How to Easily Integrate with Epic & Cerner Using SMART on FHIR and Medblocks Plasma

Summary

Software developer Eric demonstrates Medblocks Plasma, a platform that streamlines building integrated health IT apps connecting to EHRs like EPIC and Cerner. He shows how Plasma can quickly connect an existing diabetes risk scoring app to multiple EHR environments with minimal code changes. The platform normalizes EHR differences allowing developers to avoid complex branching logic. He recommends developers with existing auth use SSO to link EHR accounts while new apps can leverage EHR login. He invites developers to try Plasma to accelerate connected app development.

Takeaways

• 😀 Eric worked at Epic for 8 years building their EHR software
• 📝 Medblocks Plasma platform makes integrating health apps with EHRs simple and fast
• 👨‍💻 Goal is to open up health IT industry to more third party developers and innovation
• 📱 Built a quick diabetes risk scoring app to demo integration with EHRs
• 🔌 Added SMART API sandbox using simple configuration
• 💡 Pulled patient data from FHIR APIs to prefill form fields
• ⚙️ Easily connected app to Epic and Cerner sandboxes with no code changes
• 🌏 Normalizes API requests across different EHR types under the hood
• 🔗 Can configure SSO to link user accounts across systems
• ✅ Platform enables developers to focus on their app, not complex integrations

Q & A

What is the purpose of the Medblocks Plasma platform?

The Medblocks Plasma platform aims to make it as simple, fast, and easy as possible to build integrated health IT applications that can integrate with different EHRs. It is designed to open up health IT development to third party developers to help drive innovation in the industry.

What programming language and framework was used to build the diabetes risk scoring app demo?

The diabetes risk scoring app demo shown was built using React.

What EHR systems does the Plasma platform currently integrate with?

The Plasma platform currently integrates with major EHR systems like EPIC, Cerner, and Allscripts. It also works with the SMART Health IT sandbox.

What FHIR resources does the demo app use to get patient data?

The demo app uses the Patient, Observation, and other FHIR resources to get the patient gender, age, BMI, and smoking status data.

What authentication standards does the Plasma platform support?

The Plasma platform supports the SMART on FHIR authentication standard to securely connect apps with EHR systems.

How can a developer launch their integrated app to users?

A developer can provide a launch URL on their website, embed the URL in an EHR system, or use their own login system and link accounts to the EHR identities.

What is the benefit of using the Plasma client SDK in apps?

The Plasma client SDK makes it easier to interact with the Plasma platform by providing a typed API instead of calling REST endpoints directly.

How long does it take to connect an existing app to a new EHR system?

Using the Plasma platform, it takes only about 60 seconds to add a new EHR platform and environment to connect an existing app.

Can developers use their own identity management system?

Yes, developers can use their own identity platform and link EHR user accounts to it via single sign-on provided by Plasma.

Where can I learn more about the Medblocks Plasma platform?

You can visit the Medblocks website and signup for early access to try out the Plasma platform yourself and integrate apps with EHRs.

Outlines

00:00

😀 Introducing Eric, Medblocks, and demo app

Eric introduces himself as a software developer with 8 years experience at EPIC building EHRs. He started Medblocks Plasma to make it easy for developers to build integrated health apps. He demonstrates a sample diabetes risk scoring app and shows how he can integrate it with EHRs using Plasma.

05:05

😃 Connecting app to SMART sandbox

Eric adds the SMART sandbox as a platform in Plasma. He launches the app from the patient/clinician test screen, logs in as a provider, selects a patient, and approves the app. Data is now loaded from the SMART sandbox FHIR APIs.

10:08

😄 Integrating real EHR data into app

Eric installs the Plasma client SDK and writes code to query gender, age, BMI, smoking status from the FHIR API and prefill the form. He tests it and shows real patient data loaded from the SMART sandbox EHR.

