First HALO-enabled apps will revolutionize EMR functionality

Canadian doctors unable to easily process referrals, access patient health information stored in other systems, consult with specialists and make use of third-party applications through their EMRs are seeing the very first steps toward the promise of interoperability.On February 4, the federal government re-introduced Bill C-72, the Connected Care for Canadians Act, requiring vendors of electronic medical record software to comply with standards that will allow data to be shareable between healthcare providers and across provinces and territoriesIt will take time for doctors to see the impact of legislation requiring the adoption of interoperability standards but some small steps toward interoperability are already underway in British Columbia and Ontario using the Health Application Lightweight Protocol (HALO) standard developed by Canada Health Infoway.British Columbia’s Ministry of Health says it is “proud to be among the first jurisdictions in Canada to operationalize the HALO standard working closely with Canada Health Infoway on early app development and testing.” B.C.’s first HALO-enabled application is a Patient Summary that provides a snapshot of patient information from a clinic’s EMR and allows it to be made available to the broader health sector, including hospital information systems. To date, two EMRs in B.C.—Oscar Pro and Intrahealth—have adopted the HALO standard allowing primary care physicians using the two HALO-enabled EMRs to download the Patient Summary app. Once the app is embedded in an EMR, a family physician can electronically transmit a patient summary to an ED doc, for example, who requires more information about a patient’s health.“It’s not possible for external systems to pull the patient summary from the EMR,” B.C’s Provincial Health Services Authority clarified. “This allows the physician time to review and curate the patient summary prior to sharing it with the hospital information system to ensure the information is accurate, complete and pertinent to the context in which it will be used.” The content and format of the Patient Summary has been designed to comply with Canada Health Infoway’s PS-CA standard and incorporates some B.C.-specific requirements.There are currently 10 clinics participating in the pilot for the Patient Summary application in B.C. Other HALO-enabled applications will be developed in B.C. as the ministry states “it is committed to working with partners to expand HALO adoption and explore tools that improve interoperability and workflow efficiency across the system.”According to Dr. Ed Brown, an advisor to Canada Health Infoway and former CEO of the Ontario Telemedicine Network, the Ontario Ministry of Health is also working on a HALO-enabled app, but no one from the ministry could be reached to provide any information about it.“In the absence of interoperability, it’s very hard for providers to interact with all of the different other organizations they need to interact with across the healthcare system, so it’s very frustrating,” said Dr. Brown. “They spend a lot of time looking for information and have to sign in to different portals to do things and find things.” Doctors complain the lack of interoperability contributes to their administrative burden, leading to burnout, early retirement and abandonment of family medicine for less stressful healthcare roles.“The goal of HALO,” said Dr. Brown, “is to connect providers in a way that makes their lives easier and also liberates data for patients and the rest of the healthcare system.”Just like iPhone and Android phone users who add to the functionality of their devices by downloading apps from the App Store or Google Play, doctors will be able to download HALO-enabled healthcare apps to their EMRs from app stores managed by provincial health authorities, predicts Dr. Brown.In addition to the Patient Summary app developed by British Columbia, it’s likely that other apps will be developed for referrals, specialist consults, online booking and AI scribes.HALO, said Dr. Brown, “will unleash all kinds of innovation” by startups, established vendors and technology talented doctors who will be able to make their apps available for streamlined use in physician EMRs.Family doctors will be the main beneficiaries of HALO, but provincial and territorial health authorities and software vendors will also benefit.The HALO standard will benefit health authorities by making it easier to roll out applications because “now, when they want to integrate something with a provider’s EMR, they have to work with the provider’s EMR vendor, and they have to pay them. Often, the vendors don’t have the time or capacity to make the changes, so it’s expensive and very slow,” complained Dr. Brown. “Once the EMRs and the apps are HALO-enabled, it becomes plug and play.“With HALO,” said Dr. Brown, “there would be an eReferral app that would work for everybody. The family physician and the specialist would subscribe to it. The family doctor just clicks on eReferral and with the patient chart open, it will pre-populate the form with the patient’s data, including their date of birth, gender and address. It might also pre-load the reason for the referral from the AI scribe. Then the doctor simply chooses the specialist, clicks ‘send’ and off it goes.”“For vendors it’s more of a mixed picture because it will cost them some money to implement the standard, but ultimately it should benefit them because they’ll be able to leverage third-party applications much more simply and seamlessly.”HALO incorporates the Smart on FHIR standard that enables third-party healthcare apps to seamlessly and securely integrate with EMRs without requiring users to sign in. Once a physician subscribes to an app, explained Dr. Brown, “it looks like it’s part of their EMR even though it’s not.Whether HALO will be one of the standards and specifications that vendors of electronic health information products will have to comply with under Bill C-72 will have to await the passage of the legislation and the development of the regulations governing it.

First HALO-enabled apps will revolutionize EMR functionality

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