Patent Publication Number: US-2023154581-A1

Title: Gateway conformance validation

Description:
CROSS-REFERENCE TO RELATED APPLICATIONS 
     This application is a continuation application of U.S. patent application Ser. No. 16/443,677 entitled “GATEWAY CONFORMANCE VALIDATION,” filed on Jun. 17, 2019, which is herein incorporated by reference in its entirety for all purposes. 
    
    
     BACKGROUND 
     Users typically visit more than one health institution (e.g., medical providers) to obtain medical treatment. For example, a user may periodically visit a neighborhood clinic for annual physical evaluations and for minor medical procedures. An electronic health record (EHR) is a computer-stored and transferrable copy of a user&#39;s physical health record. The neighborhood clinic may maintain an instance of the user&#39;s electronic health record (e.g., using an EHR system, sometimes referred to as an electronic medical record (EMR) system). When the user visits a provider, a medical professional may update the electronic health record. However, different instances of the user&#39;s electronic health record may be maintained by other health institutions that are unaffiliated with the neighborhood clinic, which may use different versions of the same EHR system or may even use completely different EHR systems (e.g., developed by a competing company). Thus, instances of the user&#39;s health record may be distributed among multiple health institutions, and depending on which type and version of EHR systems used by the health institutions, their records may be stored using multiple different EHR types and versions. 
     A health record sharing system can include functionality for patients to download these disparate instances of their health records to their user devices. For a health institution to have its records available on the health record sharing system, the health institution may be required to participate in an onboarding process defined by an operator of the health record sharing system. During the onboarding process, an administrator or other user of the health institution inputs information that describes many technical aspects of the health institution&#39;s EHR system. Existing onboarding processes can be time-consuming and error prone. 
     BRIEF SUMMARY 
     A system of one or more computers can be configured to perform particular operations or actions by virtue of having software, firmware, hardware, or a combination of them installed on the system that in operation causes or cause the system to perform the actions. One or more computer programs can be configured to perform particular operations or actions by virtue of including instructions that, when executed by data processing apparatus, cause the apparatus to perform the actions. One general aspect includes a computer system, including: a first user interface configured to receive a gateway identifier corresponding to a patient record gateway, the patient record gateway associated with one or more patient record servers configured for storing electronic health records for a plurality of patients, and a memory including computer-executable instructions that, when executed by a processor, cause the processor to access a gateway conformance statement based at least in part on identifying information associated with the patient record gateway, the gateway conformance statement defining characteristics and capabilities of the one or more patient record servers. The processor also performs a configuration test of one or more capabilities of the patient record gateway using the gateway conformance statement and a set of test patient credentials. The processor also, in accordance with a determination that the patient record gateway passes the configuration test, adds the patient record gateway to a list of supported patient record gateways. The computer system also includes a second user interface configured to present the list of supported patient record gateways. Other embodiments of this aspect include corresponding computer methods, apparatus, and computer programs recorded on one or more computer storage devices, each configured to perform the actions described herein. 
     Implementations may include one or more of the following features. The computer system where performing the configuration test of the one or more capabilities includes: validating the one more capabilities. The computer system may also include validating one or more characteristic of the patient record gateway. The computer system where the memory includes additional computer-executable instructions that, when executed by the processor, further cause the processor to at least: parse the gateway conformance statement based at least in part on results of the configuration test. The processor may further define a gateway schema for the patient record gateway based at least in part on parsing the gateway conformance statement. 
     The computer system where the gateway schema defines a protocol for authorization of a patient and retrieval, by the patient using a user device, of a portion of an electronic health record of the patient that is hosted by the patient record gateway. The computer system where accessing the gateway conformance statement includes requesting the gateway conformance statement from the patient record gateway and receiving the gateway conformance statement from the patient record gateway. The computer system where the patient record gateway includes a test version of the patient record gateway that operates in a test environment. The computer system where adding the patient record gateway to the list of supported patient record gateways includes, in accordance with the determination that the test version of the patient record gateway passes the configuration test, adding a production version of the patient record gateway to the list of supported patient record gateways. Implementations of the described techniques may include hardware, a method or process, or computer software on a computer-accessible medium. 
     One general aspect includes a computer-implemented method, including: receiving a gateway identifier corresponding to a patient record gateway, the patient record gateway associated with one or more patient record servers configured for storing electronic health records for a plurality of patients. The computer-implemented method also includes accessing a gateway conformance statement based at least in part on identifying information associated with the patient record gateway, the gateway conformance statement defining characteristics and capabilities of the one or more patient record servers. The computer-implemented method also includes performing a configuration test of a plurality of capabilities of the patient record gateway using the gateway conformance statement and a set of test patient credentials. The computer-implemented method also includes in accordance with a determination that the patient record gateway passes the configuration test, adding the patient record gateway to a list of supported patient record gateways. Other embodiments of this aspect include corresponding computer systems, apparatus, and computer programs recorded on one or more computer storage devices, each configured to perform the actions of the methods. 
     Implementations may include one or more of the following features. The computer-implemented method where performing the configuration test of the plurality of capabilities includes instructing a test harness to perform the configuration test by simulating authorization of a test patient using the set of test patient credentials and simulating retrieval of a test electronic health record associated with the set of test patient credentials. The computer-implemented method further including providing a user interface for presentation at a user device, the user interface including the list of supported patient record gateways. The computer-implemented method where the patient record gateway is one of a plurality of patient record gateways provided by a patient record vendor, each patient record gateway of the plurality of patient record gateways associated with a particular gateway conformance statement. The computer-implemented method where the one or more patient record servers are further configured for outputting electronic health record information in accordance with one or more predefined standards. The computer-implemented method where the one or more predefined standards includes the Fast Healthcare Interoperability Resources (FHIR®) standard. The computer-implemented method where the characteristics of the gateway conformance statement (also called capability statement) include an authorization uniform resource locator (URL), a token URL, a resource URL, a first list of supported resources, a second list of supported search parameters, and types of supported interaction. The computer-implemented method where performing the configuration test includes: verifying connectivity of the one or more patient record servers of the patient record gateway using the gateway conformance statement. The computer-implemented method may also include verifying conformance of the patient record gateway with one or more predefined standards for patient record storage and transmission based at least in part on the gateway conformance statement. The computer-implemented method may also include simulating authorization of a user device by the patient record gateway based at least in part on test patient credentials. The computer-implemented method where performing the configuration test includes: identifying one or more resources associated with the patient record gateway based at least in part on the gateway conformance statement, the one or more resources being available at the one or more patient record servers of the patient record gateway. The computer-implemented method may also include parsing the gateway conformance statement to create one or more gateway schemas for accessing patient record data from the one or more resources. The computer-implemented method where performing the configuration test further includes: accessing the one or more resources to obtain test patient record data in accordance with the one or more gateway schemas. The computer-implemented method may also include comparing the test patient data obtained from the one or more resources with a user data standard specification for patient record storage on a user device. Implementations of the described techniques may include hardware, a method or process, or computer software on a computer-accessible medium. 
     One general aspect includes one or more computer-readable media including computer-executable instructions that, when executed by one or more computer systems, cause the one or more computer systems to perform operations, including: performing a configuration test of a patient record gateway by at least verifying connectivity of one or more patient record servers of the patient record gateway based at least in part on a gateway conformance statement, the gateway conformance statement defining characteristics and capabilities of the one or more patient record servers. The operations also include verifying conformance of the patient record gateway with one or more global standards for patient record storage and transmission based at least in part on the gateway conformance statement. The operations also include identifying one or more resources associated with the patient record gateway based at least in part on the gateway conformance statement, the one or resources being available at the one or more patient record servers of the patient record gateway. The operations also include parsing the gateway conformance statement to create one or more gateway schemas for accessing patient record data from the one or more patient record servers. The operations also include generating a notification including a result of the configuration test. Other embodiments of this aspect include corresponding computer systems, apparatus, and methods, each configured to perform the actions described herein. 
