Applied Bimatics - An Informatics & eHealth Blog

I am a clinician with a passion for informatics. This blog is about my eHealth journey exploring interoperability in Electronic Medical Records (EMR/EHR), Patient Safety, Pharmacovigilance, Data Analytics, Clinical Research and Bioinformatics in a clinical context. Comparing Canadian, Indian and Middle Eastern healthcare systems and services. Join our open facebook group here: https://www.facebook.com/groups/clinical.bioinformaticians/


Apple HealthKit: Health Information Exchange for Apps

Last year, one of my colleagues proposed an add-on for a popular fitness app as a course project. There has been a whopping increase in the number of health and fitness apps, monitoring a variety of parameters from blood sugar to the number of strides you take. As my colleague pointed out, all the necessary features are never there in any single application. How do you write an add-on for an existing app? Apps do not talk to each other much like their big brothers: health information systems.
English: Mediated Reality running on Apple iPhone
(Photo credit: Wikipedia)

Apple is trying to solve just that, with its new HealthKit framework. HealthKit allows apps that provide health and fitness services to share their data with the new Health app in the cloud and with each other. A user’s health information is stored in a centralized and secure location and the user decides which data should be shared with your app. I have a couple of friends currently working on population pharmacokinetics. HealthKit may be an ideal framework for sharing pharmacokinetic data too.

Though HealthKit is lingering over a last minute bug that slows down apps that use this framework, it may be a novel and effective tool for app designers. However whether the technology will bring the prophesied ‘Healthcare revolution’ remains to be seen. The new generation apps are going to make life difficult for physicians, already inundated with lots of data. Hope the proverbial ‘Apple a day’ does not happen!

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Intelligent Federated Clinical Viewers IFCV

I have blogged about federated search clinical viewers before. Essentially such viewers query source health information systems in real time and provide the user with a consolidated view. There is no data repository, ensuring data integrity and data privacy. Though the system can be slow because of the real-time search, there are many successful regional implementations of this type.

There is an obvious disadvantage here. Intelligence cannot be built into such viewers. Since there is no server side data storage, there is no scope for server side processing. The data comes together only in the rendered view. Some  mixed systems that have a data-repository provide some crude warning flags that are not-real time. But clinically useful alerts are beyond the capabilities of federated systems. So how do we build intelligent federated clinical viewers?
Intelligent Federated Clinical Viewer #IFCV

As HTML5 specifications mature, intelligence can be built into clinical viewers by client side processing and storage. Though local database storage implemented by Safari is too insecure at this stage for this purpose, it might become viable in the future. Some useful functionality can be built with the Session storage functionality that has been expanded to store up to 4MB of data depending on browser implementations. This is much more than the conventional cookie storage. The Sessions object persist only till the window is active and is reasonably secure. I have listed some typical use cases below.

A typical pharmacy module of a clinical viewer brings together all the medications the patient is on from all source hospitals. A client side script could identify drug interactions by analysing the view. This is beyond the local EHR system as disparate systems do not talk to each other.

If all the active drugs can be stored locally during the pharmacy module view, contraindications such as steroids in hyperglcemia can be alerted when the lab module is accessed. These intelligent alerts could be clinically invaluable.

The utopian dream of cross-communicating EHRs are still a long way in the future. Regional federated clinical viewers are going to rule the roost for some time. So intelligent federated clinical viewers may be worth a consideration. I don't know whether this is already in the pipeline for vendors such as Mulesoft, Medseek or Mirth. If not, a link here (and a mail) will be highly appreciated when they do.

Twitter hashtag for this topic: #IFCV

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About Me

As a Dermatologist and Informatician my research mainly involves application of bioinformatics techniques and tools in dermatological conditions. However my research interests are varied and I have publications in areas ranging from artificial intelligence, sequence analysis, systems biology, ontology development, microarray analysis, immunology, computational biology and clinical dermatology. I am also interested in eHealth, Health Informatics and Health Policy.

Address

Bell Raj Eapen
Hamilton, ON
Canada