Capable Health is a purpose-built developer platform to launch best-in-class consumer health apps. You can think of us as the API middleware powering modern healthcare experiences that delight patients and providers alike.
Benefits of Capable
Based on our experience building high-growth healthcare products, we’ve learned firsthand how regulatory compliance makes it difficult to build quality patient-centered services, and how vendors that will work with personal health information are limited and often too expensive.
Capable empowers developers with a flexible API-first infrastructure to launch consumer health apps faster and better than doing it alone. The platform powers end-to-end patient onboarding and engagement, with the vision to help every person achieve their health and wellness goals.
With Capable, clients can:
Launch and scale for a faction of the time and cost.
Turbocharge your care and engineering teams with tools built for purpose.
Unified analytics and secure data to run your business with confidence.
Powerful out of the box. API-first and extensible so you’re never boxed in.
How to Get Started
Capable helps healthcare organizations get from zero to launch in 12 weeks. Capable empowers an organization's engineering and product teams to focus on the implementation of their care model and patient-facing experience, leaving the time consuming back-end, data architecture, and compliance to the experts.
When getting started, healthcare organizations can expect the following steps:
Scope: As technical experts, Capable helps clients refine their product roadmap based on what’s best for their patients and business.
Build: Healthcare organizations use the Capable platform to power their patient app. Leave the compliance, security, and back-end plumbing to us.
Launch: Capable works side-by-side with clients throughout the QA process and during launch.
Share: After launching with Capable, clients continue as part of the Capable Builders Community, a private forum for healthcare startups to share insights and updates.
Access: As a client, healthcare organizations are the first to access Capable’s new beta features.
What Capable Users are Saying
“Personalized care is at the core of what we do. After finding previous technical implementations cumbersome to work with, we switched over to Capable to power important parts of our back-end. Their Dynamic Care Plan offers a complete solution for delivering care that’s tailored to our members’ sleep goals. Partnering with them is helping us launch and grow faster.”
—Alexander Gould, Deep (Sleep health)
We are very excited to be partnering with Capable Health. We believe their platform will provide the right level of personalized experience for the Alloy member. Working with the entire Capable team so far has been fantastic. They are true partners and willing to create solutions that are the best for our members and our business.
—Stacy Gordon, Alloy (Women’s health)
What Are EMR Systems?
An electronic medical record (EMR) system provides a vital service to the healthcare industry, as it helps relieve healthcare workers’ administrative burden and free up more time directly caring for patients. Although its name may suggest something complicated, both patients and providers can easily access and use these systems, and a variety of software options are available to healthcare organizations.
Serving as the software that automates the documentation, storage, and retrieval of electronic patient records, EMR systems record the digital data that tracks patient health, as well as provide physicians and patients the ability to review information remotely. EMR systems vastly improve doctors, nurses, and patients’ access to information and have been widely adopted across the healthcare system.
Previous to the adoption of EMR systems, healthcare workers and administrators spent significant time on manual paperwork and administrative duties each week—up to 15.6 hours, according to the 2020 Medscape Physician Compensation Report. With such a high administrative burden, EMR systems provide efficiencies better allocated to critical tasks that drive positive health-related outcomes.
It is widely accepted that these systems improve a medical provider’s access and ability to track and monitor patient health over long durations, yet the process of selecting, implementing, and utilizing EMR systems requires careful thought and planning. Understanding the basics of these systems can help aid healthcare organizations in their decision-making process.
Defining EMR Systems
At its core, an “electronic medical record” entails medical data or patient information. An EMR system is the software used by clinicians during patient diagnosis, treatment, and follow up. EMR systems are often described as a digital version of a paper chart formerly used in a healthcare setting.
These digital records generally contain the medical and treatment history of a healthcare organization’s patients, such as:
Lab and test results
Administrative and billing data
EMR systems help automate many common functions and create a more seamless experience for both patients and medical professionals. In day-to-day practice, medical providers can use these systems to chart a patient’s medical history, create patient portals where patients can access their own medical information, manage and request prescriptions, order lab testing, as well as communicate virtually.
Some of the most common features supported by EMR systems include:
Charting: A patients’ medical history and diagnoses are automatically recorded in a secure, digital space, removing the need for physical charts. Digital records are also more accurate, accessible, and clearer to read resulting in fewer treatment errors.
