The SIMPLE Architectural Pattern for Integrating Patient-Facing Apps into Clinical Workflows: Desiderata and Application for Lung Cancer Screening

Abstract

In December 2022, regulations from the U.S. Office of the National Coordinator for Health IT came into effect that require electronic health record (EHR) systems to accept the connection of any patient-facing digital health app using the SMART on FHIR standard. However, little has been reported with regard to architectural patterns that can be reused to take advantage of this industry development and integrate patient-facing apps into clinical workflows. To address this need, we propose SIMPLE, short for Standards-based Implementation Maximizing Portability Leveraging the EHR. The SIMPLE architectural pattern was designed to meet several key desiderata: do not require patients to install new software; do not retain patient data outside of the EHR; leverage EHRs' existing personal health record (PHR) capabilities to optimize user experience; and maximize portability. Using this pattern, an application for lung cancer screening known as MyLungHealth has been designed and is undergoing iterative user-centered enhancement.

Figure 1.

Overview of the SIMPLE architectural pattern. The SIMPLE pattern leverages native PHR and EHR functionality such as native PHR health history questionnaires (D) and native EHR reconciliation mechanisms (F). This ensures the EHR database (H) remains the single source of truth while mitigating the need for an external data store (A). Patient and provider facing SMART on FHIR applications (B & C) can be launched from the PHR (E) and EHR (G), respectively, for seamless integration. EHR – electronic health record. PHR – personal health record.

Figure 2.

A) MyLungHealth application for patient education on personal lung cancer risks and potential benefits from screening. B) Patients can review the EHR-derived parameters used to compute their risk, and they can update these parameters for risk calculation purposes. C) Dissemination of the patient-facing SMART on FHIR app via pre-visit questionnaire. D) Native PHR pre-visit health history questionnaire for collecting smoking history.

Figure 3.

Native EHR mechanism for reconciling patient-entered history collected from pre-visit health history questionnaires. Patient-entered history must be reviewed and filed, usually by a medical assistant, before it becomes a part of the patient’s medical record.