This Week in Health IT
September 23, 2020

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September 23, 2020: Deep dive into FHIR. Kevin Maloy, MD with MedStar Institute for Innovation walks us through the process of developing our first FHIR app. What are some of the healthcare problems that lend themselves well to this technology? Where do I start? How do I access it? Does every EHR automatically have FHIR turned on? Are there different versions? FHIR unleashes the potential to do things that normally take too long for Cerner and Epic to do. Now we can do it ourselves.

Key Points:

  • What are some healthcare problem sets that lend themselves well to FHIR? [00:06:54] 
  • FHIR gives patients the ability to read their information and gives providers the ability to create as well as read [00:13:35] 
  • Apple Health example [00:20:52]
  • Bulk FHIR for multiple patients is supposed to come out within the next three years [00:22:07]
  • FHIR DevDays Virtual conference
  • patient.dev

Developing a FHIR App

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Developing a FHIR App with Kevin Maloy, MD with MedStar

Episode 307: Transcript – September 23, 2020

This transcription is provided by artificial intelligence. We believe in technology but understand that even the smartest robots can sometimes get speech recognition wrong.

[00:00:00] Bill Russell: [00:00:00] Before we get going. I want to make you aware of one thing. We’ve launched clip notes. Now, you know that, but let me tell you what’s going to happen. You’re going to get busy and you’re gonna miss a couple of episodes. You’re going to wonder what happened. Wouldn’t be great. If you had an email for each episode that had key moments in bullet point format.

[00:00:17] So you can just view and see what was said on the show. You could see who was on the show and then it had one to four short clips. Of one minute to about three minutes of key moments from the show that you could share with your [00:00:30] team or that you could just watch real quick. I know that happens to all of us.

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[00:01:03] [00:01:00] Welcome to This Week in Healtyh IT where we amplify great thinking to propel healthcare forward. My name is Bill Russell, healthcare, CIO, coach, and creative. This Week in Health IT is a set a podcast videos and collaboration events. It’s dedicated to developing the next generation of health leaders this episode.

[00:01:17] And every episode, since we started the COVID-19 series, that’s been sponsored by Sirius Healthcare. Now we’re exiting in that series and Sirius has stepped up to be a weekly sponsor of the show through the end of the year. Special thanks to Sirius for supporting the show’s efforts [00:01:30] during the crisis and beyond.

[00:01:33] I’ve been wanting to do an episode on FHIR, but more specifically, I’ve been wanting to do an episode on developing an application around FHIR for quite some time. And I just haven’t gotten around to it. And in today’s episode, we are going to be really diving deep into FHIR, and I’m excited to have Dr. Kevin Malloy with the MedStar innovation. Institute, I’ve met at MedStar [00:02:00] Institute for innovation, MI2 on the show. And I became aware of him. He and I connected. He’s a listener of the show. We connected a little while back. He has shared some stuff with me. He has since produced some videos. He has some meetups that he pulls people together who are looking to write FHIR apps.

[00:02:17] And I thought. Great opportunity to have a conversation around what it takes to develop a FHIR application, in healthcare. So here’s the show. Hope you enjoy. 

[00:02:27] All right, today, we are going to explore a [00:02:30] topic that I have been very interested in for a while. And I found a. I don’t know if he’ll be offended by this, but I find, I found a doctor who’s also a nerd and informaticist. Kevin Malloy is a doctor. He works for the, he works with the MedStar Institute for innovation MI2. And I’m looking forward to having this conversation. We’re actually going to walk through the process of developing my first FHIR app. So Kevin, welcome to the show. 

[00:02:54] Kevin Maloy, MD: [00:02:54] Yeah, thanks for having me. I’m a longtime listener actually. I think what you’re doing is great. [00:03:00] 

[00:03:00] Bill Russell: [00:03:00] I appreciate that. It’s, I actually recorded my 300th episode today, so we’re recording a little bit before it will. We’ll air, our episode will air, but today is actually the day, September 8th, we aired our 300th episode.

[00:03:15]so thanks for being a listener, but I am, I’m really jazzed about this. Cause some people know this. I, I was a am a CIO, but really a CTO by training. I started my career as a developer. Now we don’t write many [00:03:30] Dbase apps anymore, Dbase three, or Dbase four apps or Fox based or Fox pro apps.

