Datica Podcast

May 9, 2017

Joshua Mandel, MD — FHIR and barriers to widespread adoption of Clinical Decision Support

Dr. Mandel responds:

On defining SMART: "SMART is an acronym that stands for Substitutable Medical Applications and Reusable Technology. This idea of substitutability was the key focus. The idea, whether it was a patient or a clinician should be able to pick the apps that they want to use and interact with healthcare data using those apps."

On helping developers build SMART-enabled apps: "At docs.SMARTHealth.org, we describe how to get started building a browser-based app. You could even take a set of sample code that runs right in the browser, tweak it, write some new FHIR queries and get started writing code without having to download or installing packages locally."

On the benefits of SMART on FHIR: "SMART provides a way to embed these apps directly inside either an EHR or a patient portal, so that when you are in the middle of a clinical workflow, you can pick and choose the tools that you want to use, without having to sign into another system."

On alerts for clinical workflows: "Alerts are often incorporated into an EHR as a way to enforce a policy but not necessarily a way of enhancing a clinical workflow or clinical decisions. So, I think that alerts, in general, have a bad rap for good reasons."

On the pushing standards forward: "The best kind of arrangement that we have to push these standards forward is what I call a triad, where there is a hospital system that is interested in adopting a CDS product in the context of their EHR. If we can get all three of those together, that is by far the best way for us to develop a new feature in a specification like CDS Hooks."

On preparation for CDS: "Make an early investment in FHIR and make sure that basic data types like medications, allergies and lab tests are available through a FHIR interface."

On CDS and what it really means: "Clinical decision support is a bit of a jargon-y term. What we really mean is third-party services, such as helpful contextual information, for clinicians while they are going through their daily workflow."