Population Health App May Facilitate Large-Scale Data Sharing

December 23, 2020 - A population health app may allow payers to access permitted data and metrics on covered populations, potentially creating a foundation for pay-for-performance and assessment of value-based care.

In a recent ONC blog post, Tracy Okubo and Kenneth Mandl describe the SMART-PopHealth app, a tool developed at Boston Children’s Hospital with a two-year, $1 million grant awarded through the Leading Edge Acceleration Projects (LEAP) in Health IT funding opportunity. LEAP supports innovation to address emerging challenges and advance interoperability in health IT.

The authors noted that apps could help promote large-scale data sharing among providers, payers, and public health officials.

“Because of advances in interoperability, it’s becoming increasingly common for people and their healthcare providers to access and share information from EHRs using apps.  An app providing shared insights into a common dataset could transform the way value-based care is delivered and measured,” Okubo and Mandl wrote.

“Hospitals could share subsets of EHR data with payors while using the system to gauge their own performance in terms of patient safety, quality, and value of care. Payors, in turn, could share claims data. By analyzing data from both EHRs and payor claims, it would be possible to discern trends in healthcare processes, outcomes, and costs, reflecting what is happening at the population-level.”

As part of the Strategic Health IT Advanced Research Projects (SHARP) program, ONC previously awarded $15 million in April 2010 to the Computational Health Informatics Program (CHIP) at Boston Children’s Hospital.

The award was for the development of a universal application programming interface (API) called Substitutable Medical Applications, Reusable Technologies (SMART). Researchers aimed to enable EHRs to behave similarly to smartphones.

The team combined SMART APIs with the emerging Health Level 7 (HL7) FHIR standard, and SMART on FHIR now supports apps that run universally on health IT systems that access and use data in individual EHRs.

The goal of this LEAP project was to build on established momentum and develop a system for accessing and analyzing at scale data on whole populations rather than one patient at a time. The population health app builds on the team’s more recent work defining an API called the SMART/HL7 FHIR Bulk Data Access API, Okubo and Mandl said.

“The FHIR Bulk Data Access API is the population-level counterpart of SMART on FHIR that is used in SMART-PopHealth. The output is an easily consumable flat file also referred to as ‘Flat FHIR,’” the authors stated.

“Existing APIs that use HL7 FHIR work well for accessing small amounts of data, but large exports can require hundreds of thousands of data requests. The FHIR Bulk Data Access API’s standardized data export function makes it easy to extract large amounts of EHR data, and the data format is the exact same everywhere.”

Boston Children’s Hospital set out to use the Bulk Data Access API to create a seamless data exchange between provider organizations and third parties, using the exchange of EHR and claims data between a provider and payer as a use case.

The team designed, developed, and tested a substitutable population health app, SMART-PopHealth, which allows a payer to access permitted data and metrics on covered populations directly through the API. Researchers tested the SMART-PopHealth app using synthetic data from more than one million patients, representing about 24GB of data.

The app has the potential to improve interoperability throughout the healthcare industry.

“The model of shared payer-provider data made possible with SMART-PopHealth could create a new basis for pay-for-performance, assessment of value-based care, and approaches to quality management,” Okubo and Mandl concluded.

“This LEAP in Health IT project helps shift us away from the current reporting model, where providers often send payers an annual report or spreadsheet with summary data. In contrast, SMART-PopHealth presents data on an ongoing basis in a live, interactive environment, with permissions to view or download data contractually defined and enforced in the software.”