15:12

😁 Connecting to EPIC and Cerner EHRs

Eric adds EPIC and Cerner platforms to his app in Plasma. With no code changes, he launches his app from EPIC and Cerner sandboxes successfully, loading in real patient data.

20:13

💡 SSO and managing user authentication

Eric explains how developers can implement SSO by calling an endpoint to get user identity information. He suggests linking accounts for existing logins or using EHR login for new apps.

Keywords

💡EHR integration

Integrating electronic health record (EHR) systems like EPIC and Cerner with third-party applications. This is a key theme as the video demonstrates a platform to simplify EHR integration so developers can focus on their apps.

💡Interoperability

The ability of different information systems like EHRs to communicate and exchange data, which is essential for integration. The video platform enables interoperability across EHRs.

💡FHIR

Fast Healthcare Interoperability Resources (FHIR) is a standard for exchanging healthcare data between systems. The platform uses FHIR APIs to integrate apps with EHRs.

💡SMART on FHIR

An open standard that uses OAuth and FHIR to integrate apps with EHRs for security and authorization. The platform supports SMART on FHIR.

💡Normalization

Converting data into a standard format. The video mentions normalizing requests across different EHR APIs to simplify integration.

💡SDK

Software development kit. The video demonstrates using a SDK to simplify integrating with the platform vs. calling APIs directly.

💡SSO

Single sign-on allows users to access multiple applications with one set of credentials. The video discusses supporting SSO with EHRs.

💡Launch workflow

The ability to launch an app from within an EHR system. The platform supports configuring launch URLs for integration.

💡OAuth

An authentication standard used by SMART on FHIR for authorization. The platform handles OAuth flows when launching apps.

💡Sandbox

A testing environment that mimics production systems. The video shows connecting apps to the SMART sandbox for testing.

Highlights

The Medblocks Plasma platform makes it simple, fast and easy to build integrated health IT applications.

The goal is to open up health IT development to third party developers to help innovate in ways that major EHR vendors haven't been able to.

The Plasma platform handles normalizing requests across different EHRs so developers don't need custom integration code for each one.

The Plasma client SDK provides easy access to the Plasma REST API for querying and updating FHIR resources.

The SMART health IT sandbox provides sample FHIR data for testing integrations before connecting to real EHRs.

The Plasma platform allows launching apps in context of a patient for streamlined clinician workflows.

Plasma supports integrating with both provider-facing and patient-facing apps with the same API.

Plasma handles app registration with EHR vendors like EPIC to get required credentials.

Plasma environments represent individual client endpoints for testing and production.

Plasma provides SSO support to link user accounts across apps and EHR login.

For new apps, developers can use the EHR login as the identity provider.

For existing apps, users can link EHR account to their login through SSO.

Minimal custom code is needed to populate app forms from EHR data.

The Plasma platform and client SDK handle all complex integration tasks.

Early access to Plasma is available for initial users and development partners.

Transcripts

And I'm gonna go ahead and copy mine. You're  gonna do both EPIC and Cerner in 60 seconds?!  

Yes, and now you'll see it's connected to EPIC  hyperspace, which is EPICs EHR. So that's actual  

data coming from EPIC Yes, exactly. It's..  Hey Eric. Nice to have you you've got a very  

interesting background. So How about we start  from there? Sure. Yeah, I'm a software developer  

I've been a software developer for about 10 years  and eight years of that was spent working at EPIC  

building helping to build their EHR software.  So right now you've been working with us for  

some time now. We've been helping a lot of  clients with their integrations with EPIC,  

Cerner and other EHRs. What are we doing today?  Sure today we're going to show off the Medblocks  

plasma platform, which is a platform used to  make it as simple fast and easy as possible  

to build integrated health IT applications  that can integrate with different EHRs and  

It's cross-platform. So it works with any of  the major EHRs so before we go into the demo,  

I'd like to just ask you why you started working  on the solution and yeah you already had most of  

this in your mind before you came into Medblocks.  And so I wanted to know what prompted you to build  

these. Yeah, good question. Well, I'm interested  in the health IT industry that's where I worked,  

like I said, for eight years and I like making  apps myself. I find it enjoyable. So it started  

as just tinkering around making my own health  apps and trying to find the best solution for  

that and I expanded on it because I believe  this has the potential to really open the  

health IT industry to third party developers to  make the industry better by Innovating in ways  

that maybe some of the major EHR vendors haven't  been able to do so that's ultimately the goal is  

to make this is to open this up for third-party  developers to help innovate on the industry.  

