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. 2021 Oct 12;28(11):2379-2384.
doi: 10.1093/jamia/ocab171.

The ecosystem of apps and software integrated with certified health information technology

Wesley Barker  1 , Christian Johnson  1
Affiliations

The ecosystem of apps and software integrated with certified health information technology

Wesley Barker et al. J Am Med Inform Assoc. .

Abstract

Objective: This study: 1) characterized the app market by EHR app gallery and type of app; 2) tracked changes in the EHR app galleries from the end of 2019 through 2020; and 3) examined how apps connect to EHR data systems, and if the apps support the HL7 FHIR standard.

Materials and methods: We developed a program that gathered data from the public app galleries hosted by Allscripts, athenahealth, Cerner Corporation, Epic Systems Corporation, and SMART. Data collection for this study began in December 2019 and ended December 2020. The program was run 11 times during this period, and the data collected were used to generate the findings and trends observed in this study.

Results: The total number of unique apps increased from 600 to 734 during the study period. The most common types of apps marketed were intended for administrative (42%) and clinical use (38%). About 1 in 5 apps (22%) described support for the FHIR standard. Support for FHIR varied by intended functionality and gallery.

Discussion: This study provides early insights into the number of third-party apps that are connecting to EHRs, what services they provide, and if these connections use standards-based application programming interfaces (APIs).

Conclusion: It is a federal government priority to improve the access and use of electronic health information, including third-party apps that can introduce competition as well as best-of-breed functions and user experiences. This study shows that there is room for growth, and variation exists among some of the largest EHR developers.

Keywords: APIs; FHIR; apps; health IT; interoperability.

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Figures

Figure 1.
Figure 1.
Number of apps added and removed from each app gallery in 2020. Notes: (1) Added = all apps discovered for the first time in each gallery during 2020. Removed = all apps, previously discovered, not found during final December 15, 2020 data pull. Current = number of apps discovered on December 15, 2020. (2) Applications may be listed in multiple galleries, therefore added or removed applications in a given store may not be reflected in the “All 5 Galleries” group if that application is listed in another gallery. The “All 5 Galleries” group reflects unique applications. (3) Figure represents the number of applications discovered in the online app galleries hosted by Allscripts, Athenahealth, Cerner, Epic, and SMART from December 30, 2019 to December 15, 2020.
Figure 2.
Figure 2.
Number of apps that support FHIR for each gallery. Notes: (1) Added = all apps discovered for the first time in each gallery during 2020. Removed = all apps, previously discovered, not found during final December 15, 2020 data pull. Current = number of apps discovered on December 15, 2020. (2) Applications may be listed in multiple galleries, therefore added or removed applications in a given store may not be reflected in the “All 5 Galleries” group if that application is listed in another gallery. The “All 5 Galleries” group reflects unique applications. (3) Figure represents the number of apps discovered in the online app galleries hosted by Allscripts, Athenahealth, Cerner, Epic, and SMART from December 30, 2019 to December 15, 2020.
Figure 3.
Figure 3.
Proportion of apps that use the FHIR standard by the number of galleries where the app was discovered from December 2019 to December 2020. Notes: *Statistically significant from the “1 Gallery” group. Figure represents the number of apps discovered in the online app galleries hosted by Allscripts, Athenahealth, Cerner, Epic, and SMART from December 30, 2019 to December 15, 2020.
Figure 4.
Figure 4.
Proportion of apps that use the FHIR standard by functional category. Notes: (1) Functional categories are not mutually exclusive. (2) Figure represents the number of apps discovered in the online app galleries hosted by Allscripts, Athenahealth, Cerner, Epic, and SMART from December 30, 2019 to December 15, 2020.
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References

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