, showing how a tailored standard can not only advance the SMART Member Spotlight on and uninterrupted clinical workflow environ- team’s objective for promoting substitutable Anita Walden................................ 19 ment can be implemented to incorporate third apps sooner, but also generate an even larger party apps. market place for vendor-neutral shared clinical HL7 Benefactors............................ 20 data repositories, decision support systems, Life in the TSC and HL7- The SMART apps shown at HIMSS14 on clinical knowledge bases, and more. What is Next............................ 20-21 SMART on FHIR platforms included two apps developed by SMART (the SMART Pediatric About SMART News from the PMO.................... 21 Growth Chart App, winner of the 2014 Red Dot SMART’s Principal Investigators, Isaac Design Award, and the SMART Blood Pressure Kohane, MD, PhD and Kenneth Mandl MD, Congratulations on Passing the HL7 Certification Exams.......... 22 Centiles App), one by Polyglot Systems, Inc. MPH, proposed how an ecosystem approach (the Meducation® App), one by Logical Images, would usher in an era of accelerated innova- HL7 Organizational Members... 23-25 Inc. (the VisualDx® diagnostic clinical decision tion that would increase the utility, quality, support system), and one by Intermountain® value, and flexibility of EHR systems (No 2014 Technical Steering Healthcare (the Bilirubin app). David Kreda, Small Change for the Health Information Committee Members .................... 26 Translation Advisor for the SMART Project, Economy, NEJM 2009). In 2010, Harvard Steering Divisions......................... 26 observed that “these examples of data-aware Medical School and Boston Children’s Hos- external SMART apps running unchanged on pital received a $15 million award from the HL7 Work Group Co-Chairs......27-29 EHR systems that adopt SMART on FHIR show US Office of National Coordinator (ONC) to how the right technologies can make a big con- develop ways to promote the interoperabil- HL7 Facilitators...................... 30-31 tribution to clinical IT innovation.” ity of clinical data stored in EHR systems by Affiliate Contacts.......................... 32 lowering barriers to absorbing medical apps For EHR vendors, FHIR’s incrementally imple- into existing EHRs. HL7 Staff Members....................... 33 mentable API and SMART’s developer-friendly 2014 Board of Directors.............. 34 HL7 FHIR Institute and Meaningful Use Implementation Workshop........... 35 is the official publication of: Health Level Seven International Upcoming Working Group 3300 Washtenaw Avenue, Suite 227, Ann Arbor, MI • 48104-4261 USA Meetings...................................... 36 Phone: +1 (734) 677-7777 • Fax: +1 (734) 677-6622 • www.HL7.org 2 Mark McDougall, Publisher • Andrea Ribick, Managing Editor • Karen Van Hentenryck, Technical Editor HL7 NEWS May 14 COVER.indd 2 4/30/14 10:57:20 AM HL7 International and AEGIS.net, Inc. Partner to Launch HL7 Conformance Testing Program By Andrea Ribick, HL7 Director of Communications HL7 and AEGIS.net (AEGIS) launched Mario Hyland, Senior Vice President of AEGIS said, the new Conformance Testing Pro- “AEGIS is proud to partner with HL7 International to gram for HL7 standards at HIMSS bring its members a unique benefit offering HL7-spe- 2014. The HL7 Conformance Test- cific conformance testing for continuous interoperability ing Program provides a platform for through the AEGIS DIL. The DIL’s automation and ease Andrea Ribick ongoing, iterative testing that helps of use will help ensure that HL7 conformance testing healthcare IT developers get highly truly adds value without creating inefficient layers of interoperable products to market quickly and cost-ef- complexity.” fectively. The testing program will make interoperability significantly more efficient for vendors and implement- The entire HL7 International community, including af- ers by reducing interface development time and costs. filiates, benefits from this shared testing service, which can eventually be used to identify test cases that are “We chose to partner with AEGIS because they’re an sufficiently mature to comprise a certification program. industry leader in the testing of interoperability between Participating in this program takes the burden off of Health Information Technology systems and HIEs,” said vendors to validate technical interoperability and offers Charles Jaffe, MD, PhD, CEO of HL7 International. “Go- vendors a major market differentiator. This effort also ing forward, HL7 anticipates using the AEGIS Develop- builds upon and accelerates consensus toward national ers Integration Lab to provide a testing platform for all standards, EHR certification criteria, and testing proce- new standards.” dures for Stage 2 of Meaningful