Yeah, I totally agree with that and I think Big  EHR will never be able to do everything well,  

and you have so many other people out there who  can innovate who can bring more to the table and  

I think it makes sense to open up the ecosystem  to a wider range of people too. So, cool, so let's  

see something. As a as a really basic demo I want  to take an existing app that I've created and show  

how I can use the plasma platform to integrate  this with multiple EHRs in just a few minutes and  

so the app that I'm demonstrating here is a very  simple risk scoring app it's called the Cambridge  

Diabetes risk score and I have, you can find more  information about it right here, but essentially  

it's just a form that a physician might use to  assess a patient's risk for developing Diabetes  

and you can see that as we update the parameters  here, the patient's score is updated accordingly,  

and this is just a basic react app that I've  built and I'm going to demonstrate how to  

use the plasma platform to integrate that with  different EHRs so the first step would be to,  

and by the way interrupt me if you have  any questions or anything, Yeah, yeah,  

I would say this is something that a developer  usually would have, it's easy to build but they're  

then stuck on how to exactly integrate this with  an existing EHR. That's when they usually come  

to us. They approach us ask us for help. So  I think this is a pretty typical application.  

Exactly and it can be tricky to do the integration  but with this platform, it makes it extremely  

simple so the first step would be to to locate  your instance of plasma and here I'm running it  

locally on localhost:3000 and you would log in,  this is password protected so everything you put  

in here is is behind a protected gateway and  you'd go to your account, I'm already logged  

in here. And the first step is to create a new  project here, so I'm going to create a project  

and a project represents an application. So here  let's just put diabetes risk score as the type of  

project and you'll select what type it is, this  has to do with the authentication workflows for  

SMART on FHIR. So this is a clinician app because  a clinician is the intended user and we'll we'll  

have this app, we'll have the clinician login  before using the app. So I'm going to choose  

clinician and I'm going to set the location of my  app as localhost:3001/main. That's just where I'm  

currently hosting this sample app. Okay, so I'll  save my project and now I've got my diabetes risk  

score app here. The next step is to specify the  EHRs I want to connect to and the health systems  

endpoints that I want to connect to, so to start  off with we're going to use the SMART health IT  

Sandbox just for testing and then once we're  finished I'll show you how to connect it to  

EPIC and Cerner, which are common EHRs that  people want to connect to. So the first thing  

I'm going to do is add a platform and here's where  I select the EHR type. We have some of the major  

ones listed or you can always choose other, I'm  just going to call this SMART and I'm going to set  

the scope here to just basically give me access  to everything from the patient and user contexts  

and then I'm going to specify launch/patient  to indicate that when I launch the app I want  

to select a patient before continuing. The last  step is to choose my health system endpoint and  

so you can imagine that you might be supporting  multiple health systems that are all using EPIC,  

for example, and they all each have their own  individual endpoints. That's where you would  

come. Here's where you would configure that I'm  just going to choose the SMART sandbox with this  

quick button and then I'm going to associate  this environment with my SMART platform.  

