Kukhareva Polina, Warner Phillip, Rodriguez Salvador, Kramer Heidi, Weir Charlene, Nanjo Claude, Shields David, Kawamoto Kensaku
Department of Biomedical Informatics, University of Utah, Salt Lake City, UT, USA.
AMIA Annu Symp Proc. 2020 Mar 4;2019:562-571. eCollection 2019.
SMART on FHIR applications are standards-based tools integrated with electronic health record (EHR) systems and intended for dissemination across EHR platforms. A key challenge for disseminating many apps is that EHR vendors provide different levels of support for FHIR. Thus, app developers must balance functionality versus portability. In this case study, a feature-rich app for neonatal bilirubin management was developed prioritizing physician-requested functionality, with custom FHIR interfaces implemented within the EHR as needed. Following wide intra-institutional use, several approaches are being pursued for adapting the app for cross-institutional dissemination: user surveys and interviews to identify least-valued app features which could potentially be omitted; enabling the application to provide differential features depending on available EHR FHIR capabilities; replacing custom FHIR interfaces with native EHR FHIR interfaces as they became available; and using a canonical logical data model known as QUICK that can be mapped to different FHIR versions and profiles.
基于快速医疗互操作性资源（FHIR）的智能应用程序是与电子健康记录（EHR）系统集成的基于标准的工具，旨在跨EHR平台传播。传播许多应用程序面临的一个关键挑战是，EHR供应商对FHIR的支持程度不同。因此，应用程序开发人员必须在功能与可移植性之间取得平衡。在本案例研究中，开发了一个功能丰富的新生儿胆红素管理应用程序，优先考虑医生要求的功能，并根据需要在EHR中实现自定义FHIR接口。在机构内部广泛使用之后，正在采取几种方法来调整该应用程序以进行跨机构传播：进行用户调查和访谈，以确定可能被省略的最不值钱的应用程序功能；使应用程序能够根据可用的EHR FHIR功能提供不同的功能；在可用时用原生EHR FHIR接口替换自定义FHIR接口；以及使用一种称为QUICK的规范逻辑数据模型，该模型可以映射到不同的FHIR版本和配置文件。