     Implementations may include one or more of the following features. The one or more computer-readable media where performing the configuration test further includes: accessing the one or more patient record servers to obtain test patient record data in accordance with the one or more gateway schemas. The operations also include comparing the test patient data obtained from the one or more patient record servers with a user data standard specification for patient record storage on a user device. The one or more computer-readable media where performing the configuration test further includes simulating authorization of a user device by the patient record gateway based at least in part on a set of test patient credentials. Implementations of the described techniques may include hardware, a method or process, or computer software on a computer-accessible medium. 
    
    
     
       BRIEF DESCRIPTION OF THE DRAWINGS 
         FIG.  1    illustrates a block diagram and a flowchart for onboarding a health institution to a provider cloud using a conformance statement, according to at least one example. 
         FIG.  2    illustrates a block diagram showing an example architecture or system for onboarding a health institution to a provider cloud using a conformance statement, according to at least one example. 
         FIG.  3    illustrates a data flow for onboarding a health institution including a custom electronic health record system to a provider cloud using a conformance statement, according to at least one example. 
         FIG.  4    illustrates a data flow for onboarding a health institution including a commercial electronic health record system to a provider cloud using a conformance statement, according to at least one example. 
         FIG.  5    illustrates a data flow for creating a gateway schema for a gateway of a health institution, according to at least one example. 
         FIG.  6    illustrates a user interface for obtaining configuration data for a gateway of a health institution, according to at least one example. 
         FIG.  7    illustrates a user interface for obtaining configuration data for a gateway of a health institution, according to at least one example. 
         FIG.  8    illustrates a user interface for presenting a list of supported gateways, according to at least one example. 
         FIG.  9    illustrates an example flow chart showing a process for onboarding a health institution to a provider cloud using a conformance statement, according to at least one example. 
         FIG.  10    illustrates a simplified block diagram depicting an example architecture for implementing the techniques described herein, according to at least one example. 
     
    
    
     DETAILED DESCRIPTION 
     In the following description, various examples will be described. For purposes of explanation, specific configurations and details are set forth in order to provide a thorough understanding of the examples. However, it will also be apparent to one skilled in the art that the examples may be practiced without the specific details. Furthermore, well-known features may be omitted or simplified in order not to obscure the example being described. 
     Examples of the present disclosure are directed to, among other things, methods, systems, devices, and computer-readable media for efficiently and effectively onboarding health institutions to a provider cloud. In particular, instead of requiring every health institution to arduously provide technical information about its EHR system, the techniques described herein rely on technical information previously gathered from commercial EHR vendors to onboard health institutions. This approach is based on the fact that most health institutions use one or more commercial EHR vendor products and, for the most part, the form of the technical configuration data for each vendor&#39;s EHR product will be the same irrespective of the health institution that is being onboarded. Thus, the health institution need only supply information about its gateway (e.g., type and version of EHR system) and the system described herein is able to access the relevant configuration data (e.g., in the form of a conformance statement), perform configuration tests, and perfect the onboarding process with little to no additional burden on the health institution administrators. 
     The provider cloud allows users to search for relevant health institutions and download, to their smartphones or other user devices, their respective electronic health records from the health institutions. In some examples, this connection may represent a data pipeline connection with the health institution. The provider cloud operates as an intermediary between user devices and gateways of the EHR systems. The gateways are effectively outlets or endpoints provided by the EHR systems. These endpoints are accessible for downloading data from the EHR systems. The techniques described herein efficiently onboard the gateways, test the gateways, and ensure that quality data connections are possible with the gateways. 
     The EHR systems may be configured differently from one another. For example, data storage formats, user and administrator functionality, and coding schemas may be unique to each. A purpose of the provider cloud described herein is to enable individual, ongoing data pipelines to be established with each of these disparate sources. Once a pipeline is connected, the provider cloud provides a platform for normalizing the data storage formats, user and administrator functionality, and coding schemas from these disparate sources. Thus, once each pipeline has been connected, the data may be stored on a user device in a uniform format, with a predefined set of user functionality, and according to a single coding schema. Doing so results in not only a technical improvement to a computing device, but does so in a way that stores data from the disparate sources in an optimized manner. The data is optimized as to storage capacity and storage access. Because of this, the computing device operates more efficiently than other devices that access electronic health records. This effectively frees up other computing resources for performing other processes. 
     Generally, the provider cloud enables a process for onboarding new health institutions such that user devices can establish connections to their EHR systems. The gateways share electronic health records with the user devices using an industry standard format such as Fast Healthcare Interoperability Resources (FHIR®) created by the Health Level Seven (HL7®) International standards organization. 
     Turning now to the figures,  FIG.  1    illustrates a block diagram  102  and a flowchart showing a process  100  for onboarding a health institution to a provider cloud using a conformance statement, according to at least one example. The diagram  102  includes patient user device  104   p,  which can be any suitable electronic user device capable of communicating with other electronic devices or systems over a network such as the Internet. In some examples, the user device  104   p  can be a smartphone or other user device on which specialized applications can operate. The user device  104   p  is associated with or otherwise operated by a user  106   p.  The user  106   p  is an example of a patient whose electronic health records are the subject of this specification. 
     The diagram  102  also includes a vendor user device  104   v.  The vendor user device  104   v  can be any suitable electronic user device capable of communicating with other electronic devices or systems over a network such as the Internet. In some examples, the vendor user device  104   v  can be a laptop, personal computer, or other user device on which a vendor user  106   v  may interact. The vendor user  106   v  is an example of a representative of a commercial EHR vendor (e.g., an administrator). Examples of commercial EHR vendors include companies such as Cerner, Epic, Meditech, and other such companies that provide applications for storing health records and, in some examples, operating a health institution. The vendor user  106   v  uses the vendor user device  104   v  to interact with a provider cloud  112 . The provider cloud  112  is used to onboard and manage which entities such as health institutions, EHR systems, and other such entities can be accessed for downloading EHR data for patients. For example, the provider cloud  112  onboards different types and versions of EHR products so that configuration details for the EHR products are made available by the provider cloud  112 . The provider cloud  112  also functions to enable users such as the patient user  106   p  to subscribe to particular entities to create pipelines for downloading EHR data for the patient user  106   p.    
     The diagram  102  also includes a health institution user  106   h  who uses the health institution user device  104   h  to interact with the provider cloud  112 . For example, the health institution user  106   h  may use the health institution user device  104   h  to subscribe the health an EHR system of the health institution to the provider cloud  112 . 
     Medical information associated with the health institution (e.g., electronic health records of patients of the health institution) is stored at one or more EHR system(s)  114 . The EHR system  114  may be associated with one or more health institutions (e.g., organization entities, brand entities, and/or location entities). In particular, the EHR system  114  may store, organize, and/or otherwise manage health record data generated by medical professionals of the health institutions. The EHR system  114  includes one or more gateways, each including one or more endpoints to enable multiple connections between the EHR system  114  and other electronic devices. In some examples, user devices such as the patient user device  104   p  may interact with the EHR system  114  using any suitable interfaces such as gateway application programming interfaces (API). The gateway APIs may define a set of function calls for communications between the EHR system  114  and the user device  104   p.    