Okay, so that's all the configuration  that needs to be done and now my app is  

ready to go and to be launched with the Plasma  platform. I can quickly test that by going to  

the patient/clinician test screen. I can choose  my project here and choose the environment that  

I want to launch it from. Here's the launch URL  that you would use, so you could provide a link  

to this on your website or configure the EHR to  launch this link if that's what you want to do  

or we can click launch here and it's going to take  us through the authentication workflow. So first,  

I'm going to log in as a physician and then since  I chose launch/patient I need to choose a patient  

to launch this app in the context of,  

I'll approve the application and now I'm brought  to my app and it's actually a little bit more  

complicated than I thought, and it's actually  working right now, it's connected to the EHR so  

I can make queries to that EHR but of course the  app looks the same as it did when I first showed  

it because we we haven't changed any of the  code to actually utilize that data from the  

EHR yet. Purpose of this demonstration is I  want to pull the patient's gender, age, BMI,  

and smoking history, and I want to pre-populate  this form with those data points so that way it  

just optimizes the physician's workflow. They're  not required to enter these fields in because we  

can actually get that data from the EHR itself  and it may be possible some of this other data,  

but it's just for simplicity sake, I'm just  going to get those four things. Let's do it.  

Alrighty, so the first step that we want to  do is we want to install the Medblocks Plasma  

client SDK and that just gives us an SDK to work  with the Plasma platform. It's optional, you can  

just call our REST API directly, but this makes  it a little bit easier. So I'm going to install  

Medblocks Plasma client, when it's got  install the Medblocks plasma client SDK.  

There we go, now that it's installed  I'm going to import it into my project.  

Okay, so if you'll give me just a moment I'm going  to write some code to actually query the data  

from the EHR using the Plasma client SDK. So, I'm  going to make a function called load patient data,  

that function will take a patient ID and  it's going to load in the patient data. So,  

the first thing I need to do  is initialize my Plasma client,  

I'll provide that Plasma URL, then I'm going  to get the patient information and this is all  

type strongly type. So, here I'm going to set  my patient equal to Plasma client.read patient  

pass in the patient ID, I'm going to get the  smoking observations. So, the smoking history is  

returned as an array of observation resources  and I'm going to use the Plasma client.read  

smoking status. That's in my patient  ID here and lastly, I'm going to get  

the BMI information, which is also an array  of observations. So, it's a BMI observations  

and the way I can do that is by calling read  patient resource, specify that this is an  

observation type of resource, and I'll pass in  the patient ID. The name of the resource that I  

want to provide, and any search parameters that  I want to give, in this case I want to search  

by the BMI code, which I've already specified  right here 39156-5 that's the code used for the  

BMI. So that's going to do a filter query and I'm  sorry, this should be search patient resource, so,  

it's going to search observations on this patient  that match the given code here. So, now I have all  

the information that I need from the EHR in order  to pre populate my form. Let me just return these  

and the last thing I need to do is actually pre  populate my form. So, give me one second to do  

that as well. This is a react app, so, I'm going  to create a use effect and this is going to be  

dependent on the patient ID. So, as soon as we  have set the patient ID, I want to run this. We  

will call, set is loading to be true, that shows a  loading spinner on the screen and then we're going  

to call a load patient data with the patient's ID  and then I'm just going to autocomplete this, here  

I'll explain it. Okay, so we're just calling  load patient data to load the data from the EHR,  

and now that we have this data, we're going  to set the fields in the form so that they  

are initialized properly. So, the first thing I  want to do is I just have it saving off the data  

into some state variables in case I want to use  them later. So, let's say save patient data and  

then I want to initialize fields in the form or  this, I have a function that I've created called  

get params from FHIR resource that takes those  exact FHIR resources and that's going to give me  

the gender, the age, the BMI, and the smoking  status. So, with that I can call set gender,  

set age, which is expected to  be a string set, smoke status,  

and set BMI. Okay, so took me a bit of,  a little bit of time to write the code,  

but it's not much code at all. Basically, I need  to initialize my Medblocks Plasma client with the  

