The EHR App Store is Open – What is on the Shelf?

Electronic Health Records Software

Just about every major Electronic Healthcare Records Software (EHR) vendor nowadays attempts to stake a claim in “openness” – the ability to enhance its capabilities and interoperate with other systems and organizations using the latest plug-and-play technologies and emerging data standards.

A majority of the efforts in standardization and open access revolve around the Argonaut Project – a private industry initiative sponsored by leading EHR vendors and a number of major Healthcare institutions. The purpose of the Argonaut Project is to develop a specification for an API and Core Data Services based on the emerging HL7 FHIR standard as well as on the SMART platform originating from Boston Children’s Hospital.

The Argonaut Project and emerging standards like FHIR and SMART not only benefit institutions and EHR vendors, but they will also provide patients with an opportunity to take control of their own medical records and healthcare identity as these standards become mainstream.

At least three major EHR vendors – Epic, Cerner, and Allscripts now allow third-parties to openly build FHIR-driven applications and seamlessly authenticate application users into their systems using a SMART OAuth 2.0 profile. Following in the footsteps of Apple, Google and Amazon these vendors are building their own app stores to offer a selection of applications for patients and clinicians to choose from.

Here at First Line Healthcare, we have been closely monitoring the SMART on FHIR and Argonaut communities, participating in their activities and discussions, and building expertise in these technologies.

At the request of, and in collaboration with, the leading Patient Advocacy Organizations, we have developed applications for Epic, Cerner, and Allscripts on their respective app development platforms. The goal of this initiative has been to understand whether such applications are true as open and portable as the vendors claim them to be.

We’ve learned that our applications are indeed mostly portable not only within multiple institutions that are on the same vendor EHR but also work across all three vendors. Obviously, there were substantial differences in working with vendor Sandboxes (test environments) and there were some differences with how user authentication works between vendors. Most importantly, however, vendors and institutions impose different processes and control the exposure of the applications to users.

We are certainly a long way from the true “openness” of  EHR systems and portability of the patient record regardless of how well emerging standards have evolved. One of the key reasons is the reluctance of institutions and vendors to give up control over patient data. The government regulations and incentives as well as market forces however are putting pressure on the institutions and vendors that will eventually lead to lowering the barriers for open interoperability and patient custody of their own medical record.

For more detailed findings on the above initiatives and to discuss how emerging data and interoperability standards could affect and benefit your organization please contact our Healthcare IT Practice.

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