SHARP Area 3: SMART - PowerPoint Presentation

Slide1

SHARP Area 3: SMART(Substitutable Medical Apps)

Josh C. Mandel, MDJoshua.Mandel@childrens.harvard.eduLead Architect, SMART (http://smartplatforms.org)Research Faculty, Harvard Medical SchoolSharp Area 4 Face-to-face, July 1 2011Slide2

SMART goals

Health IT users work with installable, substitutable apps

Health IT systems benefit from

efficient

marketplace

of apps

vibrant

developer communitySlide3

Why substitutable apps?

Improved user experienceMore integrated innovation

Case study

: Wired competitionSlide4

Why substitutable apps?

Improved user experienceMore integrated innovation

Case study

: Wired competitionSlide5

Why substitutable apps?

David

McCandless

&

Stefanie

Posavec

for

Wired Magazine

informationisbeautiful.netSlide6

Vocabulary

Apps

Containers

APISlide7

Vocabulary

Containers

Apps

APISlide8

A Substitutable App

Your system here.

SMART Reference EMR

Indivo

PCHR

i2b2Slide9

Vocabulary

Containers

Apps

APISlide10

SMART $5K ChallengeSlide11

SMART $5K ChallengeSlide12

An app runs against

one container (at a time)A container connects to multiple data

sources

Apps

and

containersSlide13

SMART componentsSlide14

SMART componentsSlide15

SMART componentsSlide16

SMART componentsSlide17

Web standards!

Apps can run on separate servers,different implementation stacks

Inspired by

Web APIs

Facebook

,

OpenSocial

, GoogleSlide18

Data Context, Medical Record Elements

UI Standards-based integration, flexibilityAuthentication

In-browser, server-to-server

Apps need

(

at least!

)Slide19

Contextual

data (patient, physician)  low-hanging fruitMedical data

(blood pressure, cholesterol)

existing standards?

pragmatic approaches?

Apps

need data!Slide20

Open standards

?Slide21

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Open standards?Slide22

Intuitive payload?Slide23

What’s practical?

PCHRs provide practical data models

Indivo

http://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.htmlSlide24

SMART

d

ata

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 timeSlide25

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

>Slide26

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 IDsSlide27

Data principles

Consistent coding systems

Medications:

RxNorm

(SCD, SBD, Packs)

Problems:

SNOMED CT

Labs:

LOINC

Containers may need to

translate

from other terminologies, with provenanceSlide28

Data principles

Consistent coding systems

Example of a translated LOINC code

Medications:

RxNorm

(SCD, SBD)

Problems:

SNOMED CT

Labs:

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

>Slide29

Data principles

Consistent coding systems

Example of a translated LOINC code

Medications:

RxNorm

(SCD, SBD)

Problems:

SNOMED CT

Labs:

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

>

sourceSlide30

Data principles

Consistent coding systems

Example of a translated LOINC code

Medications:

RxNorm

(SCD, SBD)

Problems:

SNOMED CT

Labs:

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 translationSlide31

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)Slide32

SMART

g

overnance

Open

specifications

, documentation

Open-source

reference

implementation

Open-source

client

libraries

Apps and Containers

needn’t be

open-source

(promote a commercial ecosystem)Slide33

Translation

/ Integration efforts CHB’s Cerner

OpenMRS

HealthVault

,

Indivo

i2b2

Exploring

Extended data models

Integration of CDS

Mobile apps + containers

Ongoing

projectsSlide34

Cross-SHARP sharing

of:sample datalogical models

Collaboration around

integrating SHARPN functionality as SMART

apps

(e.g. CTAKES pilot)

extracting patient record

data

Other opportunities?

Discussion topics!Slide35

Questions?Slide36

Container UISlide37

Container UISlide38

Container UISlide39

Container UISlide40

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

.

Authentication

AuthenticationSlide41

App distribution model?Slide42

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)Slide43

App distribution model?