SMART on FHIR Genomics: facilitating standardized clinico-genomic apps

Alterovitz, Gil; Warner, Jeremy L.; Zhang, Peijin; Chen, Yishen; Ullman-Culleré, Mollie; Kreda, David; Kohane, Isaac S.

doi:10.1093/jamia/ocv045

Cited by 110 publications

(74 citation statements)

References 14 publications

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“…One potential solution would be to use the interoperable Fast Healthcare Interoperability Resources (FHIR) standard from Health Level Seven International, which uses the SMART platform (SMART on FHIR Genomics). 12 With increasing attention to the importance of standards in the interoperability of cancer-specific data, it is likely that the SMART on FHIR Genomics framework will be a solution for future exchanges of genomic information. 13 Although using such a standard would not necessarily resolve the process issues encountered during this implementation, it would facilitate implementation with vendor EMRs that support such data standards.…”

Section: Discussionmentioning

confidence: 99%

Implementing and Improving Automated Electronic Tumor Molecular Profiling

Rioth

Staggs

Hackett

et al. 2016

JOP

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Oncology practice increasingly requires the use of molecular profiling of tumors to inform the use of targeted therapeutics. However, many oncologists use third-party laboratories to perform tumor genomic testing, and these laboratories may not have electronic interfaces with the provider's electronic medical record (EMR) system. The resultant reporting mechanisms, such as plain-paper faxing, can reduce report fidelity, slow down reporting procedures for a physician's practice, and make reports less accessible. Vanderbilt University Medical Center and its genomic laboratory testing partner have collaborated to create an automated electronic reporting system that incorporates genetic testing results directly into the clinical EMR. This system was iteratively tested, and causes of failure were discovered and addressed. Most errors were attributable to data entry or typographical errors that made reports unable to be linked to the correct patient in the EMR. By providing direct feedback to providers, we were able to significantly decrease the rate of transmission errors (from 6.29% to 3.84%; P , .001). The results and lessons of 1 year of using the system and transmitting 832 tumor genomic testing reports are reported.

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Section: Discussionmentioning

confidence: 99%

Implementing and Improving Automated Electronic Tumor Molecular Profiling

Rioth

Staggs

Hackett

et al. 2016

JOP

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“…36 A consortium of EHR vendors are working together to test these standards. 28 The new FHIR standards also work in conjunction with APIs to allow easier development of consumer-facing applications 37 that may empower patients to take ownership of their health data.…”

Section: The Path Forwardmentioning

confidence: 99%

Health Information Exchange in US Hospitals: The Current Landscape and a Path to Improved Information Sharing

Holmgren

Adler‐Milstein

2017

Journal of Hospital Medicine

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Electronic health information exchange (HIE) was a foundational goal of the 2009 Health Information Technology for Economic and Clinical Health (HITECH) Act, but 7 years later we are far from a nationally interoperable health system. Connected electronic health records have the potential to enable fast access to a wealth of clinical data and can deliver a solution to the highly fragmented US healthcare system. In this review, we present a history and background of HIE, including its potential to deliver significant cost savings to the healthcare system. We examine the key components of HIE, including exchanges, the mechanism, and options available to providers. Health information exchange faces significant challenges, ranging from technical issues to lack of a clear goal, but continued policy initiatives and new technologies represent a promising path to providing clinicians with routine, electronic patient data. Journal of Hospital Medicine 2017;12:193-198. © 2017 Society of Hospital MedicineThe US healthcare system is highly fragmented, with patients typically receiving treatment from multiple providers during an episode of care and from many more providers over their lifetime.1,2 As patients move between care delivery settings, whether and how their information follows them is determined by a haphazard and error-prone patchwork of telephone, fax, and electronic communication channels.3 The existence of more robust electronic communication channels is often dictated by factors such as which providers share the same electronic health record (EHR) vendor rather than which providers share the highest volume of patients. As a result, providers often make clinical decisions with incomplete information, increasing the chances of misdiagnosis, unsafe or suboptimal treatment, and duplicative utilization.Providers across the continuum of care encounter challenges to optimal clinical decision-making as a result of incomplete information. These are particularly problematic among clinicians in hospitals and emergency departments (EDs). Clinical decision-making in EDs often involves urgent and critical conditions in which decisions are made under pressure. Time constraints limit provider ability to find key clinical information to accurately diagnose and safely treat patients. [4][5][6] Even for planned inpatient care, providers are often unfamiliar with patients, and they make safer decisions when they have full access to information from outside providers. 7,8 Transitions of care between hospitals and primary care settings are also fraught with gaps in information sharing. Clinical decisions made in primary care can set patients on treatment trajectories that are greatly affected by the quality of information available to the care team at the time of initial diagnosis as well as in their subsequent treatment. Primary care physicians are not universally notified when their patients are hospitalized and may not have access to detailed information about the hospitalization, which can impair their ability to provide high qu...

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“…As such, it includes genomic components known as FHIR Genomics API/specification integrated in its core. These genomics components evolved from the SMART on FHIR Genomics standard [65] and integrated work of the HL7 Clinical Genomics Workgroup, and the standard is based on the requirements of Meaningful Use 3.0. FHIR is an emerging standard for Electronic Medical Records (EMRs) and clinical apps being adopted by numerous vendors in the healthcare space.…”

Section: Fast Healthcare Interoperability Resources (Fhir)mentioning

confidence: 99%

Enabling Precision Medicine via standard communication of HTS provenance, analysis, and results

Alterovitz

Dean

Goble

et al. 2017

Preprint

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Abstract. Precision medicine can be empowered by a personalized approach to patient care based on the patient's unique genomic sequence. T o be used in precision medicine, genomic findings must be robust, reproducible, and experimental data capture should adhere to FAIR Data Guiding Principles. Moreover, precision medicine requires standardization that extends beyond wet lab procedures to computational methods.Rapidly developing standardization technologies improves communication of genomic sequencing by introducing concepts such as error domain, usability domain, validation kit, and provenance information. T hese advancements allow data provenance to be standardized and ensure interoperability. T hus, a resulting bioinformatics computation instance that includes these advancements can be easily communicated, repeated and compared by scientists, regulators, clinicians and others, allowing a greater range of practical applications.Advancing clinical trials, precision medicine, and regulatory submissions requires an umbrella of standards that not only fuses these elements, but also ensures efficient communication and documentation of genomic analyses. T hrough standardized bundling of HT S studies under an umbrella, regulatory agencies (FDA), academic researchers, and clinicians can expand collaboration to drive innovation in precision medicine with the potential for decreasing the time and cost associated with NGS workflow exchange, including FDA regulatory review submissions.

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SMART on FHIR Genomics: facilitating standardized clinico-genomic apps

Abstract: This prototyping work suggests that an entirely data (and web) standards-based approach could prove both effective and efficient for advancing personalized medicine.

Cited by 110 publications

References 14 publications

Implementing and Improving Automated Electronic Tumor Molecular Profiling

Implementing and Improving Automated Electronic Tumor Molecular Profiling

Health Information Exchange in US Hospitals: The Current Landscape and a Path to Improved Information Sharing

Enabling Precision Medicine via standard communication of HTS provenance, analysis, and results

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