       FIGS.  1  and  9    illustrate example flow diagrams showing processes  100  and  900 , according to at least a few examples. These processes, and any other processes described herein, are illustrated as logical flow diagrams, each operation of which represents a sequence of operations that can be implemented in hardware, computer instructions, or a combination thereof. In the context of computer instructions, the operations may represent computer-executable instructions stored on one or more non-transitory computer-readable storage media that, when executed by one or more processors, perform the recited operations. Generally, computer-executable instructions include routines, programs, objects, components, data structures and the like that perform particular functions or implement particular data types. The order in which the operations are described is not intended to be construed as a limitation, and any number of the described operations can be combined in any order and/or in parallel to implement the processes. 
     Additionally, some, any, or all of the processes described herein may be performed under the control of one or more computer systems configured with specific executable instructions and may be implemented as code (e.g., executable instructions, one or more computer programs, or one or more applications) executing collectively on one or more processors, by hardware, or combinations thereof. As noted above, the code may be stored on a non-transitory computer-readable storage medium, for example, in the form of a computer program including a plurality of instructions executable by one or more processors. 
     The process  100  begins at  108  by onboarding a commercial EHR. The provider cloud  112  performs  108  based on information received from the vendor user device  104   v.  For example, the vendor user  106   v  may use the vendor user device  104   v  to provider configuration data (e.g., authentication, tokens, resources addresses) to the provider cloud  112  responsive to a set of prompts generated by the provider cloud  112 . In some examples, the set of prompts are included in a form-fillable webpage provided at the vendor user device  104   v.  At  108 , the vendor user  106   v  may provide configuration data for each commercial EHR system offered by the commercial vendor. This can include multiple versions of the commercial EHR system, custom builds of the EHR system for certain customers, and the like. In this manner, the provider cloud  112  will include configuration data for multiple commercial EHR systems. The configuration data includes, in some examples, standard addresses for patient record servers, communication protocols used for communicating with the commercial EHR system, authentication protocols, web addresses for particular services, and the like. At  108 , the process  100  also includes storing the configuration data for the commercial EHR system within a provider database  110 . 
     At  116 , the process  100  includes receiving a gateway identifier for a health institution  111  using the commercial EHR system  114 . The provider cloud  112  performs  116 . For example, the health institution users  106   h  may use the health institution user devices  104   h  to share information about the health institution  111  with the provider cloud  112 . The gateway identifier refers to a network address of an endpoint of the EHR system  114  used by the health institution  111 . The endpoint is a connection point of the EHR system  114  that enables sharing of patient record data stored by the EHR system  114 . The gateway identifier may take any suitable format such as a path, a uniform resource locator (URL), or other such manner for representing the network address. In some examples, the gateway identifier is referred to as a FHIR base URL. 
     In some examples, the health institution user  106   h  may easily provider the gateway identifier using a user interface provided by the provider cloud  112 . For example, the health institution user  106   h  may use the health institution user device  104   h  to navigate to a webpage associated with the provider cloud  112  and there input the gateway identifier. As part of inputting this data, the health institution user  106   h  may identify the type and version of EHR system  114  used by the health institution  111 . For example, the user  106   h  may designate that the health institution  111  uses “Best EHR Storage” system, version 2.1.3. Based on the gateway identifier and, in some examples, the type and version information, the provider cloud  112  relies on a record in the database  110  created at  108  for continuing the onboarding process for the health institution  111 , instead of requesting additional information from the health institution user  106   h.  In some examples, resolving the gateway identifier enables the provider cloud  112  to determine the type and version of EHR system  114  used by the health institution  111 . 
     At  118 , the process  100  includes accessing a conformance statement for the identified gateway of the health institution  111 . This is performed by the provider cloud  112 . For example, the provider cloud  112  may use the gateway identifier to access the gateway of the EHR system  114  and obtain the conformance statement from the EHR system  114  used by the health institution  111 . In some examples, the conformance statement defines a set of capabilities and characteristics of the gateway of the EHR system  114 . It may be used as a statement of the actual functionality of the underlying server(s) that make up the EHR system  114  and are available via the gateway. The conformance statement essentially provides the know-how for interacting with the EHR system  114 . In this manner, the conformance statement can be used in place of obtaining technical configuration details from the health institution user  106   h.  In some examples, the conformance statement is an example of a “capability statement” as used in Fast Healthcare Interoperability Resources (FHIR)® STU-3 and later. 
     At  120 , the process  100  includes using the conformance statement to generate a gateway schema for the identified gateway of the health institution  111 . This is performed by the provider cloud  112 . In some examples, block  122  is conditional on the gateway passing the test at block  120 . The schema may include at least a portion of the conformance statement information and other information discovered, generated, or otherwise obtained during the testing at block  120 . In particular, generating the schema may include validating the information during testing at block  120  and parsing the conformance statement into the schema that is specific to the gateway of the health institution  111 . 
     At  122 , the process  100  includes testing the identified gateway of the health institution  111  using the gateway schema. This is performed by the provider cloud  112 . In some examples, the testing involves testing the set of capabilities and confirming the characteristics of the gateway. Testing can include testing against an industry standard specification for sharing health data such as the FHIR standard. Testing can also include testing against one or more other specifications such as one created by an operator of the provider cloud  112 . While the FHIR standard may identify general standards for sharing health data, the operator-created standard may define specific standards to ensure a consistent user experience for users who download their medical records from the EHR system  114  (e.g., the patient user  106   p ). 
     In some examples, the testing occurs with respect to a testing gateway. In this manner, errors identified during testing can be rectified before production gateway is made available for user connections. The testing can include simulating a user connection to the gateway and downloading a patient health record. 
     At  124 , the process  100  includes enabling a user device to connect to the identified gateway (e.g., the gateway of the EHR system  114 ) of the health institution  111  using the gateway schema generated at block  122 . This is performed by the provider cloud  112 . For example, the patient user device  104   p  may connect to the EHR system  114  using the gateway schema, which may be shared with the patient user device  104   p  by the provider cloud  112  when the user device  104   p  first attempts to connect to the gateway of the EHR system  114 . Downloading health record data may include downloading electronic health records using the FHIR standard. In some examples, the patient user device  104  may connect to and download from more than one EHR system  114 . 
       FIG.  2    illustrates a block diagram showing an example architecture or system  200  for onboarding a health institution to a provider cloud using a conformance statement, according to at least one example. The system  200  includes a few elements introduced in  FIG.  1   . In particular, the system  200  includes the provider cloud  112 , one or more user devices  104   a - 104   n,  and one or more EHR systems  114   a - 114   n  associated with one or more health institutions  111   a - 111   n.  The provider cloud  1112  also includes a business registration system  206  and a queue  214 . As appropriate and as illustrated by the arrows, the elements of the system  200  may be communicatively coupled via one or more networks. 
     Beginning with the business registration system  206 , the business registration system  206  may be any suitable collection of hardware and software components configured to collect, store, update, and otherwise manage business locations including those of the health institutions  111 . For example, the business registration system  206  may include a business database  208  and a registration service  210  to enable subscription of the health institution  111 . When health institution  111  is subscribed and active, the user devices  104  may be allowed to connect to and download health record data from the associated EHR system  114  (e.g., a gateway of the EHR system  114 ). 
