Dell Medical School Building FHIR-Based Community Data Platform

In 2021, the Dell Medical School at the University of Texas received grant funding from the Office of the National Coordinator for Health IT to build a FHIR-enabled Social and Health Information Platform (FHIRed-SHIP).

During a Feb. 23 ONC Social Determinants of Health (SDOH) Information Exchange Learning Forum, Dell Medical School executives described some of the progress they’ve made.

The platform is being designed to integrate a closed-loop social services referral system accessible through the electronic health records (EHRs) maintained and used by Federally Qualified Health Centers (FQHCs). The system will help manage social needs identified in clinical settings; exchange information between clinical providers and community-based organizations; and integrate clinical workflows and EHRs.

The system will leverage FHIR APIs and the Gravity Project’s use case package, which outline use cases for the collection of SDOH data as they relate to food security, housing stability, and transportation access.

“Our social and health information platform that we started putting together in 2019 was trying to bring longitudinal records of individuals’ data from social services and clinical data in such a way that it delivers information at the point of care and an easy way for clinicians and providers to react to it,” said Eliel Oliveira, M.S., M.B.A., director of research data infrastructure on the data integration team in the Dell Medical School’s Department of Population Health. “For instance, for pediatric asthma it brought data from many sources to be able to summarize very easily how care can be provided.”

As Oliveira explained, Dell Med is now building on an existing patient engagement platform—the FHIRedApp funded by the ONC in 2019.  They developed FHIRedApp as a patient engagement technology to make it easier for patients to gain and provide access to their health data. The FHIRed-SHIP app adds a social and health information component to facilitate sharing across sectors and integrate clinical and social sector data. The Dell Med team is applying the same development approach used for the FHIRedApp, which included the use of community engagement studios, human-centered design, and engagement with the project’s community advisory group, according to an ONC blog post. The model identifies patients, providers, purchasers, payers, policy makers, developers, and principal investigators as key stakeholders from a patient-centered outcomes approach.

ONC said that FHIRed-SHIP will demonstrate the implementation of a patient-centric “closed-loop” referral management platform using open, non-proprietary standards, community-supported health information exchanges, and modern internet-based delivery systems, including:

• FHIR application programming interfaces,

• Nationally available social services referral digital platforms,

• Regional health information exchanges (HIEs), and

• Secure responsive mobile and web apps.

Additionally, the project team will partner with two regional HIEs in Texas and Louisiana to demonstrate scalability and interoperability of the solution. Data captured on FHIRed-SHIP from social needs assessments, social service referrals, and healthcare utilization will be used to assess the potential impact on patient outcomes and social service referrals.

Oliveira said that the use of standard APIs offers the team visibility to understand where things may be falling through the cracks and not allowing individuals to complete an application process, which happens frequently. “For about 50 to 70 percent of the referrals that we place in our community, we don't know where they are. They do not get to the end of the process, and we believe that this ecosystem would allow us to have better visibility.”

Prior to joining Dell Medical School, Oliveira was the chief information officer at the Louisiana Public Health Institute (LPHI) in New Orleans where he led the architectural design and implementation of the Research Action for Health Network as one of the leading nodes in the national Patient-Centered Outcomes Research Network infrastructure. Oliveira also directed the technical teams at LPHI in the management of the Greater New Orleans Health Information Exchange (GNOHIE).