Human Factor FHIR-FLIs: Applying SEIPS 2.0 to Cross-Platform App Development
Event Type
Discussion Panel
TimeThursday, April 153:30pm - 4:30pm EDT
LocationDigital Health
DescriptionThe SEIPS 2.0 model (Holden et al., 2013) has become a predominant model for demonstrating the sociotechnical aspect of healthcare. The work system is based upon the person interacting within aspects of their work setting including the internal environment, external environment, organization, tasks, and tools and technology. With the rapidly evolving technological landscape of healthcare, the new tools and technology entering healthcare today need to emphasize usability engineering principles to support the execution of work tasks. Further, development of app-based tools should be usable across several platforms, increasing transferability and usability.

In December 2018, Google introduced the open-source UI toolkit Flutter (Google, n.d.). Flutter allows for simultaneous cross-platform app development on Android, iOS, and (soon) the web. Flutter was built with design-thinking principles in mind, specifically focusing on ease of use from the perspective of its developers.

Focusing on usability, Flutter follows four primary tenants: 1) Beautiful; 2) Fast; 3) Productive; 4) Open.
1) Beautiful: Flutter is built using a declarative UI structure, which means that developers simply state what they want to see (typically, in the form of a “widget”), and the app will render exactly that.
2) Fast: Flutter handles its own UI drawing, rather than attempting to use the native Android or iOS widgets via translation. This enables 60+ frames per second even on older phone hardware.
3) Productive: the addition of “Stateful Hot Reload” means that developers can press “Save” on their integrated development environment (IDE) while the app is running on a phone/emulator and see an immediate redraw of the UI. This allows for rapid prototyping and far greater adaptability than what was previously seen, where the app would need to stop, re-compile, and re-run from the beginning (thus losing the app’s “state”).
4) Open: the entire toolkit is open-source, which allows for others to draw inspiration from the Flutter architecture when building their own product.

To date, the authors have coordinated multiple 2- and 4-hour Flutter workshops at AMIA’s virtual Clinical Informatics Conference and have created asynchronous videos available for continuing medical education credit (Manning, 2020a). They have also connected Flutter to the global standard for health data interoperability, HL7 International’s Fast Healthcare Interoperability Resources (FHIR), with open-source works available teaching others how to harness this technology (Faulkenberry & Manning, n.d.-a, n.d.-b; Manning, 2020b). This open-source collaborative -- FHIR with Flutter Library Integration (FHIR-FLI) -- is gaining interest and momentum on a national and international scale.

During this virtual panel, the authors will introduce Flutter as a toolkit, live-code basic examples of its use, and provide examples on how it may be utilized for human factors research / projects. Opportunities will exist for group discussion and for direct, targeted examples based on interest.

Faulkenberry, J. G., & Manning, J. D. (n.d.-a). FHIR, A Dart/Flutter package for working with FHIR resources. Github. Retrieved January 13, 2021, from
Faulkenberry, J. G., & Manning, J. D. (n.d.-b). Vigor, a mHealth Platform, utilizing FHIR, written in Dart/Flutter to create transcendent data. Github. Retrieved January 13, 2021, from
Google. (n.d.). Flutter - Beautiful native apps in record time. Flutter. Retrieved January 13, 2021, from
Holden, R. J., Carayon, P., Gurses, A. P., Hoonakker, P., Hundt, A., Ozok, A. A., & A, R.-R. J. (2013). SEIPS 2.0: a human factors framework for studying and improving the work of healthcare professionals and patients. Ergonomics, 56(11), 1669–1686.
Manning, J. D. (2020a, February 12). Flutter 101: How to make health apps in Android/iOS. AMIA.
Manning, J. D. (2020b, November 5). GetFluttered [YouTube]. Youtube.