Patient Portals: With an EMR system, patients are given direct access to their medical information. The software offers an online portal where patients have secure access to their past visits, medication history, and lab results from a specific hospital or clinic.
E-Prescribing: Pharmacies can receive prescriptions with the e-prescribing function of most EMR systems, and patients and pharmacists can send notifications about dosage amounts, allergies, and potential drug interactions to physicians.
Order Entry: Among other functions, these systems make it easier for providers to store and send orders for lab tests. With automated systems, there are fewer opportunities for lost or misplaced paperwork, saving patients time and hospitals resources.
:In addition to patient portals, most EMR systems include functions that help patients manage certain aspects of their healthcare. Patients receive alerts and reminders about scheduled treatments, appointments, and even health- and wellness-related recommendations.
Some core benefits clinicians experience via these systems include the ability to track patient data over time, identify when patients are due for preventive screenings or checkups, and track and monitor patient health milestones, such as blood pressure readings or vaccinations. This assists and improves the monitoring of quality of care within a practice—all while alleviating time-consuming back-office responsibilities.
Guide to EMR Software
There are many factors for a healthcare organization selecting an EMR system for the first time, or implementing a new system, to consider, and the experience of adopting and utilizing the system can vary greatly. The adjustment from paper-based health records to a digital experience is significant, and there are steps an organization can take to better promote a more seamless selection and adoption process. The first step is understanding the software itself.
When it comes to EMR systems, there are many options available that generally fall into two types: cloud-based or locally hosted.
Cloud-based EMR software: Cloud-based software is scalable and allows data to be accessed online, as medical information is securely stored on remote servers. Some of the most compelling features of this type of software is speed of implementation as well as the ability to access information remotely. Generally, cloud-based software can reduce upfront costs because they do not require local servers to host data. Cloud-based systems also offer higher levels of IT service availability than in-house support. At the same time, there are more data security considerations, and a healthcare organization may have less manual control compared to locally hosted options.
Locally hosted EMR software: This software requires data to be housed on a healthcare organization’s on-site servers. This option is more desirable in rural settings where high-speed internet is often less available or when outsourcing data security is not preferred. Locally hosted EMR software requires an organization to take responsibility for keeping its servers secure, as well as perform regular data backups.
After an organization decides between a cloud-based or locally hosted software system, there are often stages of preparation required before EMR system implementation. By setting the right management structures, both before implementation, and after it is in place, a healthcare organization can ensure a positive experience for staff and administrators.
During the pre-implementation stage, an organization can prepare for the EMR system by creating a detailed project plan and governance model. It is important to communicate and involve a healthcare organization’s staff and patients in the planning process, while offering ample training. Fostering early buy-in creates a sustainable process that will carry over when the EMR system is in place.
There are also ways to customize the software to meet a healthcare organization’s specific requirements during the implementation process. Additionally, organizations can start to incorporate a change-management process to help upload records into the EMR system.
It is critical to anticipate and plan for the time needed for staff to train and learn the system. It’s also vital to encourage and incentivize staff along the way.
EMR system implementation does come with challenges. There are common barriers to adopting such large-scale software. According to the Agency for Healthcare Research and Quality, some notable barriers include:
Concern that EMR software will become obsolete after a short period of time
Lack of skilled resources for implementation and support afterwards
For smaller practices, and even some larger healthcare providers, high costs and uncertain return on investment
Underestimation of the organizational capabilities and the true degree of change management required
Concern regarding unintended, negative consequences of technology, such as security and privacy issues
Inability or failure to redesign clinical processes and workflow to incorporate the technology systems in effective ways
Concern that current market systems are not meeting the needs of rural health centers or federally qualified health centers
There are many benefits to storing and retaining patient data electronically with EMR software, but it is important to note that the information recorded in these systems doesn’t easily leave the practice’s on-site location—this is one of the key differences between an EMR system and an electronic health record (EHR) system.
Top Features of EHR Systems
Often “electronic medical record” and “electronic health record” are used interchangeably, but there are crucial distinctions. EMR systems focus on the “medical” records clinicians use for treatment and diagnosis, whereas EHR systems are more comprehensive and can cover not only physical but also behavioral health.
