DIHI has been focused on creating a framework that would enable any device or platform to access an Epic-based EHR.  This enables developers to build apps that can be integrated with patient data within Epic.  With the goal of ease of use and interoperability, DIHI joined the SMART (Substitutable Medical Apps and Reusable Technologist) efforts happening at Boston Children’s Hospital.  The code for our framework is now SMART and FHIR (Fast Healthcare Interoperability Resources, supported by HL7) compliant. 

In addition to the framework, DIHI is involved in building both provider and patient facing technologies and apps that help enhance the delivery of care to patients and improve care coordination.  The goal is to address important problems encountered by care providers, patients and their loved ones both at Duke and nationally across the country. 

Digital Health Accelerator 

Digital health technologies have already begun to revolutionize how providers can create efficiencies in clinic and also how patients can achieve better health. In order to take a company that has a prototype and “accelerate” it through proper validation of the technology and business model, digital health accelerators have been created throughout the United States and world to provide that support to new companies. The current problem that exists is that many companies have novel technologies but are not integrated into the clinical workflow and therefore will not gain adoption by patients or providers.  

To combat this, through the work of the technology pillar of DIHI, we are planning a new digital health accelerator that not only provides business support to new companies but can validate the technology within the clinical workflow of the provider and patient. DIHI plans to utilize the wealth of mentorship ranging from faculty to administrators at Duke but will also leverage the work invested in jointly by DIHI and Duke Health Technology Solutions (DHTS) to ensure that proper integration and validation occur. 

This accelerator will be the first of its kind to not only provide business support and validation of the technology, but truly validating that the technology within the clinical workflow. For information on this accelerator, and if you interested in opportunities to partner on a novel digital health accelerator.  

DASH: Duke Apps Supporting Healthcare 

Current EHRs are among the most complex pieces of software ever written. They serve a critical role to help standardize clinical workflow, facilitate billing, and integrate simplistic forms of clinical decision support, yet tremendous effort is required to customize these systems to meet the needs of diverse hospital systems. 

We felt there had to be a better way. 

Starting in 2012 DIHI started investigating ways to create a framework built on top of our Epic-based EHR that would allow us to access the EHR in a standard way from any device or platform. By the summer of 2013 we had a functional proof of concept that allowed us to access patient demographics, problem lists, medications and more from a simple Android app. Duke Apps Supporting Healthcare, referred to internally as DASH, was born! 

Around this same time, we started learning more about a similar effort underway at Boston Children’s Hospital called SMART (Substitutable Medical Apps and Reusable Technologist) that incorporated a new REST-based open API called FHIR (Fast Healthcare Interoperability Resources, supported by HL7). Since DIHI’s goal was general ease of use and interoperability, it made sense to join this effort, originally funded by the ONC via the SHARP program. There were already many proof-of-concept apps written to be SMART on FHIR compliant, so from a practical standpoint, this made sense. 

We updated our code to be compliant with both SMART and FHIR and as of January 2015 we became the first Epic-based hospital system to run SMART apps on our EHR. We presented this work at the HIMSS 2015 national conference, and you can view the demonstration here: 

DIHI now looks forward to further refining this platform and working with other institutions to test this technology to ensure it will serve us well for years to come. To that end, we’re participating in the Argonaut program as an Implementer. This will serve as the backbone for many of the innovations here at Duke that require high-quality real-time medical data.

Insights in Innovation (Articles by DIHI staff and affiliates)