Small osteopath clinic from New Zealand needed integration with government insurance provider ACC. They already used EHR solution called Cliniko. Unfortunately, it doesn’t provide such functionality. However, practitioners like it. Since Cliniko provides API for appointment and treatment notes we decided to integrate with it instead of building everything from scratch.
We developed an app that provides book and appointment functionality for a patient. As part of book an appointment flow patients fills their part of insurance claim. Practitioner fill treatment notes that contain practitioner’s part of insurance claim plus extra information that sync back to Cliniko. As a result, all data was saved in Cliniko and sync to ACC as a claim. Practitioner keep using software they are familiar with while new features was added on top if it.
Prenosis are experienced in ML and data analysis. They have created software that uses biomarkers for early sepsis detection. The source of health data required to detect sepsis is EHR. So to use the software the data should be extracted from the EHR. Also, not all patients need sepsis detection. Only patients from ICU that get specific blood tests need it.
The target EHR platform is Epic. We decided to use SMART on FHIR backend service to load the data from EHR. Unfortunately, Epic FHIR API is patient centric. You need patient ID to query any data. So it wasn’t possible to use FHIR API for discovery.
We choose HL7v2 ADT feed for discovery. We get events about ICU admission thought HL7v2. Then all other data was loaded via FHIR API. As a result we created and event driven system that monitore patient admission and detect sepsis in real time. Prenosis is still focused on ML part while Beda take care of integration process.
We worked with large hospital from Texas that needed mortality prediction system. They already developed ML based algorithm and user interface for it. However the in-house ML team was not experienced with Epic EHR integration.
We implemented a SMART on FHIR practitioner application that launches inside Epic Hyper drive. This software load pre-calculated mortality index from ML module and display it in Epic Hyper drive.
The software was delivered 3 years ago and still keep working without major maintenance. It is used by practitioner to get better overview about patients and see which require more attention right now.
The similar integration we implemented for Switzerland startup called Juli. Juli track information about chronic conditions. For practitioner it is important to see what happened with a patient between visits. Some kind of patient dashboard is needed inside the EHR.
We started with mobile application for patient that track chronicle conditions. Then we implemented web based dashboard for practitioners.
This dashboard was integrated into Epic and Cerner EHRs as SMART on FHIR application. This integration open new target market for July because they can start providing their services to hospitals.