[00:03:35] But, but I still have some of those skills. and I was wondering, can I translate some of those skills into where we’re going? but before we get there, give us a little background of your background. with regard to FHIR development and, what you’ve been doing.

[00:03:50] Kevin Maloy, MD: [00:03:50] Sure. so probably like you, self-taught in kind of web, like HTML JavaScript. when I was in med school, I was fortunate enough to, Be able [00:04:00] to learn how to code in a way with, a group at MedStar health went by Mark Smith. Who’s now the chief innovation officer at MedStar health. he’s an ER doc and I randomly reached out to him and being like, I’d like to learn how to code.

[00:04:12]and he said, sure, come over. And we’ll have somebody teach you. so I did a month with him. And, I swore I’d never do it again. I don’t know if anyone else who, you’re like, it took me like a month to get the number two from a database onto a webpage or something like that.

[00:04:25] And I was reading the JavaScript Bible. I don’t know, it was like this thing that was this big [00:04:30] and, it was right around like YouTube videos coming out where you can learn to code on your own and stuff like that. But I swore I’d never do it. again, but then I ended up doing residency inside it as emergency department. And I, started realizing that there’s a lot of cool stuff I could make for myself when I’m practicing clinically, to, to just make the job easier and keep patients a little safer. so I started making stuff in web and HTML and a system called Axisci at that time, which you hadn’t invented and it subsequently got sold to [00:05:00] Microsoft and was Amalga.

[00:05:01] Now it’s carried on. so I started making web stuff, flash forward to now I still work at MedStar. but the web technology stuff is still applicable. because of FHIR. in Cerner and Epic, a lot of them behind the scenes actually like web based in a way. but, FHIR is like moving 100%.

[00:05:20]it lends itself 100% to web as well as iOS and Android and that type of stuff. so what I do day to day, I still see patients clinically and I’m still able to [00:05:30] like dog food, my own, Stuff that I make. but I also chaired a FHIR steering committee at the health system. yeah, about quarterly, we meet up with the CIO, the CMIO, the CNO kind of make sure our APIs are on track.

[00:05:43]I also host a bunch of educational sessions throughout the, health system and the idea of, yeah, those is that, our goal at the innovation Institute is to catalyze innovation. So we don’t necessarily get consumed five years from now. I’m probably not going to be doing FHIR anymore because it’s [00:06:00] just going to be the way things are done in the organization.

[00:06:02]but what we do now is we catalyze in one way to catalyze is by educational events for, people who are, coders out in the enterprise. So like people from. Radiation oncology or radiology or custom dev team, or like core team, that type of stuff, just to have an educational event for them to learn how to use FHIR and kind of incorporate it into their, 

[00:06:25] Bill Russell: [00:06:25] and now you’re doing meetups on helping people to, yeah.

[00:06:28] Kevin Maloy, MD: [00:06:28] Yeah. So I, as a little side [00:06:30] project, I’m trying to teach, patients how to code, to use the FHIR API’s, cause one of the observations I don’t know about you when you were doing Dbase and stuff like that, the best way to learn is to have a problem and patients have the problem of, whatever’s going on in their healthcare journey.

[00:06:45]so I try to teach them how to, if they have a problem, how to actually use FHIR to maybe help them in some way. Or a family member 

[00:06:54] Bill Russell: [00:06:54] will give us an idea of some of those problems. So what are some examples of the applications that you’ve written and what are some problem sets [00:07:00] that lend themselves well to FHIR where it’s at today?

[00:07:03] Kevin Maloy, MD: [00:07:03] Yup. Yup. one thing, probably the starter and where we started with this was just, Installing like a inside of your environment, the basic growth chart app, which is like a provider facing app where providers in Cerner or Epic and they click a button and it opens up this FHIR app.

[00:07:20] And you don’t know you’re using a FHIR app, but it’s code that’s written by Boston Children’s and it’s free. And it pulls in the height and weight and makes us really nice graphical [00:07:30] user interface. For the doc to plot out, the, the growth chart for the patient. And then there’s like a, parent facing one.

[00:07:36] So you could turn the screen around and they can look at it and they can print it out for the parents too. so a lot of people, start out, I think in, we did two just with the growth chart app and like an open source available, app that you can plug into your EHR for providers. The other thing, people, I think probably then move on to I’m some kind of single sign on stuff.

