When SMART on FHIR is widespread enough to serve as the basis for exchanging health information between providers, this might be done in either or both of two ways. In one scenario, hospitals and doctors could use the FHIR API to extract data from the EHRs of other providers, perhaps on a cloud-based platform. Alternatively, patients could use apps to download their own health information to personal health records (PHRs) stored in the cloud. They could then decide which data to share with particular providers, family members, or others.
Experts are divided over which of these scenarios is more likely. Tripathi says that both will occur, but that more information exchange will occur between providers. “It’s the providers who have the immediate clinical and business need to do it every day,” he says.
Most patients today expect their physicians and hospitals to store their data and allow them to access it through a portal, Tripathi says. However, patients with serious chronic diseases are more interested in making sure that their records are shared among providers, he adds.
Mandel agrees that both information-sharing scenarios will occur. The patient-mediated method of data exchange has advantages in terms of data control and privacy, he says. “On the other hand, we’re not going to enable this data liquidity in one fell swoop,” he notes. Initially, he predicts, providers will share patient data only in ways that make business sense to them and will open it up only to apps they trust.
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