This white paper discusses Carefluence software architecture and the architect’s view of True Interoperability for Healthcare, how the Carefluence platform successfully implemented FHIR® for the benefit of healthcare communities.
This section discusses the need for True Interoperability, integration choices, and shows how the Carefluence platform evolved over time to support Internet of Interoperable Things™ Services.
The team behind Carefluence has had its initial experience rooted in the area of Electronic Health Records and Revenue Cycle Management. After more than 15 years of experience in the healthcare technology arena, they experienced firsthand the need for a streamlined interoperability solution for community healthcare. The Carefluence platform was produced for healthcare interoperability to support the sharing of data with Hospitals, HIEs, Registries and Clearing Houses.
Carefluence is enriched with a decade of healthcare knowledge of physicians, payers, practices, hospitals and the allied technologies to support the creation of vast repositories of patient data. With each EHR implementation, the Carefluence team had learned how to capitalize on the data to make better decisions and improve outcomes. Integrations with other systems have broadened the understanding of interoperability and its practical challenges.
Most community healthcare systems functioned at the point of care but often failed to share their data easily with others, either due to their technology, infrastructure, or network. During the very early stages, the Carefluence team knew that the root of interoperability challenges was not with data formats or the evolving HL7 standards, but with the missing ‘best-practices’ in integrations with other systems within the healthcare industry. This has often resulted in customizing integrations and maintaining them constantly in laborious detail. Undoubtedly, these kinds of integrations are still popular throughout the healthcare industry and create tightly coupled connections from one point to another. The Carefluence product aims at making these integrations more consistent and simpler to maintain.
In early 2013, Carefluence developed a community hub on top of its platform for a hospital in order to connect all the clinics within the hospital community and share the patient data back and forth. When designing the Carefluence software for this community hub, it was important not to develop a limited point-to-point integration. A flexible interoperability option was necessary for future integrations and for all the systems within the hospital community to maintain low maintenance and shortened lead-times to go live.
One of the key components of the Carefluence Community Hub platform was to provide its own Open Application Programming Interfaces (APIs). The Carefluence OpenAPI stack facilitates integrations at the EHR vendor-level to maintain every version change of the EHR and deploy the changes as hub plugin versions compatible with each connected EHR version. The Carefluence OpenAPI enables the development of health IT applications for the community benefits that are not directly covered by EHRs. The goal was always to provide a true value of interoperability, such as the ability to simultaneously access different systems, no matter how the data is stored. Carefluence’s value proposition is to make interoperability available at the point of care and to meet users where they are with a special emphasis on availability, even on a mobile infrastructure.
In early 2014, the Carefluence team was introduced to HL7 FHIR® and evaluated the FHIR® roadmap with Graham Grieves, architect-developer of FHIR®, at HIMSS 2014. From this conversation, it was apparent that discontinuing the development of its own APIs and adopting FHIR® was beneficial to the future of Carefluence’s OpenAPI and its platform’s applications. Today the Carefluence OpenAPI is a production ready platform and a living example of a complete FHIR® implementation in its core strategy towards the Internet of Interoperable Things™ around any healthcare system or medical device.
The Carefluence OpenAPI platform adopted HL7 FHIR® in its core strategy to offer innovative solutions as Internet of Interoperable Things™ Services around any healthcare system or medical device.
The FHIR® Standard has brought a resource approach to the Carefluence OpenAPI platform’s information model (For example; Patient, Condition, Procedure, or Immunization), which is more granular than any other standard and fast to learn, develop, and implement solutions.
This section briefly discusses all of the components that make up the Carefluence platform to support Internet of Interoperable Things™ Services.
At the heart of the Carefluence OpenAPI platform, HL7 FHIR® DSTU2 standard is rooted and adopted completely to offer Internet of Interoperable Things™ Services. EHR companies can license the Carefluence OpenAPI platform and configure it to work seamlessly to meet Meaningful Use Stage 3 requirements as listed below:
The following diagram is a representation of the implementation of Carefluence and Internet of Interoperable Things™ Services. This is a real-world implementation of accessing patient data from EHR and providing, in real-time, evidence-based clinical decision support for that particular patient.
In the current implementation of evidence-based clinical decision support, Carefluence has the following actors. The Carefluence OpenAPI platform with HL7 FHIR® DSTU2 standard was used to accomplish the complete use case.
This section discusses the value of using the Carefluence OpenAPI platform and the benefits of implementing FHIR® standards to provide true interoperability with Internet of Interoperable Things™ Services