[00:07:57]and the way FHIR works, it’s  actually [00:08:00] smartFHIRe. There’s a way to authenticate and then there’s a way to get data out. And what you can do is use that authentication mechanism to embed. Something that you are here on to making providers go into, like a browser window and enter their username password into, and then pull it up over there.

[00:08:18] So an example, and Medstar was one of the really early things we did was embed our anti bio gram, which was this little website that was outside of her ear. We embedded it within an EHR and you just click on and a button [00:08:30] and it opens and you don’t have to put a username password or anything like that.

[00:08:33] There, some other stuff we’ve moved on to is, we’re using FHIR for, research grants. so there’s a large human factors group at MedStar health that got a leap grant from the office of national coordinator. And what we were able to do with them was to embed. A risk calculator inside of the provider’s workflow.

[00:08:53] So in certain there’s a little workflow thing you can scroll down. and one of those you usually have like meds and [00:09:00] conditions and, like upcoming appointments, that type of thing. We’re able to put a box there that was actually a FHIR app that calculated their cardiac risk score. 

[00:09:09] Bill Russell: [00:09:09] so you’re using it a fair amount internally. You’re the same, quite frankly, the same way we used to build access databases is what you made. It just sound like not quite as insecure and not quite as messy in the backend, but almost as easy. it’s sitting there going look, if you know how to access APIs and you now have to create a single sign on.

[00:09:29]you’re going [00:09:30] to have access to this data set, and then you can embed it wherever you need to embed it. And you can launch it on a mobile app or on a anywhere you need to launch it. that’s what you’re making it sound like. And again, you’re educating me, so feel free to correct me. 

[00:09:43] Kevin Maloy, MD: [00:09:43] No. No, absolutely. I don’t know if, you ever went to any training courses at like Epic, like I did physician builder and I went there and, it struck me that there’s this whole educational system built up around training and maintaining your EHR because it’s so custom. [00:10:00] the cool thing about FHIR is that it’s all just regular web technology.

[00:10:04]if you have a regular web. Developer, you can just point them at this spec that’s online and they can go at it. They don’t really need, they need maybe a little like bump of energy to get them over. Yeah. Using it. I’ve taken people within an hour. I took one of the radiology people and now he’s integrating.

[00:10:21] FHIR data into PACS. he knows a bunch of web. so it’s not I think one of the things that is unique about FHIR is its [00:10:30] existing stuff that people already know how to do. It’s not like I got to go and, do something about, NPH development or CCL development is just. Web development.

[00:10:40] Bill Russell: [00:10:40] Alright, so you’re going to walk me through this and we can go in two directions. I’m going to go to the easier direction first. And that is I work for a health system, So I work for health system. We are, we’re just like everybody else. So we have multiple EHR. Yeah. we have a clinically integrated network that has some Cerner our core system might be Epic.

[00:10:59] We might have [00:11:00] some touch works and that kind of stuff. But I have this idea for, presenting a set of metrics of some kind across the entire clinically integrated network. What questions? So I’m a physician I’m sitting there going, Oh, I’m listening to this podcast. I know that I could do some things with FHIR. What kind of questions do I ask at this point? 

[00:11:19] Kevin Maloy, MD: [00:11:19] What kind of questions. Can you ask FHIR? 

[00:11:22] Bill Russell: [00:11:22] Yeah. What kind of questions would I ask my health system? Like where do I go? How do I access it? Does every EHR automatically have FHIR turned [00:11:30] on? Is there certain versions of FHIR? Where do I start? 

[00:11:34] Kevin Maloy, MD: [00:11:34] Yup. Yup. if you’re at a, Cerner Epic shop, you just go to FHIR.cerner.com or epic.cerner.com.

[00:11:40] And it has all the documentation publicly available to tell you how to use the authentication and what data is. And the APIs like, they have a list of all the available APIs, like the ability to read documents or to create documents in EHR. the ability to read labs, the ability [00:12:00] to get radiology reports, 

[00:12:02] Bill Russell: [00:12:02] any chance it’s not turned on, or is it just, is it required to be turned on at this point?

[00:12:06] Kevin Maloy, MD: [00:12:06] Yeah. So that’s cures act, Is, you gotta have these APIs to be a 20, 15 certified EHR technology. To be 2015 certified and to report in MIPS, you have these APIs somewhere. they are probably turned on because you’re probably attesting to, like MIPS, information blocking stuff.

