We are developing an iPhone app that supports patient-centered, team-based care plans. Our objective is to enable the patient, family caregivers, and all members of the care team to be active participants in using and updating a shared care plan for managing chronic conditions. Members of the care team create and update a care plan using their organization’s EHR system, or using other applications that support a standards-based interface. A care plan addresses specific health problems, defines measurable goals, and includes interventions, medications or other activities that the patient should perform. The patient may contribute activity data (weight, blood pressure, blood glucose, pain score, etc.) that helps their care team evaluate progress, or lack of progress, toward goals. All aspects of a care plan are available on a patient’s personal iPhone, and changes to the plan are updated in real-time from their care team’s health record system.
We are leveraging two complementary technologies that are uniquely suited for putting the patient at the center of care planning and managing wellness: HL7 FHIR®© standards 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.
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.