Care without Boundaries enabled by Smile Digital Health on AWS

Blog guest authored by Shane McNamee, SVP, Strategic Growth and Peter Yiu, Director, Strategy and Transformation of Smile Digital Health

The inconsistent implementation of interoperability in healthcare today can directly impact quality of care, population health, payor and provider workflows, and increase operational costs. Smile Digital Health‘s Smile CDR enables organizations to address these challenges with a composable FHIR framework to meet their specific interoperability requirements.

Interoperability Drivers

One of the most challenging aspects in the healthcare industry today is the lack of interoperability. Interoperability is the ability for different systems to access and exchange data across organizational boundaries in a timely manner to optimize the health of individuals and populations.

For providers, a lack of interoperable healthcare data can directly impact the quality of care when decisions are made on inaccurate or outdated information. For example, faulty data can lead to prescription errors or late detection of critical health issues. For payors, the quality of population health data used to identify emerging healthcare risks or trends are impacted. For health IT companies, the complexity of managing non-standardized data results in higher operational costs due to the additional complexity.

New regulations are also driving the need for interoperability standards across the healthcare industry. The new CMS and ONC g(10) regulations require providers to implement Health Level 7 (HL7) Fast Healthcare Interoperability Resources (FHIR) data standard application programming interfaces (APIs) by December 31, 2022. Providers must then facilitate patient access and the exchange of clinical information between healthcare stakeholders through near real-time data exchanges.

Smile Digital Health’s data fabric, Smile Clinical Data Repository (Smile CDR), on Amazon Web Services (AWS) addresses these challenges by providing an enterprise data fabric platform for healthcare data. A data fabric allows different data sources to communicate with each other by employing standards that easily translate inputs into a cohesive unit. Smile CDR is powered by the HL7 FHIR data standard. Its design allows for interoperable solutions to be composed from various modules. This composability allows users to easily select the input formats and configurations to fit their individual needs. This flexible design enables each organization to achieve interoperability of their healthcare data.

Healthcare organizations leveraging Smile CDR can benefit from the following capabilities:

• Support of open standards and regulatory requirements
  • Fully featured health data fabric built on the FHIR standard
  • Ability to ingest healthcare data in various industry formats and transform the data into FHIR standard resources
  • Identity management including Open Authentication (OAuth)/OpenID Connect (OIDC)
  • Support for 21st Century Cures Act compliance for Health Payors and Providers
• Composable solutions
  • Extensive modules which readily integrate with your existing healthcare systems
  • Smile Digital Health’s AppSphere, a safe and secure, SMART on FHIR marketplace for clinicians and patients
  • Master data management capabilities
• Operations and Security Controls
  • Fine grained access security controls, consent and access models
  • Rich reporting, analytics and business intelligence capabilities
  • Options from in-account installs and a fully-managed SaaS implementation backed by comprehensive enterprise level support

Smile CDR on AWS harnesses the strength of open standards empowering consolidation with other systems and data sets. This enables healthcare applications to be incorporated atop the data system and to mine relevant contextual data and trends when needed. Example applications include:

• Centers for Medicare and Medicaid Services (CMS) FHIR compliance solutions
• Health Information Exchanges (HIE)
• Value-based Care (VBC) outcomes to individual patients’ journeys
• Team-based care treatment programs delivering end-to-end efficiencies through automation to team-based care treatment programs
• Near real-time quality data to drive real-time care optimization
• Plug-and-play, modular, and intuitive healthcare apps that close gaps of care with existing clinical encounters

Interoperability with Smile Digital Health’s Platform on AWS

Smile CDR is designed to be a composable interoperable data fabric leveraging consistent and certified data standards. As such, it can be configured to easily ingest data from a variety of data formats, for example HL7 v2, Clinical Document Architecture (CDA), flat files, and more. It also supports common integration patterns such as batch and streams-based ingestion models. The following diagram illustrates the key components customers use to compose their individual solutions.

Figure 1 – Smile Digital Health’s Platform Conceptual Architecture

When Smile Digital Health’s platform is paired with cloud technology from AWS, healthcare entities can expect a secure, scalable, highly-performing, and resilient data fabric platform to address their interoperability requirements. Taking advantage of AWS security and compliance services, Smile Digital Health’s platform is designed to be eligible for global regulatory and compliance requirements such as:

• HIPAA (Health Insurance Portability and Accountability Act)
• PIPEDA (Personal Information Protection and Electronic Documents Act) in Canada
• GDPR (General Data Protection Regulation)

The following diagram illustrates a high-level architecture of Smile Digital Health’s platform on AWS.