[00:12:25] So more likely than not they’re turned on. if you have physicians or. [00:12:30] Parts of your team that are interested in building stuff with it. Really you just need to check out the documentation at like FHIR dot Cerner, FM, or FHIR.epic.com. and you gotta like internally, you gotta make some stuff like inserts and pref mean you gotta change a few things to get stuff to show up, but it’s relatively not a heavy lift.

[00:12:50] Bill Russell: [00:12:50] There has to be a target, right? So internally I’m going there to get the documentation. But internally at MedStar, there’s a URL or a target to. [00:13:00] To get to the data or get to the  APIs, 

[00:13:03] Kevin Maloy, MD: [00:13:03] right? yup. Yup. yup. So so MedStar will have its own FHIR URL, And, let’s say, Beaumont will have its own FHIR. URL and Hopkins will. you can actually see some of these if you’re interested in them. If you go at least for the Epic shops, they’re at, open, not epic.com and you can go to FHIR endpoints and you can see all the patient facing end points. They’re not going to be the internal provider facing endpoints because [00:13:30] FHIR, depending on who you are accessing, it will give you different information.

[00:13:35] Like it will give patients. The ability to read their information, but providers that’ll give you the ability to like create and, as well as read information. but the URLs themselves, at least for patient access are publicly available for Epic. I think Cerner is going to be coming with that and a little bit because it cures, for the provider one, you’d probably have to write, reach out to ’em like you’re. internal IS team, although you [00:14:00] could figure it out 

[00:14:01] Bill Russell: [00:14:01] we have a lot of it listeners right now who cringed and a lot of other people are like, yeah, tell us how to do that. Yeah. 

[00:14:08] Kevin Maloy, MD: [00:14:08] Yeah. Yeah. the interesting thing about a FHIR that, and I remember we were talking once about plumbing and how FHIR is like plumbing.

[00:14:16]And one of the interesting things about FHIR is you’re probably thinking of, your organization as everything behind you, your FHIRwall, and there’s a few public access, slight points and whatnot, but yeah, it’s very designed. FHIR is, [00:14:30] has to have a public access component so that patients can access it.

[00:14:33] So your provider API is, are probably just piggybacking off of those in some ways. so a lot of this stuff is beyond your FHIRwall. and, and it’s probably a different way of thinking about your EHR and where it’s like touching and where your plumbing is going. cause it’s going out into, in the, into the.

[00:14:50] Worldwide web, which is not to say that it’s, this is like something new for the worldwide web, Google, 

[00:14:57] Bill Russell: [00:14:57] Yeah. We’ve been doing, we’ve been doing this for [00:15:00] eons essentially. 

[00:15:01] Kevin Maloy, MD: [00:15:01] And it’s really just, Oh, walk two. Plus the rest API. That’s all that this essentially is. And it’s technology that people already use every day in a very public fashion. 

[00:15:10] Bill Russell: [00:15:10] All right. So let’s level set here. Not all data is available, right? what kind of data sets might not be available? 

[00:15:16] Kevin Maloy, MD: [00:15:16] Yup. Yup. why don’t I step back and just say that, just to underscore point that there’s three main roles to get data in FHIR, right?

[00:15:24] There’s going to be a patient facing role. So that’s me, I’m a patient. I log in [00:15:30] to FHIR with my youth, my patient portal, username password. And I can read that about myself right now. I currently can’t write anything. But I can read stuff out. And this is what. Apple health uses, right? The Apple health integration, and a lot of health systems have uses this patient access.

[00:15:47] I can only see my own data. I can see stuff like radiology reports, labs, vital signs stuff. That’s in the U S CDI, the U S core con core data for interoperability, all that [00:16:00] stuff patients can access. The second role is a provider access scenario, which is, a physician. I am either in my EHR or I’m not in my EHR.

[00:16:10] And I can use FHIR to get the same stuff. Patients can get labs, vitals, radiology reports. I have these other abilities, which, insert or is I can create an encounter. I can create a patient. I can patch a patient and update that their address is no longer valid. [00:16:30] I can create clinical documents and have those appear in the normal places where I would expect those appear to appear in the EHR. so the provider access role has access to pretty much all the information that patients can access, but the ability to create a lot of things. 

[00:16:49] Bill Russell: [00:16:49] so the patient we’re not creating, we don’t have created create rights yet, essentially. How 

[00:16:55] Kevin Maloy, MD: [00:16:55] no one, I haven’t seen those. Yeah. 

