sharp area 3: smart (substitutable medical apps)
DESCRIPTION
SHARP Area 3: SMART (Substitutable Medical Apps). Josh C. Mandel, MD [email protected] Lead Architect, SMART (http://smartplatforms.org) Research Faculty, Harvard Medical School Sharp Area 4 Face-to-face, July 1 2011. SMART goals. Health IT users work with - PowerPoint PPT PresentationTRANSCRIPT
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SHARP Area 3: SMART(Substitutable Medical Apps)
Josh C. Mandel, [email protected] Architect, SMART (http://smartplatforms.org)Research Faculty, Harvard Medical School
Sharp Area 4 Face-to-face, July 1 2011
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SMART goals
Health IT users work withinstallable, substitutable apps
Health IT systems benefit fromefficient marketplace of appsvibrant developer community
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Why substitutable apps?Improved user experienceMore integrated innovation
Case study: Wired competition
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Why substitutable apps?Improved user experienceMore integrated innovation
Case study: Wired competition
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Why substitutable apps?
David McCandless &Stefanie Posavec for Wired Magazine informationisbeautiful.net
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Vocabulary
Apps
Containers
API
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Vocabulary
Containers
Apps
API
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A Substitutable App
Your system here.
SMART Reference EMR
Indivo PCHR
i2b2
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Vocabulary
Containers
Apps
API
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SMART $5K Challenge
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SMART $5K Challenge
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An app runs against one container (at a time)
A container connects to multiple data sources
Apps and containers
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SMART components
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SMART components
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SMART components
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SMART components
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Web standards!
Apps can run on separate servers,different implementation stacks
Inspired by Web APIsFacebook, OpenSocial, Google
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Data Context, Medical Record Elements
UI Standards-based integration, flexibility
Authentication In-browser, server-to-server
Apps need (at least!)
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Contextual data (patient, physician) low-hanging fruit
Medical data (blood pressure, cholesterol)
existing standards? pragmatic approaches?
Apps need data!
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Open standards?
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CCR: “Licensee may access and download an electronic file of a Document (or portion of a Document) for temporary storage on one computer for purposes of viewing, and/or printing one copy of a Document for individual use. Neither the electronic file nor the single hard copy print may be reproduced in any way.”
Open standards?
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Intuitive payload?
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What’s practical?
PCHRs provide practical data models
Indivohttp://wiki.indivohealth.org/index.php/Indivo_Document_Model
MS HealthVault Data Types:http://developer.healthvault.com/types/types.aspx
Google Health Subset of CCR:http://code.google.com/apis/health/ccrg_reference.html
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SMART data
80/20 approach concentrate on common outpatient data
Payloads specified down to coding systems e.g. SNOMED for problems
Extensible representations in RDF iterative design, building models over time
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Data elements
Sample SMART Problem (RDF)<sp:Problem> <sp:problemName> <sp:CodedValue> <sp:code rdf:resource="http://www.ihtsdo.org/snomed-ct/concepts/161891005"/> <dcterms:title>Backache (finding)</dcterms:title> </sp:CodedValue> </sp:problemName> <sp:onset>2007-06-12</sp:onset> <sp:resolution>2007-08-01</sp:resolution> </sp:Problem>
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Data principles
REST Paradigm:Each patient, data element has a URI
John Smith: http://smart-emr.hospital.org/records/123
John Smith’s atorvastatin: http://smart-emr.hospital.org/records/123/medications/456
URIs can map to underlying EMR IDs
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Data principles
Consistent coding systems
Medications: RxNorm (SCD, SBD, Packs)Problems: SNOMED CTLabs: LOINC
Containers may need to translate from other terminologies, with provenance
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Data principles
Consistent coding systemsExample of a translated LOINC code
Medications: RxNorm (SCD, SBD)Problems: SNOMED CTLabs: LOINC
Containers may need to translate from other terminologies, with provenance
<sp:labName> <sp:CodedValue> <sp:code rdf:resource="http://loinc.org/codes/2951-2"/> <dcterms:title>Serum sodium</dcterms:title> <sp:codeProvenance> <sp:CodeProvenance> <sp:sourceCode rdf:resource="http://local-emr/labcodes/01234" /> <dcterms:title>Random blood sodium level</dcterms:title> <sp:translationFidelity rdf:resource="http://smartplatforms.org/terms/code/fidelity#automated" /> </sp:CodeProvenance> </sp:codeProvenance> </sp:CodedValue> </sp:labName>
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Data principles
Consistent coding systemsExample of a translated LOINC code
Medications: RxNorm (SCD, SBD)Problems: SNOMED CTLabs: LOINC
Containers may need to translate from other terminologies, with provenance
<sp:labName> <sp:CodedValue> <sp:code rdf:resource="http://loinc.org/codes/2951-2"/> <dcterms:title>Serum sodium</dcterms:title> <sp:codeProvenance> <sp:CodeProvenance> <sp:sourceCode rdf:resource="http://local-emr/labcodes/01234" /> <dcterms:title>Random blood sodium level</dcterms:title> <sp:translationFidelity rdf:resource="http://smartplatforms.org/terms/code/fidelity#automated" /> </sp:CodeProvenance> </sp:codeProvenance> </sp:CodedValue> </sp:labName>
source
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Data principles
Consistent coding systemsExample of a translated LOINC code
Medications: RxNorm (SCD, SBD)Problems: SNOMED CTLabs: LOINC
Containers may need to translate from other terminologies, with provenance
<sp:labName> <sp:CodedValue> <sp:code rdf:resource="http://loinc.org/codes/2951-2"/> <dcterms:title>Serum sodium</dcterms:title> <sp:codeProvenance> <sp:CodeProvenance> <sp:sourceCode rdf:resource="http://local-emr/labcodes/01234" /> <dcterms:title>Random blood sodium level</dcterms:title> <sp:translationFidelity rdf:resource="http://smartplatforms.org/terms/code/fidelity#automated" /> </sp:CodeProvenance> </sp:codeProvenance> </sp:CodedValue> </sp:labName>
source
SMART translation
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Data challenges
Different coding systems e.g. for medications, NDC RxNorm e.g. for problems, ICD9 SNOMED CT (?)
Different models e.g. is a problem event-at-a-time, or duration?
No models – can’t expose data you don’t have. (but some may be worth storing, e.g., fulfillments)
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SMART governance
Open specifications, documentationOpen-source reference implementationOpen-source client libraries
Apps and Containers needn’t be open-source(promote a commercial ecosystem)
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Translation / Integration efforts• CHB’s Cerner• OpenMRS• HealthVault, Indivo• i2b2
Exploring• Extended data models• Integration of CDS• Mobile apps + containers
Ongoing projects
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Cross-SHARP sharing of:• sample data• logical models
Collaboration around• integrating SHARPN functionality as
SMART apps (e.g. CTAKES pilot)• extracting patient record data
Other opportunities?
Discussion topics!
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Questions?
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Container UI
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Container UI
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Container UI
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Container UI
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Health IT systems have different authentication mechanisms!
How to keep apps agnostic?
Each container implements a consistentmechanism for delegating access: OAuth.
The app only needs to speak OAuth.
AuthenticationAuthentication
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App distribution model?
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App distribution model?Light, test-driven certification as SMART
Independent groups may endorse apps
Individual containers install selected apps(local arrangements, e.g. contractual terms)
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App distribution model?