Research results published: More and more apps are integrating EHRs

New ONC studies show that the number of apps integrated into certified electronic health records (EHRs) has increased by more than 20%.

A manuscript highlighting the results of this research was recently published in the Journal of the American Medical Informatics Association: “The ecosystem of apps and software integrated with certified health information technology“. Our study analyzed apps found in app galleries managed by EHR developers – Allscripts, athenahealth, Cerner Corporation, and Epic Systems Corporation – as well as in the SMART App Gallery. In particular, ONC wanted to understand the growth of the app market, the variety of app features available, the connection between these apps and EHRs, and whether the apps support the Health Level Seven® (HL7) Fast Healthcare Interoperability Resources® (FHIR) standard.

This study provides fundamental measurements and insights into this market prior to finalizing the final rule of the ONC Cures Act and its implementation. This research continues to this day to measure the impact of the ONC regulation and understand changes in the marketplace.

What the data says

Our research shows that the total number of unique apps and developers increased from 600 to 734 and 517 to 610 in 2020.

Administrative apps that managed scheduling, check-in, and billing made up 42% of the apps available. Clinical apps were also common, accounting for 38% of the apps; These apps perform automated tasks, population health, telemedicine, and clinical decision support. Other apps focused on care management (31%), patient engagement (20%), and research (5%).

The growth of FHIR-enabled apps stagnated. While more apps support FHIR (161 in 2020 versus 112 in 2019), there was no statistically significant increase in the proportion of FHIR-enabled apps among all apps (19% in 2019 versus 22% in 2020).

Some possible explanations for this modest growth are:

• Administrative apps, the most common type of app, usually don’t support FHIR. at least not to the same extent as apps for clinical use or care management.
• FHIR apps are typically developed around a number of specific use cases. FHIR resources are limited to sharing certain items of data, which can reduce their overall prevalence. As the number of use cases increases, so does the number of applications.

The role of secure, standards-based application programming interfaces (APIs) will be an area for researchers to explore further. Standards-based APIs can help apps connect to multiple EHR data systems without the additional overhead of using proprietary APIs for each integration. FHIR is broadly supported by healthcare IT developers, many of whom are market leaders. Tracking support for FHIR between apps over time will reveal how apps and the EHR data systems they are connected to use standards-based APIs to enable these integrations. When standardization makes integrations easier, more end users can connect to their data.

Looking for continuous growth

At ONC, we work with other government, industrial and academic partners to improve the access and use of electronic health information. This also includes finding ways to support competition and utilizing best-of-breed features.

In this study, the data showed that there is still room for growth and variation in the apps available. Updates to the ONC Health IT Certification Program resulting from the final rule of the ONC Cures Act are intended to support a more robust ecosystem of third-party apps. By the end of 2022, many certified healthcare IT developers will be required to support FHIR-based, standardized APIs for patient and population-level services, and they will need to adhere to the new Terms and Conditions and Maintain Certification API requirements for a transparent and promote competitive business practices methods exercises. Together, these updates should help improve the way third-party app developers use APIs. The published study examined the entire ecosystem of apps – for both vendors and consumers – integrated with EHRs. This ongoing study aims to further examine consumer-facing apps, particularly those that provide access to patient records, in future research.

Here, too, the aim of this study is to create a basis. ONC will continue to monitor this growth in the years to come to see what impact the rule will have on app development and integration with certified healthcare IT, and whether additional policies or practices allow the sharing and access of electronic health information via apps from Third party providers could speed up.