[00:16:58] Bill Russell: [00:16:58] All right. So I want to go back to something [00:17:00] you just said.

[00:17:00]the way that Apple does this, that’s probably the easiest mechanism, right? So I can connect really to almost any health system in the country, as long as they provide a portal, because I’m gonna use that portal authentication for the patient, and then I’m going to. I don’t know, create new ways of viewing that data, create new ways of utilizing that data through my app. is that close? 

[00:17:21] Kevin Maloy, MD: [00:17:21] Yeah. what I would say is that if you were doing it with the Apple health, like Apple health internally on the iPhone has its own set of APIs. That’s [00:17:30] interacting with the data. It’s stored there, if you’re a health system and you want to create, your patient portal V2, Like basically you would have them sign in with the same username password, and you’d have access to a lot of the same things you can do in a portal except messaging the docs.

[00:17:46]there’s the ability to create, appointments and stuff like that. So one way is, yeah, you could put it on a device, on an iOS device and then yeah. build on top of that. I’m using Apple’s API APIs or if you’re a health system, that’s very forward [00:18:00] looking. What you could do is just roll your own new V two of your portal.

[00:18:04]Using these APIs, the same username password, and you could create novel visualizations. you could bring in novel API APIs, you can create different experiences focused on different patients in particular, using a lot of the data that you’re actually going to see in the, in the portal. 

[00:18:22] Bill Russell: [00:18:22] Are you finding that health systems are struggling with this concept of, cause it feels like you’ve just created a [00:18:30] window. Into the EHR dataset, which is, as we know, it’s just loaded with a lot of value in those kinds of things, or are they seeing it more as we’re unleashing the potential of the creativity of the health system to, to do things that we just. we wait too long for Cerner and Epic to do it and we can now do it ourselves.

[00:18:51] Kevin Maloy, MD: [00:18:51] Yeah. I can really only speak internally about like where I work. but I think it’s seen as a driver of innovation, potentially to direct [00:19:00] to patients, as well as provider experiences. 

[00:19:03] Bill Russell: [00:19:03] yeah, it’s really interesting that you can, I wasn’t under the impression that you could create, I guess through the provider side, you can actually create things that really does open up a whole new host of things.

[00:19:14] And actually it reminds me of the conversation we had with John Halamka, where he said they, for the, ax, the fax initiative, directed all their faxes to, to, AWS fax server essentially took all the stuff in and it took all the data and it was just searching [00:19:30] for, prior authorizations or some aspect of something.

[00:19:33] And then once it found it. It would then go into the record and use FHIR to just check one box. It says authorization received. 

[00:19:41] Kevin Maloy, MD: [00:19:41] Oh, okay, 

[00:19:41] Bill Russell: [00:19:41] cool. No hands touching. No, it was really elegant, but that’s the kind of thing you can do. You can sit back and go, Oh look. Yeah, I can check that box.

[00:19:49] I can. We already have a ton of technology that’s available to us in the cloud, or we can scan these documents. We can pull it, we can pull out the unstructured data and the structure data. We can then review [00:20:00] that we can even apply AI and machine learning to it. And then, do things in the EHR. Now we’ve gotta be careful.

[00:20:07] Obviously we’re dealing with the medical records, but yeah, 

[00:20:10] Kevin Maloy, MD: [00:20:10] I think something you’re pointing out is that FHIR itself lends itself to this automation process, right? Because it’s standardized across the HRS and the spec is open. And what you can do with it is you can just go, you can look on FHIR dots on account FHIR dot, epic.com, and you can actually use a lot of this to [00:20:30] automate stuff that’s happening in your cloud.

[00:20:32]I would say that’s absolutely correct. 

[00:20:35] Bill Russell: [00:20:35] So it is a standard, but we have different versions of the standard as well. yeah. yep. Yep. is there a difference and which one are we most likely to see? 

[00:20:43] Kevin Maloy, MD: [00:20:43] Oh, yes. so there’s different flavors. So there’s something called , which is the draft standards for trial use too.

[00:20:52]which was the original one, which most of the patient facing applications use today, like Apple health uses it. that was the [00:21:00] earliest. Version of this, then there’s something called sq three, which is the standard trial use three, and Epic uses that. Cerner doesn’t quite use it. Then there’s something called , R4 which was released for which, is the curious final rule says that, within two years, everyone needs to be on R4 right.

