{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,13]],"date-time":"2026-03-13T08:44:07Z","timestamp":1773391447733,"version":"3.50.1"},"reference-count":42,"publisher":"Oxford University Press (OUP)","issue":"8","license":[{"start":{"date-parts":[[2024,6,11]],"date-time":"2024-06-11T00:00:00Z","timestamp":1718064000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"funder":[{"name":"National Coordinator for Health Information Technology","award":["90AX0031\/01-00"],"award-info":[{"award-number":["90AX0031\/01-00"]}]},{"name":"National Coordinator for Health Information Technology","award":["90AX0022\/01-00"],"award-info":[{"award-number":["90AX0022\/01-00"]}]},{"name":"National Coordinator for Health Information Technology","award":["90AX0040\/01-00"],"award-info":[{"award-number":["90AX0040\/01-00"]}]},{"DOI":"10.13039\/100000030","name":"Centers for Disease Control and Prevention","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100000030","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000016","name":"United States Department of Health and Human Services","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100000016","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100006108","name":"National Center for Advancing Translational Sciences","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100006108","id-type":"DOI","asserted-by":"publisher"}]},{"name":"National Institutes of Health Cooperative","award":["U01TR002623"],"award-info":[{"award-number":["U01TR002623"]}]},{"name":"National Institutes of Health Cooperative","award":["U01TR002997"],"award-info":[{"award-number":["U01TR002997"]}]},{"DOI":"10.13039\/100028773","name":"National Association of Chronic Disease Directors","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100028773","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000030","name":"Centers for Disease Control and Prevention","doi-asserted-by":"publisher","award":["NU38OT000286"],"award-info":[{"award-number":["NU38OT000286"]}],"id":[{"id":"10.13039\/100000030","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000030","name":"Centers for Disease Control and Prevention","doi-asserted-by":"publisher","award":["U18DP006500"],"award-info":[{"award-number":["U18DP006500"]}],"id":[{"id":"10.13039\/100000030","id-type":"DOI","asserted-by":"publisher"}]},{"name":"Centers for Disease Control and Prevention Cooperative","award":["NU58IP000004"],"award-info":[{"award-number":["NU58IP000004"]}]},{"name":"Centers for Disease Control and Prevention Cooperative","award":["1U01TR002997-01A1"],"award-info":[{"award-number":["1U01TR002997-01A1"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2024,8,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Objective<\/jats:title>\n                  <jats:p>To address challenges in large-scale electronic health record (EHR) data exchange, we sought to develop, deploy, and test an open source, cloud-hosted app \u201clistener\u201d that accesses standardized data across the SMART\/HL7 Bulk FHIR Access application programming interface (API).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>We advance a model for scalable, federated, data sharing and learning. Cumulus software is designed to address key technology and policy desiderata including local utility, control, and administrative simplicity as well as privacy preservation during robust data sharing, and artificial intelligence (AI) for processing unstructured text.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Cumulus relies on containerized, cloud-hosted software, installed within a healthcare organization\u2019s security envelope. Cumulus accesses EHR data via the Bulk FHIR interface and streamlines automated processing and sharing. The modular design enables use of the latest AI and natural language processing tools and supports provider autonomy and administrative simplicity. In an initial test, Cumulus was deployed across 5 healthcare systems each partnered with public health. Cumulus output is patient counts which were aggregated into a table stratifying variables of interest to enable population health studies. All code is available open source. A policy stipulating that only aggregate data leave the institution greatly facilitated data sharing agreements.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Discussion and Conclusion<\/jats:title>\n                  <jats:p>Cumulus addresses barriers to data sharing based on (1) federally required support for standard APIs, (2) increasing use of cloud computing, and (3) advances in AI. There is potential for scalability to support learning across myriad network configurations and use cases.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/jamia\/ocae130","type":"journal-article","created":{"date-parts":[[2024,6,11]],"date-time":"2024-06-11T21:38:55Z","timestamp":1718141935000},"page":"1638-1647","source":"Crossref","is-referenced-by-count":15,"title":["Cumulus: a federated electronic health record-based learning system powered by Fast Healthcare Interoperability Resources and artificial intelligence"],"prefix":"10.1093","volume":"31","author":[{"given":"Andrew J","family":"McMurry","sequence":"first","affiliation":[{"name":"Computational Health Informatics Program, Boston Children\u2019s Hospital , Boston, MA 02215, United States"},{"name":"Department of Pediatrics, Harvard Medical School , Boston, MA 02115, United States"}]},{"given":"Daniel I","family":"Gottlieb","sequence":"additional","affiliation":[{"name":"Computational Health Informatics Program, Boston Children\u2019s Hospital , Boston, MA 02215, United States"},{"name":"Department of Biomedical Informatics, Harvard Medical School , Boston, MA 02115, United States"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4513-403X","authenticated-orcid":false,"given":"Timothy A","family":"Miller","sequence":"additional","affiliation":[{"name":"Computational Health Informatics Program, Boston Children\u2019s Hospital , Boston, MA 02215, United States"},{"name":"Department of Pediatrics, Harvard Medical School , Boston, MA 02115, United States"}]},{"given":"James R","family":"Jones","sequence":"additional","affiliation":[{"name":"Computational Health Informatics Program, Boston Children\u2019s Hospital , Boston, MA 02215, United States"}]},{"given":"Ashish","family":"Atreja","sequence":"additional","affiliation":[{"name":"Innovation Technology, UC Davis Health , Rancho Cordova, CA 95670, United States"}]},{"given":"Jennifer","family":"Crago","sequence":"additional","affiliation":[{"name":"Center for Biomedical Informatics, Regenstrief Institute , Indianapolis, IN 46202, United States"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0904-5905","authenticated-orcid":false,"given":"Pankaja M","family":"Desai","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Rush University Medical Center , Chicago, IL 60612, United States"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1121-0607","authenticated-orcid":false,"given":"Brian E","family":"Dixon","sequence":"additional","affiliation":[{"name":"Center for Biomedical Informatics, Regenstrief Institute , Indianapolis, IN 46202, United States"},{"name":"Department of Health Policy and Management, Fairbanks School of Public Health, Indiana University , Indianapolis, IN 46202, United States"}]},{"given":"Matthew","family":"Garber","sequence":"additional","affiliation":[{"name":"Computational Health Informatics Program, Boston Children\u2019s Hospital , Boston, MA 02215, United 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States"}]},{"given":"Prabhu R V","family":"Shankar","sequence":"additional","affiliation":[{"name":"Innovation Technology, UC Davis Health , Rancho Cordova, CA 95670, United States"},{"name":"Department of Public Health Sciences, UC Davis Health , Davis, CA 95817, United States"}]},{"given":"Yauheni V","family":"Solad","sequence":"additional","affiliation":[{"name":"Innovation Technology, UC Davis Health , Rancho Cordova, CA 95670, United States"}]},{"given":"Elizabeth A","family":"Sprouse","sequence":"additional","affiliation":[{"name":"Double Lantern Informatics , Atlanta, GA 30305, United States"}]},{"given":"Michael","family":"Terry","sequence":"additional","affiliation":[{"name":"Computational Health Informatics Program, Boston Children\u2019s Hospital , Boston, MA 02215, United States"}]},{"given":"Adam B","family":"Wilcox","sequence":"additional","affiliation":[{"name":"Institute for Informatics, Data Science, and Biostatistics, Washington University School of Medicine in St 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