Supporting Closed-Loop Surgical Referrals with a SMART on FHIR Dashboard

Poor communication of pertinent patient health information between primary care and surgical providers during transitions of care is associated with a high rate of medical errors and adverse outcomes. Ensuring that health information is shared effectively among these different providers during transitions of care before and after surgery is critical to effective care coordination and closing the loop after a surgical referral is made. This project will design, implement, and evaluate a closed-loop surgical referral dashboard app, integrated with commercially available EHRs through a standards-based approach using SMART on FHIR. This referral dashboard will allow primary care and surgical providers to share a mental model of patient care, including shared goals and expectations, to support information exchange during surgical episodes of care from the time a referral is made through a patient's follow-up with primary care providers after surgery. This project is being conducted in collaboration between faculty in the Departments of Biomedical Informatics and Surgery (Division of Vascular Surgery) at the University of Utah, and informaticians at the Homer Warner Center at Intermountain Healthcare. 

Start Date
Projected End Date
Project Tags
  • Care Transitions
  • Epic
  • FHIR
  • High Impact Pilot
  • Surgery
Project Point of Contact:
Project Results
As of November 2017, our ONC HIP project (Supporting Closed-Loop Surgical Referrals with a SMART on FHIR Dashboard) has been focused on completing the design, development, and evaluation of both the referral and follow-up components of our surgical referral dashboard. First, the design of the dashboard has undergone iterative refinement based on usability sessions with target different clinician users. In collaboration with the Sociotechnical Service Line at the University of Utah DBMI, we completed (i) a heuristics evaluation; and (ii) a comprehensive usability evaluation of the dashboard mock-ups with target users in the Division of Vascular Surgery. This included case vignettes where providers were asked to use the dashboard and evaluate the content and organization of information provided. Based on clinician input, we then refined the design of the dashboard to address their important feedback. Second, we have developed functional dashboards for both referral and follow-up communication between surgical teams and primary care providers using SMART on FHIR technology. This has involved finding necessary data elements required for the dashboard within Epic's user interface, identifying FHIR resources for these data resources, developing a FHIR adaptor to allow the client application to retrieve the necessary data from Epic, and completing design of the user interface. Third, we have started to implement and pilot these surgical referral dashboards in clinical practice in 2 phases. The initial phase (underway) involves vascular surgery providers using the dashboards to provide follow-up information to the referring primary care providers at the time of hospital.  The next phase will be to have the primary care providers use the dashboard during the initial patient referral.