I am very new to FHIR and now i am trying the find out equivalent resource for Apple carekit data. I think i can use FHIR Careplan & Goal for the CareKit data. Is that right?
I’ve not done any work with CareKit, but Apple suggested I talk to Seth Berkowitz at BIDMC, who says:
CareKit is a set of UI and database components that provide a framework to display careplans, collect patient generated data, provide insightful feedback to and from patients via their iOS phones. By leveraging simple game mechanics and Apple’s design ethos, the UI components of CareKit help motivate patients to comply with their daily medications and activities as part of their care plan. The assessment component streamlines the collection of subjective and objective data from patients using the phone as middleware. Objective data collection is facilitated through HealthKit, which is Apple’s centralized database on it’s phones that facilitates the sharing of objective health metrics in between apps. The last component of carekit is a communication module that helps patients share their care plans and results with friends, family, and medical professionals
BIDMC we are integrating our CareKit app directly into our homebuilt EHR so that the app becomes a direct conduit of prescriptions and orders from doctor to patient, and patient generated data from patient to doctor. Although our short term goal is to benefit our own population of patients, we share Apple’s long term vision of widely disseminating these engaging apps. To that end, we are trying to leverage FHIR APIs as much as possible to serve as the connections between our EHR and the App. The hope is that Apps like this serve as a “carrot” to promote more widespread adoption of the FHIR standard. Our two main APIs using FHIR are a medication search bundle and CarePlan resource. Our medication bundle leverages our institutions participation in the Argonaut projects
CareKit encompasses several functions which pose potential FHIR interfaces for data download and upload. To date, my group has focused on leveraging FHIR for data download in order to populate the CareKit “CareCard” (a patient check list of careplan activities) and Carekit “Assessment” or subjective and objective measurements collected on the phone. An overarching question that we’ve been trying to solve is how encode UI / implementation specific data fields within the appropriate FHIR schema. For example, a careplan activity in carekit is displayed with a title, a subtitle, and more detailed instructions. For each careplan activity I’ve been using the following mapping
- Title: activity.detail.code.text
- Subtitle: activity.detail.goal (either display or description of a contained resource)
- Instructions: activity.detail.description
For quantitative measurements that are collected on the phone through the HealthKit database, I define an “observation” activity within the careplan. The activity.detail.code.coding array defines a LOINC codable concept which is then mapped to Apple’s internal reference system for various physiological measurements (heart rate, blood pressure, daily sodium intake, etc)
Finally, we define certain alert conditions that may prompt a message to the patient after a measurement is obtained. These alerts are implemented as an extension to the activity.detail.goal. The extension includes a valueQuantity which is the threshold that triggers the alert and a referenced Flag resource which is the alert prompt to the user.
There’s much more to be done to build an end-to-end CareKit FHIR interface, but that’s what we’ve been working on so far.
Thanks to Seth and also to Pascal Pfiffner, who’s been a trail blazer with regard to FHIR use on iOS (and who maintains the FHIR Swift reference implementation).
Seth noted that with the careplan resource, it feels like they’re pushing the limits of how the careplan is being used in practice – and indeed, that’s true. There’s a lot of active projects using FHIR as the format for exchange underlying shared care/ collaborative care projects that involve the patient, and their various care teams: family, professional, social etc., and this is a new – exciting! – area where there’s not a lot of established knowledge, culture, and practice for us to fall back on. So implementers should expect more change in this area than in the well established ones (patient management, diagnostics, medication administration, billing).