In early October, the Arcweb team attended the 2019 Epic App Orchard conference in Verona, Wisconsin. Like our previous two years of attending the App Orchard conference, the event covered a wealth of information about Epic’s healthcare IT ecosystem and the future of the App Orchard program.
Significantly, App Orchard was also attended by a variety of top technology and healthcare organizations, giving attendees a glimpse at the ways different parts of the healthcare ecosystem are leveraging modern EHR systems and patient data – from the rise of SMART on FHIR to the widespread adoption of HL7.
Here are our four big takeaways from the 2019 Epic App Orchard conference.
App Orchard is becoming a mature ecosystem
Back when the App Orchard program kicked off in 2017, it was hard to tell exactly what Epic’s plans for it were. Was it meant to be a full-featured app store or an at-arms-length partner program? And was it actually going to take off?
Three years on, we have our answer. With more than 500 participating organizations and its own full-time technical services (TS) team at Epic, App Orchard has grown into a mature (albeit niche) ecosystem.
While it still lacks the technical functionality of a real app store (for instance, it does not actually include a mechanism to install new modules within an Epic implementation – installs much be done “manually” by both parties), it’s become more like a traditional app storefront with each revision. For example, Epic is in the process of implementing a much more intensive review and approval process for apps, as well as user ratings, stats about the number and type of installations, and marketing functionality like embedded videos on each app’s page.
Another strong indicator of the App Orchard’s longevity: Epic is taking a much more hands-on approach with App Orchard development and implementation, encouraging App Orchard participants to avail themselves of the company’s TS team through its Sherlock developer forums for advice, development help, and even custom data sets for testing purposes.
Health systems see App Orchard as a legitimate way to approach Epic integration
Health system adoption was another big confirmation of the growth of App Orchard in 2019.
According to Epic, there are now more than 370 customers actively using App Orchard apps, with a total of 1200 app licenses and 3 billion API messages across the full customer base. That’s pretty clear evidence that App Orchard is gaining traction with provider networks and health systems, not just vendors.
Several health systems, including HealthPartners and Duke Health, delivered featured presentations detailing their own App Orchard development and deployments, and many more were in attendance. There was also a general sense from clinical attendees that the program had real promise, along with a sense that while there was still work to be done, App Orchard as becoming a real pathway for providers to extend the capabilities of their Epic implementations.
One final note about the role of App Orchard in Epic integration and the role of app stores in EHR integration. The majority of App Orchard “apps” are really closer to connectors than they are standalone products – in other words, lightweight integrations that give some other piece of software a pathway into Epic’s ecosystem, rather than a product that can be deployed in their own right. (Which makes sense, from a product POV – after all, Epic is just one EHR, albeit a very widely used one.)
SMART on FHIR is looking like the future
One of the most valuable aspects of developer conferences is getting a glimpse at the technologies other participants are excited about. And this year, the biggest focus of conversation was SMART on FHIR.
SMART on FHIR (short for Substitutable Medical Applications, Reusable Technologies on Fast Healthcare Interoperability Resources) is an open, standards-based method of integrating medical apps with EMR systems.
While many current App Orchard apps require custom deployments within an Epic workflow, SMART on FHIR apps can be integrated into an Epic clinical or patient workflow without needing to significantly modify the native Epic code. Instead, SMART on FHIR apps are launched much like a web app, running within and integrating with Epic’s workflow without actually residing within it.
One example of SMART on FHIR was Elsevier’s ClinicalPath (formerly Via Oncology Clinical Pathways), a clinical decision support tool that helps providers improve oncology outcomes care by matching patients to clinical trials, better integrate biomarker testing orders, and standardizing oncology care paths.
While ClinicalPath had previously been a separate application on clinicians’ computers (literally requiring them to tab out of Epic and manually re-enter information), the new SMART on FHIR implementation not only let Epic’s workflow automatically launch ClinicalPath at appropriate times but also pre-populate input values by securely passing patient data directly to the app.
While there are still some drawbacks to SMART on FHIR – developers are limited to pre-set workflow integration points set by Epic, for one – the method holds the potential to massively improve app portability, as well as simplify ongoing support by decoupling updates from the larger Epic maintenance and update schedule.
Looking to App Orchard’s fourth year
Since 2017, the challenges App Orchard was created to address – interoperability, portability, and better sharing of innovation – have only become more critical to the success of the modern healthcare world. App Orchard has grown in parallel to this increased need, with more providers and more vendors jumping onboard each month.
In 2020, for the fourth App Orchard conference and App Orchard’s fourth year of existence, we’re going to be keeping an out for the continued growth of the program. Will it keep pace with innovation? Will it be up to the challenges of complying with the new ONC / CMS interoperability guidelines? And most importantly will it continue to grow in both membership and adoption?
It’s too soon to say, but the answers to those questions will determine whether App Orchard becomes a temporary stopgap in the face of interoperability challenges, or a lasting part of the healthcare ecosystem.