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App story - proud to help improve quality of cancer care

At FHIT.IO, we are continuously looking for opportunities to work with our customers to for new projects and initiatives to expand and extend their current EHR system, to meet their ever changing business requirements. FHIR (Fast Health Interoperability Resources) is an open standard promoted by HL7, a not for profit organization that has been developing healthcare data standards over 30 years now. FHIR identifies itself to alleviate many of the biggest challenges in the healthcare industry of which the most complex problem is "data interoperability". FHIT.IO we have invested years into the implementation of FHIR related technologies and solutions. This is one of the projects that we fully used the advantage of openness and interoperability offered by FHIR, helped our customer to address new business needs, and compliment to their existing EHR system and workflow. Our Customer: A leading UK based hospital, which has a home grown EHR and Hospital Information system, was looking for solutions, to modernize and extend their current EHR infrastructure. They requested the FHIT team to build a portal for a new initiative to improve their cancer care diagnosis workflow management. The hospital administration had requested the project to be built using FHIR technology as that is becoming the norm with providers who are adaptive with technology which aides in administering better care for their patients. This would allow the hospital administration to see how easy it would be to build external, inexpensive applications, tailor made for each department needs. Our Project: When a physician suspects a patient of having cancer, the hospital is required to rule in or rule out cancer, within 14 days. The hospital's existing EHR system does not have an efficient way to add new workflow to adapt such requirement. Providers are under pressure in following up such patient’s case files. It adds complexity to the current standard procedures, adds extra heavy workload on physicians resulting in delay in ordering lab tests, delays in getting the results back into the system, delay in specialist referral, etc. The goal of this project is to build an application exclusively to handle such cases, to guarantee a cancer diagnosis within 14 days of the patient initial relevant encounter. The hospital wanted to build a separate application, outside of standard EHR interface, while integrated with their current EHR for information sharing and interoperability. Our Solution:

FHIR based app design

Our design approach starts with the OAUTH Single-Sign-On which allows seamless integration with the existing workflow for the physicians and enables physician to launch the new dashboard without additional login or authentication. The dashboard was created to custom fit the specific needs of the project which required us to deliver patient encounters, reports and charts. Data analysis was run with specific physician based criteria to create alerts and initiate collaboration. The integration with the existing EHR system was made possible by exposing specific entities (required only for this project) using the FHIR layer and a secured FHIR database storing all relevant medical information which can then be retrieved to run analytics. FHIR Engine Repositiory stores all the records for this application – Patient, Encounter, Practitioner, Observation, Procedure, Diagnostic Report, Clinical Impression, Care Plan, Goal, Condition, Medication Request, Medication Statement, Allergy Intolerance, etc.

Cancer Care Dashboard workflow Overview

The workflow above is initiated as a search which shows a patient “Encounter” details, with initial “Condition” suspected to be Cancer by looking for specific SNOMED CT, ICD10 codes and can show if next steps like ordering relevant lab tests are performed (using “Diagnostic Report” FHIR resource). After which it displays if the lab test carry special information or if the patient has been referred to a specialist. If yes, then it shows the “Practitioners” details, and the time taken from the date of first “Encounter”.

Dashboard capture of a Prototype Clinical Status page

Dashboard capture of a Prototype Verification Status page

The project was a huge success. It addressed the special needs for this initiative, seamlessly integrated with existing daily workflow process and ensured the project stayed on budget.

-Team FHIT

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