If patients move to a different hospital, clinic, or go to a physician outside their network, for instance, patients are not able to take EMRs with them. This is not the case, however, with EHRs.
EHRs help make information available instantly and more securely to teams of medical professionals and contain information from all clinicians involved in a patient’s care. Not only do these digital health records contain the medical and treatment histories of patients, they are also intended to go beyond collecting standard medical data. According to the Office of the National Coordinator for Health Information Technology, these virtual records are an essential part of a healthcare organization’s data infrastructure.
Interoperability is also key for EHR systems. This entails a seamless exchange of information to help healthcare professionals track treatment progress for patients. Standard EHR information formats and standards are used so patient data can be easily shared with other individuals across multiple healthcare organizations—like laboratories, specialists, medical imaging, pharmacies, emergency facilities, and school and workplace clinics.
While there are many benefits to implementing an EHR system, like EMR systems, it is no simple feat. The process is often an ongoing journey, but there are always opportunities to optimize workflows or improve data governance even after a system is in place. Healthcare organizations are incentivized to use tools like an EHR system, and the road to improve care quality and increase transparency starts with selecting the right system.
List of EHR Software Vendors
Large vendors such as Epic and Cerner are responsible for more than 50 percent of the EHR systems on the market today, but smaller vendors and proprietary systems are still an important part of servicing rural and specialized healthcare organizations.
Below you’ll find the top EHR systems by market volume.
Epic’s software is used across academic medical centers, community hospitals, dental clinics, retail clinics, rehab centers, and independent practices (among others). More than 250 healthcare organizations and more than 250 million patients in the U.S. use Epic’s electronic medical record system. John Hopkins Medicine, for example, uses Epic to create one chart that follows patients across multiple areas where they receive care.
Top reasons to use Epic EHR:
Range of features and functionality
Patient management flow
Efficient user interface
Third-party apps offer customization
Cerner aims to work at the intersection of healthcare and information technology to connect people and systems across the globe. Banner Health, for instance, implemented Cerner’s system to improve efficiency at their outpatient clinics by streamlining their adult intake form. The modified intake form, in this instance, resulted in a decrease of the average time used for documentation, as well as a reduction in the average number of clicks within the form (among other benefits).
Top reasons to use Cerner EHR:
Ease of use
Protects against HIPAA errors
Automatic transfer of chart data
Third-party app integration options
Customer support services
MEDITECH’s EHR system touts the measurable time and effort saved by hospital staff and nurses, while helping to increase clinic volumes. The company’s goal is to empower healthcare organizations large and small with better tools for secure and effective care. King’s Daughters Medical Center, a nonprofit acute-care hospital with 99 beds, implemented MEDITECH’s EHR system, resulting in time saved, efficiencies gained, and created a closer collaboration between nurses and physicians.
Top reasons to use Meditech:
Interactive web user experience
Organized user interface
Customization to improve efficiency
Helpful customer support online
Interoperability via Continuity of Care Documents (CCDs)
Evident, a CPSI Company
While Evident owns a smaller portion of overall EHR system market share, many healthcare organizations have seen measurable results from using this technology. One Texas hospital, for instance, saw that charting time went from 25 to 30 minutes to five to six minute, and the readability of the copy led to less insurance denials, as a result of Evident’s EHR system.
Top reasons to use Evident:
One complete chart travels with patients across all points of care
Allscripts aims to build open, connected communities of health by generating and providing insights that change the delivery of care. In one instance, Springhill Medical Center, a privately owned full-service hospital serving Southwest Alabama, leveraged Allscripts to help enable them to double yearly patient volume from 25,000 to 50,000 in three years, while not significantly increasing staffing.
Top reasons to use Allscripts:
Ease of use for prescriptions
Many offerings to meet varying needs
Streamlining of administrative tasks
Patient engagement platform
Nearly 140,000 healthcare providers use athenahealth’s EHR system, including Florida Community Health Centers, which used the system to help enhance patient care, engagement, and accessibility via telemedicine. Since offering telehealth visits through athenahealth, these health centers delivered more than 5,100 patient visits and helped to keep visit volume steady. The transition from in-person to virtual visits was seamless and did not have an impact on the quality of care.