URL of the Plasma instance that I'm running I  can do whatever FHIR queries that are necessary  

to perform the actions I need with my app and then  here I'm just updating the UI. So, pretty simple  

and let's go ahead and save it and test it out  and see if it works. I'm gonna come back to the  

patient/clinician test and I just remembered  one thing I need to change, the last thing I  

need to do is, that set is loading to false  to hide this, the loading spinner. Okay,  

so I'm going to come back to the patient/clinician  test screen and I'm going to launch the app in the  

SMART health IT sandbox. Once again, I'm going  to log in as a physician, Dr. Albertine Orne,  

I'm going to select a patient, I'll choose  Jeffrey Abbott, approve and now we'll see that  

I've added a header here showing the patient's  information. Here's his date of birth, age, sex,  

smoking history, and BMI and I have pre populated  the risk score form with that information.  

That's cool. And this is coming from the  FHIR API's of the SMART health IT sandbox.  

Exactly, and this is a great sandbox to use for  testing, but a lot of people want to test it out  

on real EHRs like EPIC and Cerner. So, I'll show  you how to do that in just about 60 seconds. We  

can connect these two EPIC and Cerner sandboxes  and not have to change any code at all. So I'll  

demonstrate that. The way that we do that is we  come back to the diabetes risk score project,  

and we need to add those additional platforms  EPIC and Cerner. So, I'm going to do that now  

and I'm gonna go ahead and copy mine - You're  gonna do both EPIC and Cerner in 60 seconds?! -  

Yes. Well after you edit it, okay, so I'm going to  add a new platform for EPIC, we'll call this EPIC,  

I'm gonna add my client ID here and I'm just  going to copy the same scope, paste that in  

and I'm going to add a new platform  for Cerner and set my client ID,  

and the scope is actually a little bit different  with Cerner. I'll paste in the scope for Cerner.  

Now I have configured my client IDs for those  two EHRs which is necessary to identify this app,  

and then I'll use these quick buttons to add  the EPIC and Cerner Sandboxes, and then I will  

just associate that with the EPIC and Cerner  Sandboxes, and then I will just associate those  

environments with my EPIC  and Cerner EHR credentials.  

That's all, that's necessary, now the app is  connected to EPIC and Cerner we can jump back  

to the patient/clinician test screen, choose  our application, choose the environment that  

we want to test it on, and launch it, and now  you'll see it's connected to EPIC hyperspace,  

which is EPICs EHR. I'll log in as a physician  whose login is named FHIR, choose my department,  

and now I'm brought to the patient search screen.  So, let's just choose the most recent patient  

Camilla Beacon, and we will approve, and now you  can see it has loaded in Camilla's information,  

her gender, age, everything has been  pre-populated. - So, that's actual data  

coming from EPIC. - Yes, exactly. It's it's  coming from the EPIC sandbox environment. So,  

this isn't a real person but yes, it's coming from  the EPIC EHR and the exact same process would be  

used to connect to a live EPIC health system. -  Okay, okay, we have 30 seconds for Cerner - Sure,  

so it's just as easy. I'm just going to select  Cerner. The only thing that changes is my launch  

URL, going to launch it, and actually the client  ID that I specified for Cerner is a patient facing  

app not a provider facing app so, in this case,  it's demonstrating a patient logging into the  

patient portal but that also just demonstrates  that the process is exactly the same for physician  

facing apps or patient facing apps. Nothing really  changes in terms of the Plasma platform so, here  

I'll log in as Nancy Smart, who has two children  that she's a proxy for, I'll choose her record,  

and accept it, and in just a moment the patient  header should load with her information.  