[00:21:17] It’s actually backwards compatible. So if you write some thing that is doing AI, OCR in the cloud and shoving something into your EHR. If you write it in our four, supposedly five, 10 [00:21:30] years from now that will be compatible with, our 10 or whatever. so our four is like the most backwards compatible it’s not supposed to break going forward 

[00:21:39] Bill Russell: [00:21:39] now, are there, are there any rules or context to how I’m going to use the data? So I can now use FHIR to get access to the data. this is one of the concerns, right? I could just suck a lot of data out and then start to. 

[00:21:54] Kevin Maloy, MD: [00:21:54] Yeah there, FHIR is really good for kind of one patient at a time [00:22:00] scenario. Not necessarily I’m trying to get a population or like I’m trying to get all the patients who have CHF in my organization.

[00:22:07]Those queries of patients like multiple patients at once, is supposed to be supported by bulk FHIR. Something that’s supposed to come out probably within the next three years or something. it’s in the final rule somewhere, that the EHR vendors need to offer this. But currently what it’s good at is like one patient at a time.

[00:22:25] So if you were, if you were sending something to AWS, for [00:22:30] some AI thing, OCR. text to what would it be called? Image to text. Yeah. and then shoving it in one patient at a time. That’s something FHIR can do. but if you’re looking to pull a cohort of, people who had that done to them, that would be hard for FHIR to do. it’s better at one at a time. 

[00:22:51] Bill Russell: [00:22:51] How does the community look at this point? And you typically, you have a development community around, I w I, if I were learning Java, I can find a ton [00:23:00] of communities and resources around this is that starting to really form around FHIR at this point. Yeah.

[00:23:06]Kevin Maloy, MD: [00:23:06] there’s, there’s a BI yearly conference called dev days. That’s put on by, FHIRly and, some of the Cerner engineers, I know go there. They do talks. There’s it’s this international conference where people who are, the nerdy people about five. Are like all congregate, and they also have a YouTube channel, if you will. FHIRly on YouTube, they have a channel where they post all the [00:23:30] talks and like Josh Mandel, has a talk on there from the last, dev days. And some of the people from Cerner had stuff up there, about like CDs hooks and all this stuff that they’re working on. so there is a very strong community behind it.

[00:23:44] Bill Russell: [00:23:44] Yeah. So you’ve put some stuff out there. Yeah. So talk about some of the things you’ve done. 

[00:23:50] Kevin Maloy, MD: [00:23:50] Yeah. So I won’t say that they’re very successful, but, one of the things I’m trying to do, and we talked about it was, 

[00:23:57] Bill Russell: [00:23:57] you’re comparing yourself against the wrong things. So [00:24:00] people say to me, it’s how many downloads of your podcast?

[00:24:01] You get a deck said, what about, between 800 and 900, they’re going. Oh, you’re no Joe Rogan. I’m like, yeah, but there’s only this many people who care about health IT. Joe Rogan’s smoking pot with Elon Musk. that’s entertaining for everybody. That’s a different, 

[00:24:16] Kevin Maloy, MD: [00:24:16] Now we know what you need to do on your show.

[00:24:18] Bill Russell: [00:24:18] Exactly. Elon Musk on here, smoking pot, then I’ll lose my health IT audience. 

[00:24:23] What’s he talking about?

[00:24:27] Kevin Maloy, MD: [00:24:27] You’d be surprised. but, yeah, so I put this thing [00:24:30] out there and, it’s called patient.dev. And the idea is that there’s people who are patients or family members of people with patients with chronic illnesses are going through something and. Most web developers know how to use FHIR.

[00:24:43]they just need a little push to actually start using it. So I have a bunch of videos there. It takes about 30 minutes to go through them about how to make a patient facing app. Just walk you through registering your app. Here’s some sample code you could use to actually create a, [00:25:00] because I think, I think a lot of the innovation from the patient facing stuff is going to come from. family members, patients who have these problems that, they can solve more readily. It makes me think of the maker’s movement, yeah, every once in a while there’ll be somebody talking about, Hey, I was able to do this circuitous thing to get all my data from this and I graphed it out and I realized that this was associated with this, I think those are going to be, those are trivial to make with FHIR, especially with healthcare data, from a major health [00:25:30] system or lab Corp or anywhere like that.