Top reasons to use athenahealth:
Efficient and straightforward to use
Comprehensive for managing many areas of a practice
Integrated system from start to finish with a patient
Makes documentation easier for providers
With cloud-hosting options and ability to integrate into an organization’s existing backend system, MEDHOST aims to enhance a healthcare organization’s clinical and financial performance while maintaining a focus on patient-centered care that exceeds expectations. Interoperability, implementation, and support opportunities are core characteristics of this platform.
Top reasons to use MEDHOST:
Revenue cycle and business office services
Hosted and managed service options
Customer support and assistance
Continued education services and training
Marketing services for clients
Experts with clinical backgrounds help shape Netsmart technology. Missouri Behavioral Health Council adopted Netsmart’s EHR system to help with care coordination, interoperability, analytics, outcomes, and risk stratification to eliminate manual tasks, while improving the delivery of care and reducing costs. As a result of this implementation, the organization can now use a shared system with near real-time data.
Top reasons to use Netsmart Technologies:
Cloud hosting makes maintenance and upgrades seamless
Care coordination that connects organizations to a network of providers
Self-help resources for clients
Data analytics and regulatory compliance support
Mobile app options
As a patient-centered EHR system with flexible options, Harris Healthcare aims to optimize clinical and clerical workflows while improving patient safety. Lancashire Teaching Hospitals, for instance, leveraged Harris Healthcare to transform the manual medication management process into an electronic one. Clinicians reported that the new digital process makes it easy, efficient, and safe to prescribe and dispense medications.
Top reasons to use Harris Healthcare:
Ability to access interface any time
Patient portal options
Manage patient flow and bed capacity
Optimize workload and staffing
Understanding resources, timeline, support, and setting realistic expectations becomes crucial when evaluating the top EHR systems. And while this is not an exhaustive list, it can serve as a jumping off point when selecting the best system for an organization's specific needs. As these virtual records become an essential part of a healthcare organization’s IT infrastructure and delivering quality care to patients, being detailed and intentional about making the right decision is vital.
What is the FHIR Standard?
The complexity of healthcare information continues to increase now that healthcare data is digital and stored in an EHR or EMR system. It is a healthcare imperative that data travel across sometimes disparate systems. Ensuring data integrity, however, can be a challenge.
The Fast Interoperability Healthcare Resource (FHIR) standard was created with this in mind. FHIR aims to provide resources that help define healthcare information content and structure. FHIR has become an essential protocol for data transfer ro when joining or communicating across healthcare systems.
The FHIR standard aims to define how healthcare information can be exchanged between various computer systems, regardless of how the data is stored. FHIR helps medical workers securely and more easily access healthcare information, such as clinical and administrative data, and ultimately, can help improve patient care and outcomes. FHIR is viewed as the best approach for how critical information can be shared.
Healthcare providers have been pushed to digitize health records, which led to patient information often being silhoed with limited ability to exchange data. FHIR solves this problem by allowing patients access to EHRs from their various healthcare providers.
One note, while FHIR does not have a security protocol and is opinionated on how to store data, it does define an “Audit resource.
According to the The Office of the National Coordinator for Health Information Technology, the FHIR standard provides the following advantages for software developers:
Fast and easy implementation, as well as simple interfaces
It is complementary to use with no restrictions
Support from major browsers and most EHR vendors
Downloadable online tools including reference servers and implementation libraries
A strong foundation in web standards including XML, JSON, HTTP, and OAuth
Concise and comprehensive online specifications
Serialization formats for ease-of-use
A global community to support and assist implementers
Flexibility is key when it comes to the FHIR standard, as it can be referenced for an individual task or bundled into a broader project. This is just one of the reasons why these standards are widely adopted and used by developers today. Through these guidelines, FHIR aims to cut through the complexity of transmitting healthcare data by defining patient information and influencing data structure during implementation.
FHIR is intended for a wide spectrum of users, but designed to give engineers an interface using commonly familiar technologies and standards.
Who created the FHIR standard?
Health Level Seven International (HL7)—a not-for-profit organization that offers frameworks and standards for healthcare organizations that are exchanging, integrating, sharing, and retrieving electronic health information—sets the FHIR standard. The goal of providing this guidance is to help support clinical practices in the management, delivery, and evaluation of health services.
