“The model of creating structured data elements in a standardized format for EHRs has already been leveraged in the fields of cardiology and oncology. We are hoping to put rheumatology at the forefront of medicine with the use of this format and tool,” says Dr. Subash. “Imagine being able to compare similar patients in your clinic, or picture smoothly assuming care for a newly referred patient with all the data necessary to continue treatment—no faxes or calls to outside clinics required.”
The Oncology Model
The importance of RheumCode has both legislative context and technical precedent. The 21st Century Cures Act mandates improved patient accessibility to EHR data while ensuring patient privacy. The Fast Healthcare Interoperability Resources (FHIR) provides a modern framework for managing both structured and unstructured medical data in EHRs. Initially introduced in 2012 and now in its fourth iteration, FHIR is a widely used, standardized set of rules for representing and exchanging data among EHRs.
As a model in this area, RheumCode can look to an oncology initiative called mCode, which provides a structured approach to data standardization using FHIR. The successful implementation of mCode has highlighted the importance of “use cases” in creating relevant data structures. Other medical specialties, including cardiology and radiation oncology, are now developing similar data standards, a process that RheumCode plans to emulate.
Steps Forward
The RheumCode development team is taking a stepwise approach in moving forward with this initiative. The first step is to identify specific use cases for the tool to focus their development efforts. The team has defined some uses, including monitoring osteoporosis therapy and managing DMARD therapy, and is collecting input from the community about which use cases they would find most relevant for their own practices.
The next steps will be to define a RheumCode vocabulary and develop an implementation guide, detailing both essential and optional data elements. This guide will help standardize how data are collected across EHR systems.
The team also hopes to launch pilot projects with EHR systems, such as EPIC, to test the effectiveness of the developed tools and gather meaningful data. EPIC is generally open to pilot projects led by specialists and typically provides the necessary data elements to support the development of new tools that can be customized by individual sites.
The goal is to create a package that other institutions can use for their own pilot projects. Successful projects can demonstrate value and attract interest from other clinicians and potential investors, such as pharmaceutical companies. The RheumCode team is also exploring other funding options, such as grants from the National Institutes of Health, to support tool development and cover consulting costs.