     As part of subscribing and managing subscriptions, the registration service  210  may include functionality to collect, store, update, and otherwise manage business locations. In some examples, the registration service  210  provides one or more user interfaces by which authorized users may input information about their location. This information may include geographic information (e.g., a physical address and pin on a map), image information (e.g., logos), contact information (e.g., business, legal, technical, etc.), and any other information relating to a business. The registration service  210  may also be configured to create and/or update record entries in the business database  208  based on information received. For example, an authorized user associated with the health institution  111  may share business information with the business registration system  206 . Once this information has been shared and validated, the business information may be published for public consumption (e.g., indexed for searching, made available on a map platform, shared directly with users, etc.). 
     The business database  208  may maintain the collected business information and any relationships between entities represented by the business information. In some examples, the business database  208  includes some or all of the information stored in the provider database  110 . For example, because the business registration system  206  may be used to register all business (not just health institutions  111 ), records for the health institutions  111  may be maintained in both the business database  208  and the provider database  110 . In some examples, the business registration system  206  shares business information with the provider cloud  112  in any suitable manner. 
     Turning now to the provider cloud  112 , the provider cloud  112  may include the provider database  110  introduced herein, a provider service  209 , and a test harness  211 . Generally, the provider cloud  112  may validate the EHR systems  114 , maintain information about the health institutions  111  and associated EHR systems  114 , enable searching of the health institutions  111  associated with the EHR systems  114 , and manage access of the user devices  104  to the EHR systems  114 . 
     After a health institution  111  associated with an EHR system  114  has been subscribed, the test harness  211  of the provider cloud  112  may be used to test and/or otherwise validate that the EHR system  114  meets certain standards associated with sharing health data. In some examples, the testing may be based, at least in part, on a conformance statement associated with the EHR system  114 . 
     The testing can include simulating that a test user using a test user device  104  can connect to and download data from the EHR system  114 . In this manner, the test harness  211  may simulate actions that one of the user devices  104  may perform to connect to the EHR system  114 . In some examples, the test harness  211  may test this connection when a health institution  111  is first subscribed and at other times after the initial subscription. For example, the connection may be tested periodically, when certain conditions are fulfilled, and under any other circumstance. If the test is positive, a status indicator(s) in the provider database  110  associated with the health institution  111 , the EHR system  114 , and/or a gateway associated with the EHR system  114  may be updated to reflect that the EHR system  114  or the gateway is/are active. If the test is negative, the status indicator(s) may be updated to reflect that the EHR system  114  is inactive. When active, the user devices  104  may be capable of connecting to the gateways of the EHR systems  114 . When inactive, the user devices  104  may be unable to connect to the gateways of the EHR systems  114 . 
     The provider service  209  may maintain information about the health institutions  111  and associated EHR systems  114  in the provider database  110 , enable searching of the health institutions  111  associated with the EHR systems  114 , and manage access of the user devices  104  to the EHR systems  114 . In some examples, the user devices  104  send requests to search for the health institutions  111  to the provider service  209 . The provider service  209  processes these requests and returns results. In some examples, as part of establishing a connection with one of the EHR systems  114 , the user device  104  will check in with the provider service  209  to determine whether any configuration information, which may be saved as a gateway schema, associated with the EHR system  114  has changed. The gateway schema, which may be stored in the provider database  110  may include API information, provider identifiers, status indicator information, and any other suitable information relating to the configuration of the EHR system  114  and/or other entities associated with the EHR system  114 . 
     The user devices  104  may include a health application  212 . Generally, the user devices  104  may be associated with and operated by different users (e.g., patients of the health institutions  111 , employees of the health institutions  111 ). Functionally, the health application  212  may enable the user devices  104  to communicate with the provider cloud  112  (e.g., to search for the health institutions  111 , obtain configuration information about the health institutions  111 , and perform other actions), and communicate with the EHR systems  114  of the health institutions  111  (e.g., to download data packages including electronic health records and/or updates to electronic health records and to perform other such techniques). 
     The queue  214  is configured to broker messages between the health institutions  111 , the provider cloud  112 , and the user devices  104 . In some examples, the queue  214  receives requests from producer entities and enables delivery to consumer entities. In some examples, the queue  214  is used to receive requests and pass them directly the other entities, to schedule certain actions, and the like. The queue  214  is configured to provide a unified, high-throughput, low-latency platform for handling real-time data feeds. In some examples, a storage layer of the queue  214  may include a scalable pub/sub message queue designed as a distributed transaction log. In some examples, the queue  214  connects to external systems (for data import/export) via a connect application and provides data streaming using a stream processing library. In some examples, the queue  214  is built on the Apache Kafka platform. 
       FIG.  3    illustrates a data flow  300  for onboarding a health institution including a custom electronic health record system to a provider cloud using a conformance statement, according to at least one example. The flow  300  is performed by the business registration system  206 , the queue  214 , the provider cloud  112 , and a database  216 . The database  216  may include a distributed, wide column store, NoSQL database management system designed to handle large amounts of data across many commodity servers. Such an arrangement may provide high availability with no single point of failure. In some examples, the database  216  provides robust support for clusters spanning multiple datacenters, with asynchronous masterless replication allowing low latency operations for all clients. In some examples, the database  216  is built on the Apache Cassandra platform. 
     The data flow  300  begins at ( 1 ) by the business registration system  206  sending a message to the queue  214  to validate conformance of a conformance statement of a gateway. In some examples, prior to the data flow  300  beginning at ( 1 ), the conformance statement is accessed from the gateway of a health institution or provided to the business registration system  206  in some other manner. In any event, at ( 1 ) the data flow  300  also includes the test harness  211  validating the conformance statement, which can include validating a gateway identifier for the gateway, validating a gateway version, and validating an address associated with the gateway (e.g., a FHIR-based URL). 
     At ( 2 ), the data flow  300  includes the test harness  211  sharing the results of the conformance test with the queue  214 , which are then shared with the business registration system  206 . 
     At ( 3 ), the data flow  300  includes the business registration system  206  sending a message to the queue  214  to update the gateway. This can include a message to update a client identifier, a client secret, a scope associated with the conformance statement, a base address for the gateway (e.g., base URL), and a version identifier. Also at ( 3 ), the data flow includes the queue  214  sending a message to the provider service  209  to update the gateway the information identified previously. At ( 3 ), the status of the gateway may be unpublished, e.g., unavailable, when searched by a user device. In some examples, the testing is performed on a test gateway within a sandbox environment. 
     Updating the gateway can include, at ( 4 ), updating versions of objects for the conformance statement stored in the database  216  and/or updating authorization information versions stored in the database  216 . These updating steps may correspond to the client identifier, the client secret, the scope associated with the conformance statement, the base address for the gateway (e.g., base URL), and the version identifier. 
     At ( 5 ), the data flow  300  includes the business registration system  206  sending a message to the queue  214  to run a gateway test. In some examples, the queue  214  passes the message to the test harness  211  of the provider cloud  112  to perform the gateway test. The gateway test can include the test harness  211  performing one or more configuration tests using the conformance statement. For example, the test harness  211  can test links to patient record servers identified in the conformance statement, download test patient data, simulate a user device connection to the provider cloud  112 , simulate a download of test patient data from the gateway, and confirm that the downloaded data corresponds to one or more standards. 
     Testing the gateway can include, at ( 6 ) and ( 7 ) accessing object version information from the database  216  and testing the gateway schema and the gateway schema versions. These testing steps may correspond to the test harness  211  performing the configuration test described previously. 
     At ( 8 ), the data flow  300  includes sharing the gateway test results with the business registration system  206  via the queue  214 , at ( 9 ). Once the business registration system  206  has the results, it can again begin the process of updating the gateway, which includes ( 10 ), ( 11 ), and ( 12 ). In some examples, the updating at ( 10 ) may include updating at least some of same data elements updated at ( 3 ). However, the update at ( 10 ) may result in the status of the gateway changing from not published to published. This may make the gateway a production gateway. 