There we go, so there's Nancy Smart and this  is coming from the EPIC or the Cerner sandbox  

environment so the data might be weird but as  you can see, it's once again just as easily  

loaded data from Cerner's EHR With no changes  to my actual application code at all. - That's  

really cool like, so let's, I want to look at the  application code again, so we have nothing that's  

specific for EPIC or Cerner in the code, right?  - That's correct. Yes. So one of the things that  

we do on our end is that we normalize requests  based on the EHR that you've selected so some EHRs  

although they're all using FHIR, there are  sometimes subtle differences and how you need to  

make requests for each individual EHR, and in this  case, we've avoided doing any type of branching  

in our application code so we're not going to  do that. Each individual EHR and in this case,  

we've avoided doing any type of branching in  our code that would, you know, you might you  

might see code that's checking if this is EPIC do  it this way or if this is Cerner do it that way,  

instead we've got a consistent API that works  across all the EHRs that we support and you'll  

never have to make changes to your code in the  sense of branching out on different EHRs. - I  

think it's a pretty good live demo usually  things don't work this smoothly. Yeah alright,  

so Eric so let's say that you know people use the  Plasma Portal and they connect their application.  

So they have an existing application. They  just write a bunch of code and they go to  

the Plasma Portal and then configure all of  their environments, right? So take me through  

what this would look like for an average developer  integrating with multiple EPIC hospitals. - Sure,  

so If you're a company and suppose you've got a  handful of EPIC clients that want to use your app  

and install it the process on your end is to first  register your app with the EPIC EHR and that is  

to go to EPIC's App registration page, create an  account and register your app and receive a client  

ID, and now that you've got the client ID then you  put, you save it in the Plasma platform one time  

and you don't really need to worry about it after  that to connect to all the the EPIC clients that  

you want to connect to you would configure those  in that environment screen you'd configure the  

endpoints for each of the environments. So let's  say it's Mayo Clinic they would have an endpoint  

for their FHIR server that you would configure.  Typically with EPIC there's a test server and a  

prod server and you use test for testing before  you go to production so you probably have two  

endpoints there one for test and one for prod  and those would each have unique launch IDs and  

you've got that URL there, the launch URL, and  you can you can launch that URL from anywhere  

that you want. You can put it on the home page  of your website or like I said, you can embed  

it in the EHR if you if you'd like. - Application  developers might have many ways of Launching their  

application, right? They might have their own  login mechanism. They may want to Use EPIC or  

Cerner as their login provider What would you  suggest and What's your recommendation here? -  

That's a great question and it's something that  comes up with a lot of the requests that we get,  

a lot of developers have an existing user  authentication system and they want to add  

SSO with the EHR to basically associate users  of the EHR with their identity platform, so  

you can stick to the workflow that I just  demonstrated, which is to launch the app,  

log in through the EHR, and continue working in  that way. However, we do provide SSO information  

if you want to implement single sign-on for your  application so you can call an endpoint and get  

the identity information about the logged in user  and you can choose how you want to implement that.  

My recommendation would typically be have your  users log in with your existing login platform  

and then provide a mechanism for them to link  their account with whichever EHR is relevant,  

so they would click a button, link this account.  They'd be brought to let's say EPIC's EHR they can  

log in there and from after that point you can get  the identity information about that user and then  

link the account within your own platform. - Got  it. So for people who already have Something to  

manage their login, they just link it within their  application and we get all of that information,  

for people starting new they can also opt to use  the EPIC or Cerner as their login mechanism. -  

Yes, exactly yeah, if they're starting from  scratch they can log in through EPIC and they  

can still get that identity information and use  that as the basis for their own identity platform  

that they want to build. - So the Medblocks  Plasma platform is on early access right now  

and we do have limited offer going on for the  initial few people who want to enroll with us,  

and if you are looking to integrate with EPIC,  Cerner, Allscripts and any of these EHRs and  

you don't want to write all of the code yourself  you can give us a try and just see how it goes,  

and you know that there's a link down in the  description below. You can send me an email,  

you can fill out the form on  our website, anything is fine.  

Yeah, we have this new platform and we hope that  it helps more developers connect to EHRs faster  

so that you can focus on your application  and you let us take care of connecting the  

application to the EHR for you. So thanks again  for watching and we'll see you in the next one!