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HL7 FHIR DevDays 2020, Virtual Edition US, June 15–18, 2020 | @HL7 @FirelyTeam | #fhirdevdays | www.devdays.com/us

Extend Clinical Workflows using SMART on FHIR

Dharmesh Patel & Kalyan Pamarthy, Google Cloud Healthcare

2

Kalyan Pamarthy Product Manager, Google Cloud Healthcare API

Healthcare & Life Science

Dharmesh PatelSolutions Consultant

Healthcare & Life Sciences

Topics for today

● Patient Generated Data in Clinical Workflows

● SMART on FHIR based Architecture

● Case study and Demo

Extend Clinical

Workflows using

SMART on FHIR

4

1. Patient Generated Data in Clinical Workflows

Patient Generated Data (PGD)

● Health and wellness data self reported by Patients

● Data reported to Researchers for Medical Research

○ PRO measures from PROMIS (Patient Reported Outcome Measurement

Information System)

○ Quality of life Surveys, Mental Health Questionnaires etc...

● Data generated from Personal Health and Wellness Devices

○ Data collected from Blood Glucose monitoring device, Blood pressure

monitoring device

○ Data collected from Fitness devices

Challenges and Opportunities with Patient Generated Data

Patient Generated Data

A repository of all patient-specific

healthcare information stored by

a care delivery organization

Clinical Workflow

EMR Systems

PROMIS, Quality of life survey, Mental Health survey, etc..

Custom workflow

Survey Platforms

Glucose Monitoring data, BP

monitoring, Fitness data, Sleep

patterns, etc.

PHD Platforms

Technical

Context of Care

. . .

Custom workflow

PHD = Personal Health Device

Need a secondary data repository for Patient Generated Data

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2. SMART on FHIR based Architecture

Recommended Architecture: SMART Apps with Secondary FHIR Server

PGD Systems

Primary FHIR

Server

EMR UI

EMR Systems

SMART App for

Clinicians

Clinician

Secondary FHIR

Server

A launch

A.1 Get Patient(FHIR) B.3. Fetch

PGD

B.4 Write PGD(FHIR)

SMART App for

Patients

Patient

B.1 Get Patient(FHIR)

A.2 Get PGD(FHIR)

B.3. Enter PGD

A.3 Request PGD collection

(FHIR)

B.2 Get PGD Request

(FHIR)

PGD = Patient Generated Data

Patient Portal

launch

SMART Apps with Secondary FHIR Server: Key Concepts

● Secondary FHIR Server in Cloud to store and manage the PGD

● Patient-facing SMART Apps to fetch/collect PGD from end-users

○ SMART App write PGD back to a Secondary FHIR Store

● Clinicians launch SMART Apps from the EHR to access PGD

○ SMART Apps receives patient context from EHR

○ SMART App reads PGD from Secondary FHIR Store

● User experience is seamlessly integrated on the surface

○ PGD stays separate from Clinical/EHR data

○ Interaction and data exchange accomplished through SMART

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2. Case Study & Demo: Questionnaire Workflow

Case Study: Questionnaire Workflow

Primary FHIR

Server

SMART App

Launcher

Questionnaire App for

Clinicians

Clinician

Secondary FHIR

Server

launch

A.2 Get Patient(FHIR)

B.5 Write QuestionnaireResponse

& UpdateProcedureRequest

SMART App for

Patients

Patient

A.3. Get Questionnaire &

QuestionnaireResponse(FHIR)

B.4 Complete Questionnaire &

Submit

A.5 Write ProcedureRequest

(FHIR)

B.3 Get ProcedureRequest

(FHIR)

A.1 Select Patient & Launch

A.4 Assign Questionnaire

B.1 Sign In & Launch

De-Identified Data

de-identify

Data Analytics & ML Platform

export

Researcher

Primary FHIR

Server

SMART App

Launcher

launch

B.2 Get Patient(FHIR)

Let’s see it in action….