       FIG.  4    illustrates a data flow  400  for onboarding a health institution including a custom electronic health record system to a provider cloud using a conformance statement, according to at least one example. The flow  400  is performed by the business registration system  206 , the queue  214 , the provider cloud  112 , and the database  216 . 
     The data flow  400  begins at ( 1 ) by the business registration system  206  sending a message to the queue  214  to validate conformance of a conformance statement of a gateway. In some examples, prior to the data flow  300  beginning at ( 1 ), the conformance statement is accessed from the gateway of a health institution or provided to the business registration system  206  in some other manner. In any event, at ( 2 ) the data flow  300  also includes the test harness  211  validating the conformance statement, which can include validating a gateway identifier for the gateway, validating a gateway version, and validating an address associated with the gateway (e.g., a FHIR-based URL). 
     At ( 3 ) and ( 4 ), the data flow  400  includes the business registration system  206  receiving, via the queue  214 , the results of the conformance statement validation performed at ( 2 ). 
     At ( 5 ), the data flow  400  includes the business registration system  206  sending message to the queue  214  to update the gateway. This can include a message to update a client identifier, a client secret, a scope associated with the conformance statement, a base address for the gateway (e.g., base URL), and a version identifier. At ( 6 ), the data flow  400  includes the queue  214  sending a message to the provider service  209  to update the gateway information identified previously. At ( 5 ), the status of the gateway may be unpublished, e.g., unavailable when searched by a user device. In some examples, the testing is performed on a test gateway within a sandbox environment. 
     Updating the gateway can include, at ( 7 ), updating versions of objects for the conformance statement stored in the database  216  and/or updating authorization information versions stored in the database  216 . These updating steps may correspond to the client identifier, the client secret, the scope associated with the conformance statement, the base address for the gateway (e.g., base URL), and the version identifier. 
     At ( 8 ), the data flow  400  includes the business registration system  206  sending a message to the queue  214  to run a gateway test. In some examples, this message includes an authorization code. In some examples, at ( 9 ), the queue  214  passes the message, which may include the authorization code, to the test harness  211  of the provider cloud  112  to perform the gateway test. The gateway test can include the test harness  211  performing one or more configuration tests using the conformance statement. For example, the test harness  211  can test links to patient record servers identified in the conformance statement, download test patient data, simulate a user device connection to the provider cloud  112 , simulate a download of test patient data from the gateway, and confirm that the downloaded data corresponds to one or more standards. 
     Testing the gateway can include, at ( 10 ), accessing object version information, authorization information including testing an application programming interface to a database (e.g., “data scripts API”), and EHR system authorization information including testing a custom gateway from the database  216  and testing the gateway schema versions at ( 11 ) and the gateway schema at ( 12 ). These testing steps may correspond to the test harness  211  performing the configuration test described previously. 
     At ( 13 ), the data flow  400  includes sharing the gateway test results with the queue  214 , which in turns shares the results with the business registration system  206 , at ( 14 ). Once the business registration system  206  has the results, it can again begin the process of updating the gateway, which includes ( 15 ) and ( 16 ) using the provider service  209 . In some examples, the updating at ( 15 ) may include updating at least some of same data elements updated at ( 6 ). However, the update at ( 15 ) may result in the status of the gateway changing from not published to published. This may make the gateway a production gateway. In some examples, at ( 17 ), the data flow  400  includes designating the gateway as a supported EHR system. 
       FIG.  5    illustrates a data flow  500  for creating a gateway schema for gateway of a health institution, according to at least one example. The data flow  500  is performed by the business registration system  206 , the queue  214 , the provider cloud  112 , the database  216 . 
     The data flow  500  begins at ( 1 ), by the business registration system  206  requesting the test harness  211  to perform a gateway test. The gateway test can perform as described herein. At ( 2 ), the data flow  500  includes the test harness  211  accessing gateway information from the database  216 . Such information may include version information for the gateway schema. If the gateway passes the gateway test, then, at ( 3 ), the gateway schema is generated. Additionally, at ( 4 ), a message is sent to the business registration system  2106  indicating that the test was successful. At ( 5 ), the gateway is published to the provider service  209  (e.g., made available within the provider database  110 . 
     Periodic testing of the gateway can be scheduled at ( 6 ). Then the testing can be performed at ( 7 ) and ( 8 ), which correspond to ( 2 ) and ( 3 ). If the gateway passes again, it will remain available at the provider service  209 . If not, the gateway will be removed from a list of supported gateways, as described with reference to  FIG.  7   . 
       FIG.  6    illustrates a user interface  600  for obtaining configuration data for a gateway of a health institution, according to at least one example. The user interface  600  can be presented at by the provider cloud  112  at one of the user devices  104  (e.g., a health institution user device  104   h  or a vendor user device  104   v ). The user interface  600  includes an endpoint/gateway configuration area  602 . In the endpoint configuration area  602  is presented one or more text input boxes in which can be input configuration data for configuring a gateway. The configuration data includes, for example, an authorization URL, a FHIR resource URL, and a token URL. 
       FIG.  7    illustrates a user interface  700  for obtaining configuration data for a gateway of a health institution, according to at least one example. The user interface  700  can be presented at by the provider cloud  112  at one of the user devices  104  (e.g., a health institution user device  104   h  or a vendor user device  104   v ). The user interface  700  includes an endpoint/gateway configuration area  702 . In the endpoint configuration area  702  is presented one or more text input boxes in which can be input data for configuring a gateway. The configuration data includes, for example, a FHIR base URL. The FHIR base URL functions as a gateway identifier. Using the FHIR base URL, the systems described herein can access the conformance statement that includes, among other things, similar configuration data as shown in the endpoint configuration area  602 . 
       FIG.  8    illustrates a user interface  800  for presenting a list of supported gateways, according to at least one example. The user interface  800  can be presented by the provider cloud  112  at one of the user devices (e.g., the patient user device  104   p ). The user interface  800  includes a supported gateways area  802 . In the supported gateways area  802  is presented a list of supported gateways. In some examples, the list of supported gateways may identify the health institution and which EHR system and version are used by each health institution. In some examples, a similar list, but without the health institution name, can be presented at the health institution user device  104   h.  This may be desirable for the health institution user  106   h  to select which EHR system and version the health institution operates. Using this approach may allow the health institution user  106   h  to quickly and efficiently onboard the gateway of their health institution because much of the configuring has already been performed. In particular, the EHR system and versions have been configured, e.g., by the vendor user  106   v,  and the health institution user  106   h  just needs to identify the gateway address and the process can automatically validate the gateway of the health institution as described herein. 
       FIG.  9    illustrates an example flow chart showing a process  900  for onboarding a health institution to a provider cloud using a conformance statement, according to at least one example. The process  900  begins at  902  by receiving a gateway identifier corresponding to a patient record gateway (e.g., a gateway of an EHR system such as the EHR system  114  ( FIG.  1   )). This may be performed by the provider service  209  ( FIG.  2   ) of the provider cloud  112  ( FIG.  1   ). In some examples, the gateway identifier is a FHIR base URL associated with the gateway. The gateway identifier may be received via an interface such as the user interface  700  configured to receive the gateway identifier. The patient record gateway may be associated with one or more patient record servers configured for storing electronic health records for a plurality of patients. In some examples, the one or more patient record servers are further configured for outputting electronic health record information in accordance with one or more predefined standards. The one or more predefined standards may include the Fast Healthcare Interoperability Resources (FHIR)® standard. The patient record servers may make up the EHR system  114  described herein. The patient record servers may be hosted by a third-party such as the health institutions or a vendor. 
