Browsing by Author "Taylor, David E."

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    Integration of FHIR to Facilitate Electronic Case Reporting: Results from a Pilot Study
    (IOS, 2019) Dixon, Brian E.; Taylor, David E.; Choi, Myung; Riley, Michael; Schneider, Trey; Duke, Jon; Epidemiology, School of Public Health
    Current approaches to gathering sexually transmitted infection (STI) case information for surveillance efforts are inefficient and lead to underreporting of disease burden. Electronic health information systems offer an opportunity to improve how STI case information can be gathered and reported to public health authorities. To test the feasibility of a standards-based application designed to automate STI case information collection and reporting, we conducted a pilot study where electronic laboratory messages triggered a FHIR-based application to query a patient’s electronic health record for details needed for an electronic case report (eCR). Out of 214 cases observed during a one week period, 181 (84.6%) could be successfully confirmed automatically using the FHIR-based application. Data quality and information representation challenges were identified that will require collaborative efforts to improve the structure of electronic clinical messages as well as the robustness of the FHIR application.
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    Real world performance of the 21st Century Cures Act population-level application programming interface
    (Oxford University Press, 2024) Jones, James R.; Gottlieb, Daniel; McMurry, Andrew J.; Atreja, Ashish; Desai, Pankaja M.; Dixon, Brian E.; Payne, Philip R. O.; Saldanha, Anil J.; Shankar, Prabhu; Solad, Yauheni; Wilcox, Adam B.; Ali, Momeena S.; Kang, Eugene; Martin, Andrew M.; Sprouse, Elizabeth; Taylor, David E.; Terry, Michael; Ignatov, Vladimir; Mandl, Kenneth D.; Health Policy and Management, Richard M. Fairbanks School of Public Health
    Objective: To evaluate the real-world performance of the SMART/HL7 Bulk Fast Health Interoperability Resources (FHIR) Access Application Programming Interface (API), developed to enable push button access to electronic health record data on large populations, and required under the 21st Century Cures Act Rule. Materials and methods: We used an open-source Bulk FHIR Testing Suite at 5 healthcare sites from April to September 2023, including 4 hospitals using electronic health records (EHRs) certified for interoperability, and 1 Health Information Exchange (HIE) using a custom, standards-compliant API build. We measured export speeds, data sizes, and completeness across 6 types of FHIR. Results: Among the certified platforms, Oracle Cerner led in speed, managing 5-16 million resources at over 8000 resources/min. Three Epic sites exported a FHIR data subset, achieving 1-12 million resources at 1555-2500 resources/min. Notably, the HIE's custom API outperformed, generating over 141 million resources at 12 000 resources/min. Discussion: The HIE's custom API showcased superior performance, endorsing the effectiveness of SMART/HL7 Bulk FHIR in enabling large-scale data exchange while underlining the need for optimization in existing EHR platforms. Agility and scalability are essential for diverse health, research, and public health use cases. Conclusion: To fully realize the interoperability goals of the 21st Century Cures Act, addressing the performance limitations of Bulk FHIR API is critical. It would be beneficial to include performance metrics in both certification and reporting processes.