App Store for EHRs and Patients Both

Travers Franckle, MS1, Daniel Haas, BS1, Kenneth D. Mandl, MD, MPH1
1

Children'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 medicalrecord 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

API

Containers

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

Genomics Advisor

BP Centiles

Pediatric Growth Chart

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 Experience

Cardiac Risk

SMART Apps Across Containers

Cardiac Risk App

Cardiac Risk

SMART Reference Container

i2b2

Indivo

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

Architecture
Indivo
SMART Apps SMART API SMART Medical Data Models

Hybrid Apps

Write Sharing Admin

Uniquely Indivo Data Models

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>

Legacy Indivo Problem XML

<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

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