Cumulus: a federated electronic health record-based learning system powered by Fast Healthcare Interoperability Resources and artificial intelligence

To address challenges in large-scale electronic health record (EHR) data exchange, we sought to develop, deploy, and test an open source, cloud-hosted app "listener" that accesses standardized data across the SMART/HL7 Bulk FHIR Access application programming interface (API). We advance a...

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Bibliographic Details
Published in:	Journal of the American Medical Informatics Association : JAMIA Vol. 31; no. 8; pp. 1638 - 1647
Main Authors:	McMurry, Andrew J, Gottlieb, Daniel I, Miller, Timothy A, Jones, James R, Atreja, Ashish, Crago, Jennifer, Desai, Pankaja M, Dixon, Brian E, Garber, Matthew, Ignatov, Vladimir, Kirchner, Lyndsey A, Payne, Philip R O, Saldanha, Anil J, Shankar, Prabhu R V, Solad, Yauheni V, Sprouse, Elizabeth A, Terry, Michael, Wilcox, Adam B, Mandl, Kenneth D
Format:	Journal Article
Language:	English
Published:	England 01-08-2024
Subjects:	interoperability federated networks electronic health record public health
Online Access:	Get full text
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Summary:	To address challenges in large-scale electronic health record (EHR) data exchange, we sought to develop, deploy, and test an open source, cloud-hosted app "listener" that accesses standardized data across the SMART/HL7 Bulk FHIR Access application programming interface (API). We advance a model for scalable, federated, data sharing and learning. Cumulus software is designed to address key technology and policy desiderata including local utility, control, and administrative simplicity as well as privacy preservation during robust data sharing, and artificial intelligence (AI) for processing unstructured text. Cumulus relies on containerized, cloud-hosted software, installed within a healthcare organization's security envelope. Cumulus accesses EHR data via the Bulk FHIR interface and streamlines automated processing and sharing. The modular design enables use of the latest AI and natural language processing tools and supports provider autonomy and administrative simplicity. In an initial test, Cumulus was deployed across 5 healthcare systems each partnered with public health. Cumulus output is patient counts which were aggregated into a table stratifying variables of interest to enable population health studies. All code is available open source. A policy stipulating that only aggregate data leave the institution greatly facilitated data sharing agreements. Cumulus addresses barriers to data sharing based on (1) federally required support for standard APIs, (2) increasing use of cloud computing, and (3) advances in AI. There is potential for scalability to support learning across myriad network configurations and use cases.
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23
ISSN:	1067-5027 1527-974X 1527-974X
DOI:	10.1093/jamia/ocae130