The relationship and technical workflow between a patient/caregiver-facing application and a clinician application involve several key components and data pathways. The system supports authentication processes and allows patient/caregiver data to be saved into a third-party supplemental data store (SDS) that cannot be directly written into an EHR.
These diagrams outline the structure and relationships of the system’s components, including the eCare planning applications, EHR systems, the supplemental data store (SDS), and the data flows. The components include:
- Two web-based eCare Planning applications: MyCarePlanner and eCarePlanner.
- A supplemental data store (SDS) server: A FHIR data store designed to contain health data not supported by institutional EHRs, such as patient-authored data.
- EHR system(s): Pilot EHR systems such as Epic at OHSU and VA VistA.
- Data flows: USCDI data elements represented with FHIR resources.
The MCC care plan technical architecture leverages an SDS to host patient-contributed content. Within the patient- and caregiver-facing application, users contribute to their care plans by setting health goals, adding health concerns, and completing questionnaires, then stored in the SDS. The patient/caregiver application also collected patient data from multiple third-party EHR systems where a patient receives care and writes all of these data to the SDS for sharing with clinicians at OHSU and for use in research. The current SDS design is restricted to storing patient-compartment data, i.e. resources directly related to an individual patient, not Practitioner or Medication resources.
The patient/caregiver application reads these data from multiple providers and presents the collected data in a meaningful and usable way for use by non-clinicians, featuring capabilities like categorizing diagnoses based on extensive value sets using Clinical Quality Language (CQL). Clinicians can access the aggregated patient data from their institution, allowing them to view comprehensive health information collected by patients from multiple providers, including the patient-contributed content stored in the SDS.
The U.S. 21st Century Cures Act empowers all patients with a right to access their healthcare data from each of their providers that uses an ONC-certified EHR system. These data include U.S. Core Data for Interoperability (USCDI) data elements based on the US Core FHIR implementation guide for interoperability.
Both applications incorporate the HL7 SMART on FHIR standard to launch the applications using OAuth2 security with their existing healthcare provider portal account; no additional user accounts are used or supported.
The Supplemental Data Store (SDS) is a FHIR R4 data repository server using OAuth2 for access security. The SDS holds patient/caregiver-authored content that cannot be written into the EHR, plus aggregated from all provider systems where a patient has access. These aggregated data support care coordination and shared decision-making by clinicians who are working with patients who use MyCarePlanner.
Two web-based SMART on FHIR apps:
- MyCarePlanner for patients and caregivers
- eCarePlanner for clinicians, launched from within Epic and includes a reusable JavaScript library called the “Common Data Services” which supports mapping FHIR data resources to UI view objects
- Supplemental Data Store (SDS)