[00:25:32]Bill Russell: [00:25:32] I’ll tell you one of the, one of the panels that I didn’t feel like I belonged on. At one point I had a  Annesh Chopra was moderating leash PIRO who was with. Glen Tullman back in the Allscripts days. And now the seven wire ventures, was on it. the founder of box whose name I can’t remember right now but he’s a colorful character, really fun and whatnot.

[00:25:56]An issue is he’s bringing the audience in. So everybody it’s at the [00:26:00] health evolution summit, and the audience is getting into it. And this woman stands up in the back and she goes, This is the problem I need you to solve. And if we had a topic, think we were talking about something else.

[00:26:10] And the entire topic devolved into interoperability, your EHR is, are killing me essentially is what she said. And her daughter had a chronic condition. She had been to Mayo. She’d been to a UCLA. She’d been to multiple organizations in Southern California, where I was the CIO. And she was [00:26:30] essentially saying, look, I now carry, two to three binders, or I’m working on my third binder, but I carry two binders with me.

[00:26:37] And it’s the complete medical record because you guys can’t share it amongst each other. And then I go to somewhere else and she goes, I’m just terrified that someone’s not going to read the whole binder. And when I was afraid to say to her is, you know what, almost no one’s going to read that whole binder.

[00:26:52]it’s two binders already. It’s too big. Yeah. but that lends itself. That’s a specific scenario is what FHIR was [00:27:00] created for the patient. Who’s saying, look, I’m going to 10 different organizations. You haven’t figured out how to share my data. Let me get it all my information and create an app that I can share it with the physician, when I get to whatever location I’m going to.

[00:27:15] Kevin Maloy, MD: [00:27:15] Yup. Yup. And there’s probably going to be a whole suite of tools for providers to visualize that data in a very quick way. they’re gonna need to become essential with all this interoperability happening. We [00:27:30] tried at MedStar to do this in the ER, cause I work in the ER, like my observation is like people come in. And they have, they’re a MedStar patient and they have, 300, 400 documents and free texts, like just sequentially ordered or a time ordered. And you can only show 20 at a time with any EHR. but maybe they’re there for chest pain and the, You know that the thing that’s relevant to chest pain, like they had a blood clot, five years ago, and now they’re off anticoagulation that is buried in like document number [00:28:00] 356 or something like that.

[00:28:02] Yeah. But it’s not on the top 20. And if I’m a, yeah, no. If I had all the time in the world, I could look through and try to read all this stuff. but it’s better to set up like a little algorithm. That’s always looking for stuff that’s pertinent to why that patient. Is, is having that visit today. so we set this up, it was FHIR enabled. At one point we did it with the partnership with Booz Allen, cause they had some data scientists that were helping us out. and it was an interesting experiment in like, [00:28:30] How do you actually, once you have all this data in one place, how do you make it actionable?

[00:28:36] Add to a person, make it relevant based on why that person is actually there, because they’re, if they’re in the ER for chest pain, it’s different than if they’re there for a headache. And there’s different pertinent things that we’re looking for. I think more things like that.

[00:28:50] Like we, we got it, we, try all the doubt in production. and we got some positive feedback, but part of the thing was, it just took a while to run. and we never quite [00:29:00] got around to prefetching everything and setting up, 

[00:29:02] Bill Russell: [00:29:02] You think we’ll see user groups gets stood up at most health systems as people start to get more familiar with this.

[00:29:09]Kevin Maloy, MD: [00:29:09] yeah. Yeah. You know what I think cause FHIR, you can be at any health system and essentially use the same code across all systems. It will probably be, like it’ll probably be like this week can help it workshop on, or use a group about, because it spans, I don’t think it would be focused within the organization itself, but it will be more, [00:29:30] a bunch of organizations  since there’s no, it’s standardized and you don’t really need it like a, it doesn’t rely on a code set. Specific code sets that are only in your EHR to work. It 

[00:29:45] Bill Russell: [00:29:45] You referred to some code that was open source earlier on. It was Boston children’s I guess. is there other code out there that’s been open source that people can look at?

[00:29:54] Kevin Maloy, MD: [00:29:54] Some of it is, there’s that smart health it.org. if you check it out, it’s run by Boston children’s [00:30:00] but people can put, their apps on it. so I have one or two up there. and you can look at how other people are doing this. some of them are open source. Some of them are like commercial.

[00:30:09]but that’s probably a good resource if you’re looking for some. And the thing is, if you’re using opensource quote in a healthcare system, you probably want somebody to review that code. Three years normal pathways. 

