A Blueprint for Designing and Developing M-Health Applications for Diverse Stakeholders Utilizing FHIR

Introduction

The need to develop mobile applications and services has dramatically increased in the marketplace, with the Gartner group forecasting the business demand for new and diverse mobile applications by the end of 2017 (Moore, 2015) will grow five times larger than the ability of a typical IT organization to deliver. There is an estimate that 2.1 billion mobile phone devices will be sold by 2019, which will increase the demand for new applications with a high performance and usability. According to the PEW Research Center (Smith, 2015), the percentage of American adults Smartphone owners has risen from 35% in 2011 to 64% in 2014 and the percentage is expected to increase in the following years. Moreover, about 62% of Smartphone owners use their phones to keep track of their electronic health records. Since mobile phones are portable and more convenient for typical users, these phones become a dominant way for people to access many services in most governmental and industrial sectors.

In the domain of healthcare, there has been an explosion of mobile health (mHealth) applications for patients (Rickwood, Kleinrock, Núñez-Gaviria, & Sakhrani, 2013) and medical providers (e.g., physicians, nurses, therapists, technicians, specialists, home health aides, etc.) (University of California San Francisco Library, 2016). More and more patients want to utilize a mobile device and mHealth applications to monitor and track his/her health conditions and fitness. Currently, there are many applications for pharmacies and organizing medications such as myCVS (CVS Pharmacy, 2016), MEDWatcher (MEDWATCHER, 2016), Drugs.com Medication guide and Pill Identifier Applications, (Drugs.com, 2016) etc. For patients, there are also personal health record (PHR) applications such as CAPZULE PHR, (Webahn Incorporation, 2016) MTBC PHR, (MTBC, 2016) suite of WebMD Applications, (WebMD, 2016) etc., and fitness applications such as Apple’s HealthKit app (Apple, 2016) and the Google Fit fitness tracker. (Google, 2016) In addition, medical providers seek to access electronic patient data in systems at medical offices, clinics, hospitals, etc., via mHealth applications and also to electronically submit prescriptions.

Collectively, patients and medical providers also desire to utilize the mHealth applications to access different health information technology (HIT) systems that maintain important medical information such as laboratory testing results (Quest Diagnostics, 2016), images and imaging reports (e.g., X-rays, MRIs, Ultrasounds, etc.) (Funt, 2016), etc., to ensure that all of the necessary information is collected for patient care. Examples of HIT systems include: electronic medical records (EMR), personal health records (PHR), pharmacy systems, etc. Enabling mHealth applications to access these HIT systems requires a practical way to send/receive related medical information to/from multiple HIT systems to an mHealth application. However, since each HIT system often requires community developers to access such a system using different formats (i.e., web services, cloud services, Application Programming Interface (API), etc.) and each system identifies medical concepts in different ways, the healthcare data access and health information exchange (HIE) processes become challenging integration problems which may result in increasing healthcare costs (Lamprinakos, Georgios C.; Mousas, Aziz S.; Kapsalis, Andreas P.; Kaklamani, Dimitra I.; Venieris, Iakovos S.; Boufis, Anastasis D.; Karmiris, Panagiotis D.; Mantzouratos, Spyros G., 2014). To solve this problem there is a need for a framework which will reduce such costs (Walker, Pan, Johnston, & Adler-Milstein, 2005), and for the purposes of this chapter,the means for an mHealth application to easily access health/fitness data from multiple HIT systems.