Figure 2 – Smile’s Platform on AWS High Level Architecture

To enable the best-in-class experience for their customers, Smile CDR on AWS leverages cloud-native technologies to create a highly available and reliable solution. It utilizes AWS Services such as Amazon Elastic Kubernetes Service (Amazon EKS) and Amazon Relational Database Service (Amazon RDS).

Amazon EKS is a managed Kubernetes service that automatically manages the availability and scalability of the Kubernetes control plane nodes responsible for scheduling, availability, and storage tasks. Amazon EKS, allows Smile CDR to take advantage of all the performance, scale, reliability, and availability of the AWS infrastructure, including AWS networking and security services.

Amazon RDS is a collection of managed services that makes it simple to set up, operate, and scale databases in the cloud. Smile CDR leverages Amazon RDS support for the PostgreSQL engine to take advantage of the managed upgrades, storage management, replication for high availability and read throughput, and backups for disaster recovery.

Smile CDR on AWS also leverages Amazon Route 53 (Route 53) and Application Load Balancer (ALB) along with Amazon EKS and Amazon RDS to allow customers to scale their health data fabrics to peta-byte scale and to deliver extremely high throughput.

Route 53 provides a highly available and scalable Domain Name Service (DNS) for routing traffic at scale to your applications. ALB automatically distributes incoming traffic across multiple targets across Availability Zones. ALB automatically scales the load balancer capacity in response to incoming traffic.

“When Smile’s enterprise data fabric platform is paired with cloud technology from AWS, healthcare entities can expect a state of harmonious interoperability across the spectrum of care. Healthcare organizations can leverage Smile running on AWS to provide a scalable, highly-performing, resilient, and efficient composable data fabric platform based on industry standards. Security and privacy are job zero at AWS and customers can expect Smile on AWS to meet global regulatory and compliance requirements, for example to support the controls required for HIPAA in the US when storing and sharing their sensitive health data via the data fabric.”- Peter Yiu, Director of Strategy and Transformation, Strategic Growth at Smile Digital Health

Conclusion

As industry leaders, Smile Digital Health and AWS are bolstering innovation by connecting health information through standards, such as FHIR, enabling interoperability and advancing patient care without boundaries.

There are multiple healthcare industry drivers creating the need for interoperability standards. New regulations such as ONC g(10) are requiring HL7 FHIR APIs for interoperability in healthcare. The potential for improvements in quality of care, population health, and health IT workflow implementations will all benefit from standards-based interoperable data fabrics. Smile CDR on AWS provides the interoperable data fabric supporting these drivers along with leveraging AWS’ secure and reliable global infrastructure.

Taking steps towards implementing data standards can look different for everyone. When working with Smile Digital Health’s Platform on AWS, the process is dependent on the specific engagement you choose. An integral part of the process is discovery. This includes architecture mapping, a review of services needed, and recommendations for a rollout plan for a smooth transition.

To get details specific to your needs, start with Smile Digital Health’s AWS marketplace for more information.

To find out more about how AWS or AWS’ partners can help you please contact your Representative.

Further Reading

• How interoperability improves the healthcare experience
• AWS Healthcare Compliance in the Cloud
• Industry Insights: Personalized healthcare depends upon robust cybersecurity
• Understanding the Value of FHIR
• No Escaping FHIR: New ONC Regulations Mandate FHIR For EHRs
• Why the CMS Prior Authorization Rule Is a Win for Providers and Payors

Shane McNamee, MD serves as the Senior Vice President of Strategic Growth at Smile Digital Health and as the BPM+ Health Executive Director. Dr. McNamee has over 15 years of experience overseeing the development and implementation of interoperability tools on various healthcare and technology teams, including large, complex private sector organizations. His passion is to guide the healthcare industry to adopt open standards, and intelligent automation approaches to unlock their data as scale. As a seasoned physician, Dr. McNamee has experience as a clinical solutions architect and polytrauma rehabilitation physician specializing in recovering those with traumatic brain injury (TBI) and complex combat wounds. He is also published in the fields of TBI, complex neurologic injuries, post-combat care and polytrauma.

Peter Yiu is the Director of Strategy and Transformation, Strategic Growth at Smile Digital Health. Peter has 15+ years of health care leadership experience in clinical systems implementation, process re-engineering, digital transformation, strategic planning and product management. As a Health Science academic and a Systems Design engineer, Peter is deeply passionate in making the health care system better where information is accessible, scalable, composable and simply, efficient. A better system for his children and billions of people around the world.