According to HL7, the organization is supported by more than 1,600 members from over 50 countries, including 500+ corporate members representing healthcare providers, government stakeholders, payers, pharmaceutical companies, vendors and suppliers, as well as consulting firms. HL7 drafted and developed the FHIR standard, and with this guidance, the international organization aims to empower health data interoperability across the globe, and ultimately, help ensure everyone—providers and patients—can access and use the right healthcare data when they need it.
In the past, interoperability was primarily based on patient data in physical documents—and whether they were faxed, emailed, or distributed virtually was determined by each individual healthcare provider. Now, patient information is exchanged across multiple EHR systems with a common standard, and with FHIR these systems can communicate more easily, helping healthcare organizations seamlessly coordinate care plans.
Patients also expect providers to be able to collaborate across healthcare systems—the FHIR standard ensures their data does, too. Medical information must be available while also being secure. Adherence to the FHIR standard matters for the sake of the patient and maintaining data integrity in healthcare systems.
Benefits of the FHIR Standard
Ensuring the privacy and protection of patients is crucial to the safety and security of the healthcare industry. The FHIR standard helps meet the challenge of the digital age and allows for the efficient exchange of clinical and administrative data while keeping the information secure. Files are constantly shared throughout the healthcare system, and without a standard protocol, the ability to share important patient information would be compromised.
The FHIR standard is built on modular resources, serving as the format for basic data exchange.
These resources contain relevant data and links to related resources as well as all the data that can be exchanged. FHIR specification uses RESTful principles to create, read, and update records. Those requesting a patient’s record will receive a JSON response with the relevant information rather than the entire record.
According to HL7, by providing a base set of resources, either by themselves or when combined, the information can satisfy the majority of common use cases. Resources are extensibile, i.e., creators couldn’t envision every use case for all resources and wanted to be able to add functionality in the future. This is done through a foundational component of “Extensions,” a well defined and governed component of FHIR that ensures interoperability and simplicity.
Collaboration across systems happens when each system follows a common set of rules—and the FHIR standard aims to define the information contents and structure for the core information set shared by most implementations.
Extensions are also used to make custom resources known as “Profiles.” A common profile is the US Core Profile, which defines profiled resources that have elements that are important in the United States. For example, in the US, it adds “race” and “ethnicity” to the patient resource. Profiles are a core component of FHIR and enable flexibility while maintaining structure and interoperability.
How exactly are these standards set? The FHIR standards each have a tag that contains a unique identifier for the information it holds, much like how a URL provides an address for a web page. This allows developers to build standard applications that work across different EHR systems, providing healthcare organizations and patients access to critical data.
Developers can use these core resources to best fit each clinical use case. These resources can include metadata, text, and other data elements, or they can be a collection of clinical documents, which makes the sharing of those documents easier and more straightforward for providers and system users.
Some of the benefits of FHIR, according to HL7, include:
Ensures consistency across digital healthcare ecosystems
Secure transfer of medical information and data
Strong foundation in web standards
Ease of use for developers and medical professionals
Flexible and adaptable to varying healthcare systems and local requirements
Applicable to many types of technology including apps and cloud communications
Offers better healthcare experiences for patients who expect professionals to be able to exchange electronic health records
Free to use with no restrictions
Fast and easy implementation
Support for RESTful architectures
Resources carry human-readable text display options for clinical safety
Developers can tap into the FHIR standard through a common set of application program interfaces (APIs), pieces of code that allow for data transmission. This direct connection creates back-end structures that facilitate easy and accurate communication between healthcare systems. The use of APIs helps the FHIR standard go above the limits of document-based systems and makes it easier to read and access healthcare data.
HL7 and the FHIR Standard
FHIR was created to cut through the complexity of transmitting healthcare data. The standards aim to define patient information and influence how data is structured. While these standards are widely adopted today, the flexibility of the FHIR standard makes it easy to reference resources as an individual task or bundled into a broader implementation initiative.
HL7’s Governance and Operations Manual (GOM) helps healthcare organizations uphold the uniformity, quality, efficiency, and compliance of patient data. The manual is reviewed consistently, and HL7 asks its members to proactively stay in compliance with the data governance model after implementation.
