SMART on FHIR Apps for Health Josh Mandel (Boston Children’s Hospital) Ricky Bloomfield (Duke Medicine) Kevin Shekleton (Cerner) John Voith (athenahealth) April 14, 2015 DISCLAIMER: The views and opinions expressed in this presentation are those of the author and do not necessarily represent official policy or position of HIMSS.

SMART on FHIR: Core API Goals Health IT Systems >1000 Certified (VDT, 4/2015) { authorization authentication clinical data UX

focus on Demos

Duke Medicine SMART on FHIR Demo Ricky Bloomfield, MD Director, Mobile Technology Strategy April 14, 2015 DISCLAIMER: The views and opinions expressed in this presentation are those of the author and do not necessarily represent official policy or position of HIMSS.

SMART on FHIR @ Duke Medicine Implementation: Built on latest Epic release MITREid Connect (OAuth 2.0 & OpenID) integrates with Duke’s standard credentials FHIR resources consumed: Patient Observation (vital signs) Medication + MedicationPrescription Apps integrated: Pediatric Growth Chart (open source HTML5 app) Pediatric Growth Charts by Boston Children’s Hospital (native iOS app) Duke Pillbox (HTML5 app)

EHR Demos

Apps

Crimson Care Management App Scalable, Patient-Centered Coordination Across Care Settings Crimson Care Management App Risk score updated as diagnoses pulled in from the EMR using FHIR Patient clinical information (including diagnoses, medications and allergies) automatically fed into EMR using FHIR Gaps in care presented to caregiver to view, act on, and update on completion Under Development: Care notes captured during care management encounter sent back to EMR via FHIR x ©2015 The Advisory Board Company • advisory.com

Leveraging the Power of Interoperability A New Infrastructure for Value-Based, Population-Oriented Health Care Plugging in to a Larger Effort Argonaut Project FHIR-Based Data Queries athenahealth Cerner Epic SMART Advisory Board Crimson Care Manager Partial list of participating organizations x Integrating Data Creating a comprehensive view of patients and populations Risk-Stratifying Patients Prioritizing intensive interventions based on risk factors Automating Care Planning Automatically customizing care to patient need Structuring Workflow Automated task creation, assignment, and tracking Reporting on Performance Flexible ad hoc reporting for identifying variance, supporting billing ©2015 The Advisory Board Company • advisory.com

Meducation® Addresses Health Literacy More Effective Communication Universal Medication Schedule Intuitive representations of times of day and amount of medicine to be taken Pictograms Reduce dosing errors Instructions in Plain Speak 1 line per instruction 5th to 8th grade reading level Visual spacing to reduce cognitive overload 5 font choices, up to 18 point font Select from more than 20 languages Everything from Polyglot is about improving medication adherence. The solutions that I’ve shown so far have been about improving medication adherence, by addressing low health literacy, by making medication and medical instructions engaging and easy to understand. TimeView is slightly different in that it is not for patients. It’s for you. Using Surescripts prescription fill or other data sources, TimeView provides a longitudinal view a patient’s adherence history, across all prescribers, displayed in an intuitive, “gantt chart” format, permitting interventions to be tailored quickly and appropriately. The Meducation® TimeView™ Report shows Visual representation of all medications that a patient has filled over the last 6 months, Identification of gaps in adherence, as well as “overfill” indicators,

Meducation® Improves Medication Adherence Multilingual Regimen Summaries Patient content access via QR code Everything from Polyglot is about improving medication adherence. The solutions that I’ve shown so far have been about improving medication adherence, by addressing low health literacy, by making medication and medical instructions engaging and easy to understand. TimeView is slightly different in that it is not for patients. It’s for you. Using Surescripts prescription fill or other data sources, TimeView provides a longitudinal view a patient’s adherence history, across all prescribers, displayed in an intuitive, “gantt chart” format, permitting interventions to be tailored quickly and appropriately. The Meducation® TimeView™ Report shows Visual representation of all medications that a patient has filled over the last 6 months, Identification of gaps in adherence, as well as “overfill” indicators,

Adherence Intelligence for Clinicians TimeView™ Adherence Report Non-adherence indicators Everything from Polyglot is about improving medication adherence. The solutions that I’ve shown so far have been about improving medication adherence, by addressing low health literacy, by making medication and medical instructions engaging and easy to understand. TimeView is slightly different in that it is not for patients. It’s for you. Using Surescripts prescription fill or other data sources, TimeView provides a longitudinal view a patient’s adherence history, across all prescribers, displayed in an intuitive, “gantt chart” format, permitting interventions to be tailored quickly and appropriately. The Meducation® TimeView™ Report shows Visual representation of all medications that a patient has filled over the last 6 months, Identification of gaps in adherence, as well as “overfill” indicators,

Adherence Intelligence for Clinicians TimeView™ Adherence Report Proportion of days covered, per PQA metric for Star Ratings Other Prescribers Actual patient medication adherence based upon PBM, SureScripts and/or other data Everything from Polyglot is about improving medication adherence. The solutions that I’ve shown so far have been about improving medication adherence, by addressing low health literacy, by making medication and medical instructions engaging and easy to understand. TimeView is slightly different in that it is not for patients. It’s for you. Using Surescripts prescription fill or other data sources, TimeView provides a longitudinal view a patient’s adherence history, across all prescribers, displayed in an intuitive, “gantt chart” format, permitting interventions to be tailored quickly and appropriately. The Meducation® TimeView™ Report shows Visual representation of all medications that a patient has filled over the last 6 months, Identification of gaps in adherence, as well as “overfill” indicators,

Tackling Non-Adherence at the Point of Care EHR New functionality integrated into existing workflows EHR New functionality integrated into existing workflows Physician Simple, targeted insights provide time efficiency and improved patient care PBM Deep analytics, improved adherence, and gaps in care programs Patient More informed care and better outcomes Surescripts’ Solution Combats Non-Adherence

Medication Adherence on the SMART platform Tackling Non-Adherence at the Point of Care Reduced time-to-Value SMART offers a reduced design complexity, helping Surescripts reach a wider audience without the cost of significant, one-off development efforts Greater innovation through collaboration The SMART specification extensions built in collaboration with Surescripts empower our apps to provide both information-rich and visually consistent experiences for users. Improved Interoperability SMART provides a standardized, secure way to integrate local data and network data, helping connect users to the power of the Surescripts network. Medication Adherence on the SMART platform

Our Apps Will Change Care Delivery Fueled by Geisinger R+D investment over 18+ years Adaptable to any EHR Data extracted, re-organized and presented in a user-friendly way Workflow facilitated via clinical logic; results of analyses integrated into workflow Decision support based on analysis of data outside and inside the EHR Highly valued by clinicians Confidential property of xG Health Solutions, Inc.  Re-creation or delivery to another party in any format is strictly prohibited.