     At  904 , the process  900  includes accessing a gateway conformance statement. This may be performed by the test harness  211  ( FIG.  2   ) of the provider cloud  112 . In some examples, accessing the gateway conformance statement may be based at least in part on identifying information associated with the patient record gateway. For example, the identifying information may be the gateway identifier (e.g., a FHIR base URL) or other identifying information such as an address of a location at the EHR system where the conformance statement is stored other than at the FHIR base URL. The gateway conformance statement may define characteristics and capabilities of the one or more patient record servers. 
     In some examples, the characteristics of the conformance statement include an authorization Uniform Resource Locator (URL), a token URL, a resource URL, a first list of supported resources, a second list of supported search parameters, and types of supported interaction. 
     In some examples, accessing the gateway conformance statement may include requesting the gateway conformance statement from the patient record gateway and receiving the gateway conformance statement from the patient record gateway. 
     At  906 , the process  900  includes performing a configuration test of the patient record gateway. This may be performed by the test harness  211  of the provider cloud  112 . In some examples, performing the configuration test includes testing a plurality of capabilities of the patient record gateway using the gateway conformance statement and a set of test patient credentials. The test patient credentials may be obtained from the EHR system and/or provided by an administrator of the health institution or vendor that is participating in the onboarding process. The gateway configuration test can include verifying connectivity of one or more patient record servers of the patient record gateway based at least in part on the gateway conformance statement and verifying conformance of the patient record gateway with one or more predefined standards for patient record storage and transmission based at least in part on the gateway conformance statement. The gateway configuration test can also include identifying one or more resources associated with the patient record gateway based at least in part on the gateway conformance statement. The one or resources may be available at the one or more patient record servers of the patient record gateway. The gateway configuration test can also include parsing the gateway conformance statement to create one or more gateway schemas for accessing patient record data from the one or more patient record servers, accessing the one or more patient record servers to obtain test patient record data in accordance with the one or more gateway schemas, comparing the test patient data obtained from the one or more patient record servers with a user data standard specification for patient record storage on a user device, and simulating authorization of a user device by the patient record gateway based at least in part on a set of test patient credentials. 
     In some examples, performing the configuration test of the plurality of capabilities includes instructing a test harness to perform the configuration test by simulating authorization of a test patient using the set of test patient credentials and simulating retrieval of a test electronic health record associated with the set of test patient credentials. 
     In some examples, performing the configuration test of the one or more capabilities includes validating the one or more capabilities, and validating one or more characteristic of the patient record gateway. In this example, the process  900  further includes parsing the gateway conformance statement based at least in part on results of the configuration test, and defining a gateway schema for the patient record gateway based at least in part on parsing the gateway conformance statement. The gateway schema may define a protocol for authorization of a patient and retrieval, by the patient using a user device, of a portion of an electronic health record of the patient that is hosted by the patient record gateway. 
     At  908 , the process  900  includes determining whether the patient record gateway passes the configuration test. If the patient record gateway does not pass the configuration test (i.e., the answer at  908  is “No”), the process  900  proceeds to  912 , at which a test failure message is generated. This may be performed by the provider service  209  or the test harness  211  of the provider cloud  112 . The test failure message may indicate which portions of the test the patient record gateway failed. In some examples, the test failure message may cause the patient record gateway to change states from available to unavailable. For example, when the configuration test is performed after the patient record gateway has been published (e.g., the gateway is a production gateway, not a test gateway), failing the configuration test may cause the product gateway to be disabled. When disabled, the gateway may be unavailable for selection within the list of supported gateways, as described with reference to  FIG.  8   . 
     If the patient record gateway passes the configuration test (i.e., the answer at  908  is “Yes”), the process  900  proceeds to  910 , at which the patient record gateway is added to a list of supported patient record gateways. This may be performed by the provider service  209  of the provider cloud  112 . Adding the patient record gateway may include adding the patient record gateway to the list of supported gateways, as described with reference to  FIG.  7   . 
     In some examples, the patient record gateway includes a test version of the patient record gateway that operates in a test environment (e.g., a sandbox). In this example, adding the patient record gateway to the list of supported patient record gateways may include, in accordance with the determination that the test version of the patient record gateway passes the configuration test, adding a production version of the patient record gateway to the list of supported patient record gateways. Passing the configuration test may include achieving positive results on all or a portion of the test criteria. 
     In some examples, the process  900  further includes providing a user interface for presentation at a user device, the user interface including the list of supported patient record gateways. 
     In some examples, the patient record gateway is one of a plurality of patient record gateways provided by a patient record vendor. In this example, each patient record gateway of the plurality of patient record gateways is associated with a particular gateway conformance statement. 
       FIG.  10    illustrates an example architecture or environment  1000  configured to implement techniques described herein, according to at least one example. In some examples, the example architecture  1000  may further be configured to enable the user device  104 , service provider computers  1002  to share information. The service provider computers  1002  are examples of the business registration system  206 , the provider cloud  112 , and the EHR systems  114 . In some examples, the devices may be connected via one or more networks  1008  (e.g., via Bluetooth, WiFi, the Internet, or the like). In some examples, the service provider computers  1002  may be configured to implement at least some of the techniques described herein with reference to the user device  104 . 
     In some examples, the networks  1008  may include any one or a combination of many different types of networks, such as cable networks, the Internet, wireless networks, cellular networks, satellite networks, other private and/or public networks, or any combination thereof. While the illustrated example represents the user device  104  accessing the service provider computers  1002  via the networks  1008 , the described techniques may equally apply in instances where the user device  104  interacts with the service provider computers  1002  over a landline phone, via a kiosk, or in any other manner. It is also noted that the described techniques may apply in other client/server arrangements (e.g., set-top boxes, etc.), as well as in non-client/server arrangements (e.g., locally stored applications, peer to peer configurations, etc.). 
     As noted above, the user device  104  may be any type of computing device such as, but not limited to, a mobile phone, a smartphone, a personal digital assistant (PDA), a laptop computer, a desktop computer, a thin-client device, a tablet computer, a wearable device, or the like. In some examples, the user device  104  may be in communication with the service provider computers  1002  via the network  1008 , or via other network connections. 
     In one illustrative configuration, the user device  104  may include at least one memory  1014  and one or more processing units (or processor(s))  1016 . The processor(s)  1016  may be implemented as appropriate in hardware, computer-executable instructions, firmware, or combinations thereof. Computer-executable instruction or firmware implementations of the processor(s)  1016  may include computer-executable or machine-executable instructions written in any suitable programming language to perform the various functions described. The user device  104  may also include geo-location devices (e.g., a global positioning system (GPS) device or the like) for providing and/or recording geographic location information associated with the user device  104 . 
     The memory  1014  may store program instructions that are loadable and executable on the processor(s)  1016 , as well as data generated during the execution of these programs. Depending on the configuration and type of the user device  104 , the memory  1014  may be volatile (such as random access memory (RAM)) and/or non-volatile (such as read-only memory (ROM), flash memory, etc.). The user device  104  may also include additional removable storage and/or non-removable storage  1026  including, but not limited to, magnetic storage, optical disks, and/or tape storage. The disk drives and their associated non-transitory computer-readable media may provide non-volatile storage of computer-readable instructions, data structures, program modules, and other data for the computing devices. In some implementations, the memory  1014  may include multiple different types of memory, such as static random access memory (SRAM), dynamic random access memory (DRAM), or ROM. While the volatile memory described herein may be referred to as RAM, any volatile memory that would not maintain data stored therein once unplugged from a host and/or power would be appropriate. 
