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
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