[00:30:23] Bill Russell: [00:30:23] What other, what other resources, like where would people find your stuff and what other stuff would you.

[00:30:31] [00:30:30] Kevin Maloy, MD: [00:30:31] So my stuff [email protected] I have, a few, videos. They’re a little more targeted towards, patients. periodically I have a meetup group, DC, medical API APIs, meetup group that we periodically do a workshop where we, I think, No wait, like we’ve had people talk about bulk FHIR from, us digital service and the person who is the CTO for any show pro for a little bit.

[00:30:57]so periodically we do stuff in that arena. [00:31:00] and if you happen to be a Cerner client, I, or use a Cerner EHR and actually have a kind of bimonthly meeting that I do for, cause I feel like in Cerner, our flavor of FHIR. Is, we’d probably all have the same problems with it. So what I try to do is set up like a workshop every once in a while, every couple of months, or, have a speaker come and talk on something every couple of months. so if you happen to, use Cerner, that might be high value for you. Like we had a niche Chopra talk [00:31:30] a couple of months ago, and then we had a workshop on making an app a couple of months ago as well. 

[00:31:36] Bill Russell: [00:31:36] Awesome. I do. I hope you’re a patient.dev, right? Is that what you, yeah. I hope it gets a few more hits. I will probably head over there and download a couple of things or watch a couple of things. I’m really curious. Cause I think this does have the potential. So to really, create a new environment with them, healthcare, that we can be very creative within standards, right? Within security [00:32:00] models, within standards, which is a, that’s going to benefit the providers, maybe address some of the, some of the challenges of information overload and, and burn out.

[00:32:10] And then on the patient side, the, even the use case that we gave up. Being able to transport your records. So a lot of great opportunities there having thanks. Thanks for your time. And thanks for all your work that you’re doing in this. I really, 

[00:32:24] Kevin Maloy, MD: [00:32:24] Yeah. Thank you for, for all you do. I learned a lot by listening to your podcast and hearing all the [00:32:30] other, all the CIO’s CMIOs and how they are.

[00:32:33] Thinking about stuff at their organization. So it’s really high yield for me. and I appreciate all the work you do and amplifying, I think that’s, you’re amplifying 

[00:32:41] Bill Russell: [00:32:41] Amplifying great thinking. So that puts you in that category. Now you are now great thinking, but make sure you tell your family that have this. I was put in the category of great thinking today. they’ll humble. You pretty quickly. They do for me too. 

[00:32:55] Kevin Maloy, MD: [00:32:55] You’ll have one extra subscriber my [00:33:00] mom.

[00:33:00] Bill Russell: [00:33:00] Wait. It’s so funny. I talked to my parents this weekend. It’s Oh, I’m sorry. I didn’t listen to your last podcast. I’m like, I can’t believe they’re listening to all these.

[00:33:10] I’m like, can’t possibly understand a bunch of the stuff that we’re talking about, but invariably, they’ll call me up and say, Hey, look, my medical record went from this system to this system and this happened and we’re now using Epic and here’s the portal and here’s, and I’m like, I, they’re at least grasping, from a patient perspective, some of the things that are [00:33:30] now.

[00:33:30] That happened to them behind the scenes from a technology perspective, it’s been really fascinating to watch. 

[00:33:36] Kevin Maloy, MD: [00:33:36] you put on a good show in the news day thing I think is relevant to, to like even, your parents are just normal people, it’s just here’s this, here’s how you think about what’s happening. in this news article, I think it’s actually, it’s reachable to a more general audience as well. So 

[00:33:50] Bill Russell: [00:33:50] yeah, it’s fun. it’s fun. And it’s great to meet and talk to people like you will have to. it’s a catch up, so you’ll have to develop some really cool apps between now and this time next year. And [00:34:00] we’ll catch up to, to get an update on how things are working. 

[00:34:03] Kevin Maloy, MD: [00:34:03] Excellent. Sounds good. 

[00:34:05] Bill Russell: [00:34:05] Thanks so much. Bye bye. That’s all for this week. Don’t forget to sign up for a clip notes. Send an email, hit the website we want to make you and your system more productive. Special. Thanks for our sponsors. Our channel sponsors, VMware, StarBridge Advisors, Galen Healthcare, Health Lyrics, Sirius Healthcare, Pro Talent advisors and  healthNXT.

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