     The memory  1014  and the additional storage  1026 , both removable and non-removable, are all examples of non-transitory computer-readable storage media. For example, non-transitory computer readable storage media may include volatile or non-volatile, removable or non-removable media implemented in any method or technology for storage of information such as computer-readable instructions, data structures, program modules, or other data. The memory  1014  and the additional storage  1026  are both examples of non-transitory computer storage media. Additional types of computer storage media that may be present in the user device  104  may include, but are not limited to, phase-change RAM (PRAM), SRAM, DRAM, RAM, ROM, Electrically Erasable Programmable Read-Only Memory (EEPROM), flash memory or other memory technology, compact disc read-only memory (CD-ROM), digital video disc (DVD) or other optical storage, magnetic cassettes, magnetic tape, magnetic disk storage or other magnetic storage devices, or any other medium that can be used to store the desired information and that can be accessed by the user device  104 . Combinations of any of the above should also be included within the scope of non-transitory computer-readable storage media. Alternatively, computer-readable communication media may include computer-readable instructions, program modules, or other data transmitted within a data signal, such as a carrier wave, or other transmission. However, as used herein, computer-readable storage media does not include computer-readable communication media. 
     The user device  104  may also contain communications connection(s)  1028  that allow the user device  104  to communicate with a data store, another computing device or server, user terminals, and/or other devices via the network  1008 . The user device  104  may also include I/O device(s)  1030 , such as a keyboard, a mouse, a pen, a voice input device, a touch input device, a display, speakers, a printer, etc. 
     Turning to the contents of the memory  1014  in more detail, the memory  1014  may include an operating system  1032  and/or one or more application programs or services for implementing the features disclosed herein such as a service engine  1003   a.  The service provider computer  1002  may also include a memory  1042  that includes a service engine  1003   b.  In this manner, the techniques described herein may be implemented by any one, or a combination of more than one, of the computing devices (e.g., the user device  104  or the service provider computer  1002 ). The service engine  1003  may be configured to implement the functions of the registration service  210 , the provider service  209 , the test harness  211 , and any other function of a device or system described herein. 
     The service provider computers  1002  may also be any type of computing device such as, but not limited to, a mobile phone, a smartphone, a PDA, a laptop computer, a desktop computer, a thin-client device, a tablet computer, a wearable device, a server computer, a virtual machine instance, etc. In some examples, the service provider computers  1002  may be in communication with the user device  104  via the network  1008 , or via other network connections. 
     In one illustrative configuration, the service provider computers  1002  may include at least one memory  1042  and one or more processing units (or processor(s))  1044 . The processor(s)  1044  may be implemented as appropriate in hardware, computer-executable instructions, firmware, or combinations thereof. Computer-executable instruction or firmware implementations of the processor(s)  1044  may include computer-executable or machine-executable instructions written in any suitable programming language to perform the various functions described. 
     The memory  1042  may store program instructions that are loadable and executable on the processor(s)  1044 , as well as data generated during the execution of these programs. Depending on the configuration and type of service provider computer  1002 , the memory  1042  may be volatile (such as RAM) and/or non-volatile (such as ROM, flash memory, etc.). The service provider computer  1002  may also include additional removable storage and/or non-removable storage  1046  including, but not limited to, magnetic storage, optical disks, and/or tape storage. The disk drives and their associated non-transitory computer-readable media may provide non-volatile storage of computer-readable instructions, data structures, program modules, and other data for the computing devices. In some implementations, the memory  1042  may include multiple different types of memory, such as SRAM, DRAM, or ROM. While the volatile memory described herein may be referred to as RAM, any volatile memory that would not maintain data stored therein once unplugged from a host and/or power would be appropriate. The memory  1042  and the additional storage  1046 , both removable and non-removable, are both additional examples of non-transitory computer-readable storage media. 
     The service provider computer  1002  may also contain communications connection(s)  1048  that allow the service provider computer  1002  to communicate with a data store, another computing device or server, user terminals and/or other devices via the network  1008 . The service provider computer  1002  may also include I/O device(s)  1050 , such as a keyboard, a mouse, a pen, a voice input device, a touch input device, a display, speakers, a printer, etc. 
     Turning to the contents of the memory  1042  in more detail, the memory  1042  may include an operating system  1052  and/or one or more application programs or services for implementing the features disclosed herein including the service engine  1003   b.    
     Therefore, although the present disclosure broadly covers use of personal information data to implement one or more various disclosed embodiments, the present disclosure also contemplates that the various embodiments can also be implemented without the need for accessing such personal information data. That is, the various embodiments of the present technology are not rendered inoperable due to the lack of all or a portion of such personal information data. 
     The various examples further can be implemented in a wide variety of operating environments, which in some cases can include one or more user computers, computing devices or processing devices which can be used to operate any of a number of applications. User or client devices can include any of a number of general purpose personal computers, such as desktop or laptop computers running a standard operating system, as well as cellular, wireless and handheld devices running mobile software and capable of supporting a number of networking and messaging protocols. Such a system also can include a number of workstations running any of a variety of commercially-available operating systems and other known applications for purposes such as development and database management. These devices also can include other electronic devices, such as dummy terminals, thin-clients, gaming systems, and other devices capable of communicating via a network. 
     Most examples utilize at least one network that would be familiar to those skilled in the art for supporting communications using any of a variety of commercially-available protocols, such as TCP/IP, OSI, FTP, UPnP, NFS, CIFS, and AppleTalk. The network can be, for example, a local area network, a wide-area network, a virtual private network, the Internet, an intranet, an extranet, a public switched telephone network, an infrared network, a wireless network, and any combination thereof. 
     In examples utilizing a network server, the network server can run any of a variety of server or mid-tier applications, including HTTP servers, FTP servers, CGI servers, data servers, Java servers, and business application servers. The server(s) may also be capable of executing programs or scripts in response to requests from user devices, such as by executing one or more applications that may be implemented as one or more scripts or programs written in any programming language, such as Java®, C, C# or C++, or any scripting language, such as Perl, Python or TCL, as well as combinations thereof. The server(s) may also include database servers, including without limitation those commercially available from Oracle®, Microsoft®, Sybase®, and IBM®. 
     The environment can include a variety of data stores and other memory and storage media as discussed above. These can reside in a variety of locations, such as on a storage medium local to (and/or resident in) one or more of the computers or remote from any or all of the computers across the network. In a particular set of examples, the information may reside in a storage-area network (SAN) familiar to those skilled in the art. Similarly, any necessary files for performing the functions attributed to the computers, servers or other network devices may be stored locally and/or remotely, as appropriate. Where a system includes computerized devices, each such device can include hardware elements that may be electrically coupled via a bus, the elements including, for example, at least one central processing unit (CPU), at least one input device (e.g., a mouse, keyboard, controller, touch screen, or keypad), and at least one output device (e.g., a display device, printer, or speaker). Such a system may also include one or more storage devices, such as disk drives, optical storage devices, and solid-state storage devices such as RAM or ROM, as well as removable media devices, memory cards, flash cards, etc. 
