FHIR^® and Practice Fusion: Everything You Need to Know

One requirement of the 21st Century CURES Act is for certified health IT developers to deploy application programming interfaces (APIs) using the Health Level Seven International® (HL7®) Fast Healthcare Interoperability Resources® (FHIR®) standard. HL7 FHIR® is the standard used by technologies for the exchange of healthcare data, including both clinical and administrative information. All certified electronic health record (EHR) technologies must comply with this requirement.

Practice Fusion is compliant with this Act, which calls for us to enable patients and providers to connect third-party applications to our EHR using the FHIR API standard to access patient data. The FHIR release 4 API enables fast, secure communications between the Practice Fusion EHR and third-party apps—that is, applications created by independent developers rather than by Practice Fusion. These apps connect with the EHR to access patient data for a wide range of purposes. (For more detailed information about FHIR, we recommend reading this Practice Fusion Knowledge Base article.)

This article introduces FHIR, the types of applications that use FHIR, and what you need to know about integrating FHIR-enabled apps with your Practice Fusion EHR.

Types of Apps That Use FHIR

Three general types of applications can use FHIR to connect with Practice Fusion and Patient Fusion.

Patient-facing apps are applications that patients can use in addition to, or as alternatives to, Patient Fusion. For instance, a patient might like to use an external application such as a fitness tracker or pulse monitor and connect it to their Patient Fusion account.

Provider-facing apps are applications for use by Practice Fusion users. These apps could be used as stand-alone applications or, by utilizing the SMART on FHIR® standard, they could be used as modules within the Practice Fusion platform. These apps could allow a provider in your practice to connect with a third-party application for expanding integration with medical devices; or apps for accessing administrative reporting, cardiovascular risk scores, enhanced growth charts, or population analytics.

System or Bulk Export apps are third-party applications able to request large, practice-level data exports. This type of app might be used by payers, Accountable Care Organizations (ACOs), or population health solutions to request recurring data exports of a large patient population within your practice.

Note that a third-party application may request a connection with your practice EHR using the HL7 FHIR standard, and that request may occur outside the EHR itself. However, before a third-party app of any type can connect with the Practice Fusion EHR and Patient Fusion, it must undergo a rigorous application process and meet minimum quality standards. Developers who wish to connect with Practice Fusion or Patient Fusion can navigate to the Practice Fusion website and submit their application for approval.

How to Manage FHIR API Data-Sharing Apps

Before providers and patients can use any FHIR applications, Practice Fusion administrators must enable FHIR capabilities from within the EHR. Once FHIR has been enabled within the EHR, a practice administrator must approve all FHIR apps individually before they can be used.

Practice Fusion users with administrative permissions can view and manage third-party apps that are currently available to connect with Practice Fusion within the Application Marketplace. The Application Marketplace can be accessed by two methods:

1. Navigate to the Practice Fusion home dashboard, find the Application Marketplace tile, and select Open Application Marketplace.
2. Alternatively, navigate to Settings in the upper right-hand corner of the Practice Fusion screen and select Application Marketplace from the EHR Settings menu under Data-Sharing Apps.

Applications currently available to connect to the Practice Fusion EHR will be listed in the marketplace tab. Users can employ the search bar and/or filtering options to narrow the search to a particular type of application (patient-facing, provider-facing, or system/bulk export).

Selecting a specific FHIR app within the marketplace allows you to view additional information about the app, such as its type, description, and the specific information the app could access if approved.

How to Control Data Shared with Third-Party Apps

The practice administrator can authorize or revoke an application’s ability to retrieve and read patient information (e.g., patient demographics, diagnoses, procedures, and so on) at any time. An application’s “Scope” lists the specific information an app can access if approved. This information would be retrievable and used in the manner for which the application was designed.

Note that application approval is an “all-or-nothing” process; practice administrators cannot deny any specific permissions or scopes requested within an application. You can only approve or revoke an application and its permissions in total.

Also, note that FHIR apps are never bidirectional in their data access ability. FHIR apps employ a “Pull” method, meaning that the app needs to request information from Practice Fusion each time it updates its data. Although FHIR apps can read patient information, they cannot change or write over EHR data. Data flows only in one direction, from Practice Fusion to the FHIR app, and no application can change data within your account.

If you wish to authorize or revoke an application, the specific process depends on the app type.

Patient-facing apps: Patient-facing apps are authorized separately by patients when logged into the app using their Patient Fusion account. By authorizing an app, patients can link their health information in Patient Fusion to an external application. Patients can only authorize an app to access their personal data; the approved app cannot read their credentials. If the patient wishes to revoke access, they may do so from their Patient Fusion account.

Provider-facing apps: Provider-facing apps previously approved by the system administrator will appear in the Authorized Apps tab within the Practice Fusion EHR for any practice user logged into Practice Fusion. Apps cannot read providers’ login credentials. A system administrator may revoke data access for provider-facing apps by either 1) selecting Revoke Access from the Authorized Apps tab or 2) selecting Revoke Access from an individual applications details view. The system administrator must then confirm the revoke request via the resulting notification.

Note: Authorizations can only be revoked for provider-facing or system/bulk export apps. Once authorized, patient-facing applications cannot be revoked by practice members.

System or Bulk Export apps: To authorize a system/bulk export app, a practice administrator must select the Authorize App button from the application details view. The administrator must confirm their selection by clicking Confirm on the resulting notification. Revoking access for system/bulk export apps uses the same process as for provider-facing apps.

Other Common FHIR Questions

What does it cost to use FHIR-powered apps?

At present, FHIR is complimentary to all Practice Fusion clients. FHIR is still a relatively new technology; we will update our program as it evolves. Future use of certain FHIR-related features may require you to subscribe to add-ons that support your practice’s ability to integrate with those features.

How does an FHIR API get started? Where do I direct a third-party developer for more information?

Developers with third-party FHIR apps need to begin by registering with Practice Fusion. If they have done so and need additional assistance, please have them contact Customer Support directly. Our internal team will work with them to address any remaining questions. We also recommend that FHIR developers read our FHIR Developer FAQ Knowledge Base article for additional information.

Making FHIR Work With Your Practice Fusion EHR

Practice Fusion partners with laboratories, imaging centers, billing solutions, ACOs, and numerous other service providers to deliver essential services to our physician community. If you want to learn more about partnering with Practice Fusion, please contact us today!