By Brian Warwick, Sr. Partner Solutions Architect – AWS HCLS
By Ciprian Sabolovits, VP of Software Engineering – Cognosante
Healthcare customers are adopting fast healthcare interoperability resources (FHIR) as a way to exchange healthcare information in a secure and compliant manner.
Aligning on a common data model streamlines healthcare application development and the adoption of machine learning.
Over the past year, Amazon Web Services (AWS) released two FHIR offerings, Amazon HealthLake and FHIRWorks on AWS, in order to streamline customers’ journey of freely exchanging clinical information and running artificial intelligence (AI) and machine learning (ML) on it.
While the JSON structure of FHIR removes the guesswork of how clinical data is formatted, customers often ask how they can truly understand what is contained inside a FHIR data store.
This post highlights a new way to visualize and navigate FHIR data on AWS by using eSante Clarity, Cognosante’s FHIR viewer. We’ll show users how eSante Clarity can access FHIR data on AWS and navigate the clinical dataset within.
Cognosante’s expertise includes not only public healthcare and the health insurance marketplace, military and veterans’ health, but DoD, intel, and civilian agencies in need of cloud optimization, data and analytics, cybersecurity, biometrics, and modular system development and integration solutions.
As active participants in HL7’s FHIR standard, Cognosante has invested in FHIR since its inception, maximizing the benefits of modern transport and content standards, as well as resource encapsulation. Cognosante supports nationwide clinical data interoperability and is HITRUST, CMMI L3, ISO 20000, and ISO 27001 certified.
Cognosante’s eSante Clarity marketplace solution connects to a user’s specified AWS FHIR store, passing and visually rendering FHIR resources.
This viewer creates a new tenant per customer, ensuring that no protected health information (PHI) is stored on the Cognosante platform.
The environment passes queries to the user’s specified FHIR data store, enabling Cognosante’s viewer to handle rendering and navigating the complex FHIR models within.
Figure 1 – High-level architecture for eSante Clarity.
Getting Started with a Clinical Dataset
To start viewing FHIR data, users need a FHIR data store on AWS.
This example uses Amazon HealthLake to create an FHIR data store quickly with synthetic data. Users can navigate to Amazon HealthLake in the AWS Management Console, searching for Amazon HealthLake, and creating a new FHIR store with the “Preload with Synthea” checkbox checked.
Figure 2 – Creating Amazon HealthLake store.
Viewing FHIR Data
To start viewing our HealthLake data, users can sign up for eSante Clarity through AWS Marketplace and follow the automated provisioning. Users will then receive a subdomain they can log into and begin navigating their FHIR data store.
For example, users can search for a patient and view a summary of all salient clinical information related to them in a patient story screen.
Figure 3 – eSante Clarity patient story summary.
The viewer works seamlessly with Amazon HealthLake and/or FHIRWorks. This means it can surface the AI/ML results of Amazon HealthLake associated with documents.
By navigating to a patient’s documents, for example, the viewer has added icons for several discharge summaries and physician notes.
Figure 4 – AI/ML benefits of Amazon HealthLake are visualized.
By clicking on the Amazon HealthLake Inferences icon, users can navigate the Amazon HealthLake model results and see medications, diagnoses, and other items that were previously locked within the document and have now been automatically surfaced.
Figure 5 – Inferences from Amazon HealthLake are visualized.
The eSante Clarity solution has numerous screens available for all aspects of a FHIR data store. From viewing allergies, medications, procedures, vital signs, care team information, and more, the viewer empowers users to traverse all items to understand the JSON contained within.
This enables users to apply their FHIR data in the real world because they can quickly provision access to care teams and clinicians as needed. This allows them to start using the information for clinical decision support and viewing the results of AI/ML models that may be contained within the data.
eSante Clarity is also available as eSante MyHealth, a mobile application version tailored for patients on iOS and Android. Both were developed using human centered design methodology, ensuring optimized user interfaces and user experience as your FHIR data is navigated.
As volumes of health data grow, presenting them efficiently as FHIR resources is critical to avoid the noise that can be created by excessive data. The eSante user interface, in concert with Amazon HealthLake inferences, empower the streamlining of large volumes of data about any patient.
Figure 6 – eSante MyHealth mobile FHIR viewer.
Real-World Use Cases
Cognosante’s eSante Clarity platform has been developed to serve numerous use cases, including those presented by the need to view FHIR data in meaningful ways.
The platform benefits Cognosante’s Health Information Exchange (HIE) practice in service of clinicians, care coordinators, and ultimately patients. For a major statewide HIE, Cognosante is using the FHIR repository with eSante Clarity and eSante MyHealth to serve FHIR resources to care proxies, patients, and heads of household for those receiving benefits through Medicaid.
Participants are able to download a mobile app or access the eSante Clarity viewer through their browser to access their health data and that of their dependents.
In addition, Cognosante extended their viewers and handling of FHIR to accommodate claims data to better meet the U.S. Centers for Medicare & Medicaid Services (CMS) Patient Access and Interoperability rule.
Claims data is also received and mapped to FHIR, as well as United States Core Data for Interoperability (USCDI), and rendered to the patient as claims resources, adjacent to their clinical resources.
This approach enabled one of Cognosante’s strategic state customers to meet CMS compliance mandates with the rule that emerged in 2021 and will evolve over the next few years, better empowering Medicaid beneficiaries with their own clinical and claims data.
In this post, we demonstrated how Cognosante’s eSante Clarity FHIR viewer provides instant access to view and navigate FHIR data stores on AWS. We also showed how it can be used to view the AI/ML results from Amazon HealthLake for unstructured data.
To get started viewing your FHIR data on AWS, visit AWS Marketplace and quickly signup for the offering.
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