     Such devices also can include a computer-readable storage media reader, a communications device (e.g., a modem, a network card (wireless or wired), an infrared communication device, etc.), and working memory as described above. The computer-readable storage media reader can be connected with, or configured to receive, a non-transitory computer-readable storage medium, representing remote, local, fixed, and/or removable storage devices as well as storage media for temporarily and/or more permanently containing, storing, transmitting, and retrieving computer-readable information. The system and various devices also typically will include a number of software applications, modules, services, or other elements located within at least one working memory device, including an operating system and application programs, such as a client application or browser. It should be appreciated that alternate examples may have numerous variations from that described above. For example, customized hardware might also be used and/or particular elements might be implemented in hardware, software (including portable software, such as applets) or both. Further, connection to other computing devices such as network input/output devices may be employed. 
     Non-transitory storage media and computer-readable media for containing code, or portions of code, can include any appropriate media known or used in the art, including storage media, such as, but not limited to, volatile and non-volatile, removable and non-removable media implemented in any method or technology for storage of information such as computer-readable instructions, data structures, program modules, or other data, including RAM, ROM, EEPROM, flash memory or other memory technology, CD-ROM, DVD or other optical storage, magnetic cassettes, magnetic tape, magnetic disk storage or other magnetic storage devices, or any other medium which can be used to store the desired information and which can be accessed by a system device. Based at least in part on the disclosure and teachings provided herein, a person of ordinary skill in the art will appreciate other ways and/or methods to implement the various examples. 
     The specification and drawings are, accordingly, to be regarded in an illustrative rather than a restrictive sense. It will, however, be evident that various modifications and changes may be made thereunto without departing from the broader spirit and scope of the disclosure as set forth in the claims. 
     Other variations are within the spirit of the present disclosure. Thus, while the disclosed techniques are susceptible to various modifications and alternative constructions, certain illustrated examples thereof are shown in the drawings and have been described above in detail. It should be understood, however, that there is no intention to limit the disclosure to the specific form or forms disclosed, but on the contrary, the intention is to cover all modifications, alternative constructions and equivalents falling within the spirit and scope of the disclosure, as defined in the appended claims. 
     The use of the terms “a” and “an” and “the” and similar referents in the context of describing the disclosed examples (especially in the context of the following claims) are to be construed to cover both the singular and the plural, unless otherwise indicated herein or clearly contradicted by context. The terms “comprising,” “having,” “including,” and “containing” are to be construed as open-ended terms (e.g., meaning “including, but not limited to,”) unless otherwise noted. The term “connected” is to be construed as partly or wholly contained within, attached to, or joined together, even if there is something intervening. Recitation of ranges of values herein are merely intended to serve as a shorthand method of referring individually to each separate value falling within the range, unless otherwise indicated herein, and each separate value is incorporated into the specification as if it were individually recited herein. All methods described herein can be performed in any suitable order unless otherwise indicated herein or otherwise clearly contradicted by context. The use of any and all examples, or exemplary language (e.g., “such as”) provided herein, is intended merely to better illuminate examples of the disclosure and does not pose a limitation on the scope of the disclosure unless otherwise claimed. No language in the specification should be construed as indicating any non-claimed element as essential to the practice of the disclosure. 
     Disjunctive language such as the phrase “at least one of X, Y, or Z,” unless specifically stated otherwise, is otherwise understood within the context as used in general to present that an item, term, etc., may be either X, Y, or Z, or any combination thereof (e.g., X, Y, and/or Z). Thus, such disjunctive language is not generally intended to, and should not, imply that certain examples require at least one of X, at least one of Y, or at least one of Z to each be present. 
     Preferred examples of this disclosure are described herein, including the best mode known to the inventors for carrying out the disclosure. Variations of those preferred examples may become apparent to those of ordinary skill in the art upon reading the foregoing description. The inventors expect skilled artisans to employ such variations as appropriate, and the inventors intend for the disclosure to be practiced otherwise than as specifically described herein. Accordingly, this disclosure includes all modifications and equivalents of the subject matter recited in the claims appended hereto as permitted by applicable law. Moreover, any combination of the above-described elements in all possible variations thereof is encompassed by the disclosure unless otherwise indicated herein or otherwise clearly contradicted by context. 
     All references, including publications, patent applications, and patents, cited herein are hereby incorporated by reference to the same extent as if each reference were individually and specifically indicated to be incorporated by reference and were set forth in its entirety herein. 
     As described above, one aspect of the present technology is the gathering and use of data available from various sources to provide a comprehensive and complete window to a user&#39;s personal health record. The present disclosure contemplates that in some instances, this gathered data may include personally identifiable information (PII) data that uniquely identifies or can be used to contact or locate a specific person. Such personal information data can include demographic data, location-based data, telephone numbers, email addresses, Twitter ID&#39;s, home addresses, data or records relating to a user&#39;s health or level of fitness (e.g., vital sign measurements, medication information, exercise information), date of birth, or any other identifying or personal or health information. 
     The present disclosure recognizes that the use of such personal information data, in the present technology, can be used to the benefit of users. For example, the personal information data can be used to provide enhancements to a user&#39;s personal health record. Further, other uses for personal information data that benefit the user are also contemplated by the present disclosure. For instance, health and fitness data may be used to provide insights into a user&#39;s general wellness, or may be used as positive feedback to individuals using technology to pursue wellness goals. 
     The present disclosure contemplates that the entities responsible for the collection, analysis, disclosure, transfer, storage, or other use of such personal information data will comply with well-established privacy policies and/or privacy practices. In particular, such entities should implement and consistently use privacy policies and practices that are generally recognized as meeting or exceeding industry or governmental requirements for maintaining personal information data private and secure. Such policies should be easily accessible by users, and should be updated as the collection and/or use of data changes. Personal information from users should be collected for legitimate and reasonable uses of the entity and not shared or sold outside of those legitimate uses. Further, such collection/sharing should occur after receiving the informed consent of the users. Additionally, such entities should consider taking any needed steps for safeguarding and securing access to such personal information data and ensuring that others with access to the personal information data adhere to their privacy policies and procedures. Further, such entities can subject themselves to evaluation by third parties to certify their adherence to widely accepted privacy policies and practices. In addition, policies and practices should be adapted for the particular types of personal information data being collected and/or accessed and adapted to applicable laws and standards, including jurisdiction-specific considerations. For instance, in the US, collection of or access to certain health data may be governed by federal and/or state laws, such as the Health Insurance Portability and Accountability Act (HIPAA); whereas health data in other countries may be subject to other regulations and policies and should be handled accordingly. Hence different privacy practices should be maintained for different personal data types in each country. 
     Despite the foregoing, the present disclosure also contemplates embodiments in which users selectively block the use of, or access to, personal information data. That is, the present disclosure contemplates that hardware and/or software elements can be provided to prevent or block access to such personal information data. For example, in the case of advertisement delivery services or other services relating to health record management, the present technology can be configured to allow users to select to “opt in” or “opt out” of participation in the collection of personal information data during registration for services or anytime thereafter. In addition to providing “opt in” and “opt out” options, the present disclosure contemplates providing notifications relating to the access or use of personal information. For instance, a user may be notified upon downloading an app that their personal information data will be accessed and then reminded again just before personal information data is accessed by the app. 
     Moreover, it is the intent of the present disclosure that personal information data should be managed and handled in a way to minimize risks of unintentional or unauthorized access or use. Risk can be minimized by limiting the collection of data and deleting data once it is no longer needed. In addition, and when applicable, including in certain health related applications, data de-identification can be used to protect a user&#39;s privacy. De-identification may be facilitated, when appropriate, by removing specific identifiers (e.g., date of birth, etc.), controlling the amount or specificity of data stored (e.g., collecting location data a city level rather than at an address level), controlling how data is stored (e.g., aggregating data across users), and/or other methods.