In today’s world, with Skype, Facetime, Hangouts (or is it Meet?), and numerous other video conferencing solutions, it’s not unrealistic to meet with a doctor via a screen. The value of telemedicine has officially evolved from a hypothetical game changer to a viable alternative to in-person visits for both patients and physicians.
This value only increases when the software integrates with a physician’s EHR system—an integrated application offers a highly-efficient workflow with information arriving in the right place at the right time and ensuring the full patient record stays in sync.
While integration is necessary to deliver on telemedicine’s full potential, the road to integration is not always paved with yellow bricks; with HL7, web services, and now FHIR, it’s no wonder that developers are struggling to understand how to best develop their products to both serve their users and seamlessly integrate.
The following is a rundown of the typical data needs we see in telemedicine applications with the corresponding FHIR capabilities—and how to access that data when FHIR is unavailable.
Note: the following resources will vary on a site-by-site basis; reach out if you have specific questions or a project you need help integrating.
| Data Needs | FHIR | Redox |
| Scheduling | Schedule – FMML 3 | Scheduling |
| CDA – it’s highly likely a telemedicine app would need to receive this before an appointment and also send in any updates to the EHR after an appointment. | The general idea has been that FHIR is meant to exchange small pieces of a record (an Order, an Allergy List, a Practitioner, an Appointment) while CDA is still better suited for complete “episode summarization”, where you gather more comprehensive information in one report.That said, there is CDA-on-FHIR work going on that is trying to map the two together and describe how you would bundle many resources together just like a CDA document bundles entries today. It uses the ‘Bundle’ (FMML 5) and ‘Composition’ (FMML 2) resource to do so, but it’s still more of a concept than an actual replacement for CDA right now. | Clinical Summary – this is a snapshot of a patient’s chart at a moment in time and includes information such as allergies, immunizations, and medications. |
| Order follow-up tests (imaging, lab work, etc.) | ProcedureRequest – FMML 3 | Order |
| Documentation of care delivered | Most likely Encounter – FMML 2 | If the care is documented in the application, the data can be sent to the EHR for long-term storage in the patient’s medical chart. This data could be sent into the EHR using Redox’s Media or Notes data models. For discrete documentation Results would be used.To push additional patient information into the EHR such as allergies, medications, or patient diagnoses, applications would utilize the Clinical Summary data model. |
One important note is what FMML is; FMML is the FHIR Maturity Level. Some of the FHIR Resources have been well tested in a variety of environments while others have little to no real-world experience. The FMM levels are a way of determining which resources have been tested and which have not.
Currently, the majority of resources are FMML 2 or below, and most vendors and organizations are using FMM levels as a means to determine if a resource is ready to be implemented, with the higher levels being the most consistent in implementation.
The question remains – to what extent can FHIR support telemedicine? Beyond the chart above, there are often a number of data elements needed prior to appointments which are not yet FMML 3.
While telemedicine is clearly here to stay, it will be some time before FHIR is the sole data standard used for health information exchange as part of these remote visits. It will be important to see exactly which FHIR resources various EHR vendors make available and whether they will be sufficient for executing the full integration needs of telemedicine providers.
At Redox, we can satisfy the data sharing needs of our customers today using existing functionality. Example workflows we support include:
- Update you any time an appointment is created for your RPM or telehealth service.
- Integrate with existing scheduling systems to log events as they occur and exchange necessary patient demographics to provide and document care.
- Allow patients to directly schedule appointments with providers.
- Trigger alerts or care interventions based on vitals/responses to outreach.
- Write discrete clinical values (vitals, glucose levels, etc.) captured by medical devices back to a patient’s chart.
- Send summary reports of actions taken or vital levels over time in the form of PDFs to the patient’s medical record.
Commonly supported workflows at the conclusion of a telehealth visit include:
- Order follow-up tests (imaging, lab work, etc.).
- Schedule follow-up visits with PCP or specialty provider.
- Store images used as part of the diagnosis or care event.
- Integrate the encounter documentation in the patient’s record at the EHR where the patient primarily receives care.
We are extremely excited about the prospect of improved integration when FHIR gains traction. The expanded ability to request specific pieces of information will lead to better workflows that make sure only the necessary information is being exchanged.
As always, we will continue to help telehealth providers deliver optimized solutions through seamless integration with any EHR. We’re currently able to meet the majority of our partners’ integration needs through available standards, but we look forward to further improving workflows with FHIR.
We’ll make sure to update this article as FHIR begins to be used for integrations and it becomes clearer which resources are most often used to facilitate telemedicine workflows. Until then, don’t hesitate to reach out with your integration questions. Our solutions team is standing by to help identify a strategy that can be implemented today while positioning your organization to take advantage of improvements as they are made available.