App Store for EHRs and Patients Both

Travers Franckle, MS1, Daniel Haas, BS1, Kenneth D. Mandl, MD, MPH1

1Children's Hospital Informatics Program at Harvard-MIT Health Sciences and Technology, Boston Children's Hospital, Boston, Massachusetts, USA

"SMART provides a unified mechanism for diverse applications to interact with medical-

record data."

● 15 million dollar grant from ONC to build an App Store for health

● Defines an API that enables developers to create substitutable apps

● Implemented on○ Cerner Millennium at Boston Children's Hospital

○ Allscripts

○ i2b2

○ WorldVistA

○ OpenMRS

○ Mirth Results

SMART Vocabulary

Apps

Containers

API

SMART Data

● 80/20 Approach ○ Concentrate on common outpatient data

● Consistent Coding Systems○ Medications: RxNorm

○ Problems: SNOMED CT

○ Labs: LOINC

● Extensible representations in RDF

SMART Apps for the EHR

Pediatric Growth ChartBP CentilesGenomics Advisor

● Optimized for clinical environments

SMART Apps for the EHR

● Consumer friendly

explanation of the Reynolds

Risk Score

● Based on a Creative Commons

design by David McCandless

● Interactive ExperienceCardiac Risk

SMART Apps Across Containers

Cardiac Risk

i2b2SMART Reference Container

Indivo

Cardiac Risk App

SMART Apps for the Personal Health Record

● Bringing health information directly to the patient

for ● Information reconciliation

● Medication information

● Medical problems

● Lab results

● Growth and development

Indivo

● Personally Controlled Health Record

● Focus on patient-facing apps

● Open-source

History of Indivo

Goals of SMART-enabling Indivo

● SMART apps running against Indivo

● Standardize on SMART API and data models

● Apps that are sharable across EHR and PHR

environments

● Hybrid apps that can take advantage of Indivo's rich

write API

ArchitectureIndivo

Write

Sharing

Admin

SMART Apps

Hybrid Apps

SMARTMedical

DataModels

UniquelyIndivoData

Models

SMARTAPI

Challenge: RDF & Serialization<Problem xmlns="http://indivo.org/vocab/xml/documents#"> <dateOnset>2009-05-16T12:00:00</dateOnset> <dateResolution>2009-05-16T16:00:00</dateResolution> <name type="http://codes.indivo.org/problems/" value="123">Backache</name> <comments>backache</comments> <diagnosedBy>Dr. Mandl</diagnosedBy></Problem>

<sp:Problem rdf:about="http://sandbox.indivohealth.org/records/2169591/problems/961237"> <sp:belongsTo rdf:resource="http://sandbox.indivohealth.org/records/2169591" /> <sp:problemName> <sp:CodedValue> <dcterms:title>Backache (finding)</dcterms:title> <sp:code> <spcode:SNOMED rdf:about="http://purl.bioontology.org/ontology/SNOMEDCT/161891005"> <rdf:type rdf:resource="http://smartplatforms.org/terms#Code" /> <dcterms:title>Backache (finding)</dcterms:title> <sp:system>http://purl.bioontology.org/ontology/SNOMEDCT/</sp:system> <dcterms:identifier>161891005</dcterms:identifier> </spcode:SNOMED> </sp:code> </sp:CodedValue> </sp:problemName> <sp:startDate>2007-06-12</sp:startDate> <sp:endDate>2007-08-01</sp:endDate></sp:Problem>

SMART Problem RDF/XML

Legacy Indivo Problem XML

Challenge: Updating

● Indivo UI

● Existing Apps

● Documentation

Next Steps

● Track the SMART standard

● Enhance existing SMART apps for Indivo

● Indivo in the CTSA Ecosystem○ i2b2 integration

○ REDCap Surveys integration

○ Consent management

○ Patient controlled access of external data sources