My Care Guide on FHIR

Meghan's Care Plan

Meghan’s Care Plan

My Care Guide is a unique mobile app for iPhone and iPad that puts you at the center of defining and participating in a person-centered care plan that supports a long-term view for wellness that is guided by your personal team of doctors, therapists, family caregivers, and supportive friends. You and other members of your care team create and update care plans using the My Care Guide app, their organization’s electronic health record (EHR) system, or other applications that support an HL7 FHIR®© standards-based interface.

A care plan addresses specific health problems or concerns, defines measurable goals, and includes interventions, medications or other activities that you should perform or are performed by members of your care team. You may contribute activity data (weight, blood pressure, blood glucose, pain score, etc.) that helps your care team evaluate progress, or lack of progress, toward your goals. All aspects of shared care plans are available on your iPhone or iPad, and changes to the care plans are updated in real-time from your care team’s health record system.

 

What’s Inside

My Care Guide app is based on industry standards for healthcare data interoperability. We are leveraging three complementary technologies that are uniquely suited for putting the person at the center of care planning and managing wellness: HL7 FHIR®© standards, CDS Hooks for providing real-time guidance on your progress, and the Apple CareKit™ framework. This very brief summary will be expanded in future updates to this page as the app functionality and example patient scenarios are expanded and matured.

All data displayed in the app are queried from a server using standards-based FHIR service APIs for Care Plan, Goal, Condition, and other resources (FHIR Release 3 published in March 2017). SMART® on FHIR standards for OAuth2 are implemented for robust authorization security. Our app is built on the excellent Swift iOS programming libraries for FHIR and OAuth that were developed as part of the SMART on FHIR project at Boston Children’s Hospital and Harvard Medical School.

The Apple CareKit™ framework offers core modules that include a Care Card for displaying care plan activities (e.g. medications or exercise routines), a Symptom and Measurement Tracker for collecting and tracking objective assessments (e.g. blood pressure or weight), Insights for surfacing health tips and visualizing trends, and Connect to engage care teams and family members as partners in your health journey. In our Mobile Care Plan app, all care planning data is read from shared FHIR servers, and some of those data are mapped into the CareKit data structures and interface. We have encountered several limitations in the current Apple CareKit framework that we hope will be enhanced and aligned with HL7 FHIR standards in future releases. Some of those limitations include: no support for patient goals or health concerns, and scope limited to one patient and one care plan. We are designing our app with a more flexible capability that is based on common clinical practice, where a patient’s care is guided by two or more care plans, often managed by different healthcare provider organizations.

Example Care Plans

Two fictitious patient scenarios are described below, where we have created sample FHIR data in a server and then queried and displayed those data in our iPhone Care Plan app. These patient scenarios and iPhone app examples are currently under development and will be updated periodically.


Patient Scenario 1

Meghan is a post-9/11 Veteran who served in Afghanistan and is recovering from a Traumatic Brain Injury (TBI) and PTSD. Meghan recently became pregnant with her third child and is coordinating care plans between her primary care provider at VA and a community provider outside of VA for her prenatal care. Meghan has concerns about possible negative effects of her PTSD anti-anxiety medication on her new baby.

Click on the first image to open a slideshow of iPhone app screens that display Meghan’s care plan data queried from a FHIR server, and integrates the FHIR care plan data on her iPhone with Apple’s CareKit ® framework and interface.

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Patient Scenario 2

Dan is a Vietnam Veteran who continues to struggle with the effects of PTSD and Diabetes (resulting from Agent Orange exposure). He is also being treated for hypertension. The same iOS app used to display Meghan’s FHIR Care Plan is shown in the following slideshow after reading Dan’s care plan from the FHIR server.

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