The data governance manual goes beyond the FHIR standard—the key categories of which include:
Primary standards: The primary standards include those needed for system integrations, interoperability, and compliance. These are the most frequently referenced standards.
Electronic health records: This enables the constructs for managing electronic health records.
Arden syntax: This procedural clinical knowledge helps facilitate the sharing of digital health records.
Clinical context management specification: This section helps facilitate the integration of applications as they are being used.
Clinical and administrative domains: These standards are usually implemented once primary standards for an organization are in place.
Implementation guides: All documents in this section serve as supplemental material for a parent standard.
Rules and references: These are technical specifications, programming structures, and guidelines for software and standards development.
Clinical document architecture
The FHIR standard
Cross-paradigm/domain analysis models
The FHIR standard is just one component of the broader HL7 standards. It contains two main parts: A content model in the form of “resources,” and a specification for the exchange of these resources in the form of RESTful interfaces, messaging, and documents.
Some of the FHIR standards include guidance on the following:
Interoperability of data between healthcare providers, patients, and caregivers
Modular components that solve for real-world clinical and administrative problems
Data elements for oncology EHRs
Reporting adverse events
Payer access to clinical and financial information
Clinical decision support
Clinical research laboratory data
Patient access to medication coverage
Drug formulary information interfaces
Frameworks for integration
Overview of FHIR APIs
Because healthcare data is highly complex, the FHIR standard takes a modern approach to connecting discrete data elements. The idea is that by clearly defining information content and structure, a core set of resources can solve for the majority of use cases. This is intended to help developers build standard “browser” applications no matter what healthcare system is powering them and which other systems they need to communicate with.
To achieve this technically, the FHIR standard contains a common set of application program interfaces, APIs, that enable a direct connection to implement the FHIR standard. APIs are pieces of code that enable the exchange of data between different third-party developers and the FHIR APIs connect developers to the healthcare standards powering the exchange of data through code for common use cases. These APIs help developers to meet strict data protection standards, as well as enable collaboration across multiple EMR systems.
The healthcare industry is using the FHIR APIs to read, write, search, and collaborate across systems on clinical data and EMRs. Third-party applications can implement FHIR APIs into their EMR systems and allow for the exchange of information directly into daily medical workflows. This direct connection allows for broader adoption of the standard across the industry, increased interoperability, and a more seamless implementation by developers. It also allows servers to connect with any other system using these APIs, communicating securely in minutes. FHIR also provides bulk access implementation to let organizations export large segments of their patients to aid in analysis and reporting.
Because the FHIR is meant to be easily accessible, API resources are the building blocks available through HL7. These include flexible standard resources for common use cases that can be modified to fit a specific or individual functionality. Developers can use most major coding languages, including Java and Python, to connect and build on these resources. The HL7 provides a detailed resource list to help technical teams determine how to start this process, as well as background on its data formats (XML and JSON) and extensibility.
At a high-level, the HL7 outlines five levels for launching the FHIR APIs:
Level 1: The developer builds the foundation of the programming with the basic framework on which specifications will be built.
Level 2: Here the developer begins to implement and bind those specifications, such as security, privacy, terminology, support, and exchange.
Level 3: Now the administrative piece comes to view, linking real-world concepts in the healthcare industry to the system, such as setup for patients, practitioners, care teams, devices, and organizations.
Level 4: This entails record-keeping and data exchange for healthcare, such as clinical, diagnostic, prescription, workflow and financial processes.
Level 5: The final level builds the ability to reason into the system, such as implementing guidance response and report measures.
Before developers can begin using the FHIR database, they need to install a postgreSQL database, which is a reliable, open-source system that can store data across many different applications. The JSON file stores simple data structures that transmit data from the FHIR into a system’s EHR. The best place to learn more about this technical process and get started is by reading through the HL7 resource list, as well as the patient resource definition guide.
Capable Health is a purpose-built developer platform to build best-in-class consumer health apps, the first API-driven platform dedicated to powering patient onboarding and engagement. Capable takes care of signup, onboarding, care plans, goal tracking, content delivery, secure messaging—the API middleware powering modern patient-facing healthcare experiences.