Smart-Indivo App Challenge Webinar

SMART-Indivo App Challenge

Webinar Presentation

Tuesday, August 7

On today’s call:

Adam Wong

Management and Program Analyst

ONC

Hemali Thakkar

Manager, Developer Challenge

Health 2.0

Nikolai Schwertner

Lead Software Engineer

SMART

Kenneth Mandl

Director

Boston Children’s Hospital Intelligent

Health Lab

Pascal Pfiffner

Postdoctoral Fellow

SMART

Agenda for Today’s Meeting

ONC and the Investing in Innovation (i2) Program

An Introduction to the SMART-Indivo Challenge

Q&A About the Challenge

ONC and i2

i2 Goals

• Better Health, Better Care, Better Value through Quality Improvement• Further the mission of the Department of Health and Human

Services • Highlight programs, activities, and issues of concern

• Spur Innovation and Highlight Excellence • Motivate, inspire, and lead

• Community building – Development of ecosystem

• Stimulate private sector investment

Indivo and Personal Health Platforms

• Portals:–A static view into the EHR

• PCHRs: –Apps platform, and a patient copy of the data

Ecosystem

SUBSCRIBEThe Verbs of PCHR

New Approaches to Data Liquidity

SHAREThe Verbs of PCHR

VA Survey• 79% of Veterans are willing to share personal health

information with those outside their health system–62% with a spouse or partner–23% with a child–15% with another family member–25% with a non-VA health care provider

ADD AN APPThe Verbs of PCHR

“We cannot overstate how important PHRs are to the efficient functioning of a low-cost, high quality health-care system . . . . We think that the INDIVO system, or something like it is a good place to start.”--Clayton Christensen Harvard Business School

http://commonhealth.wbur.org/2011/07/killed-google-health

• Trust issues

• No app developers• No data

The App Store for Health

ONC Funded Research Project under the

“SHARP” program

We imagine EMRs as an iPhone-like platform where an innovator can create and widely distribute an app

across many disparate EMRs and PHRs

An

Inspired Design

from Dave McCandless

(cc license)

1 Design + 1 Developer + 1 Week

1 Developerin1 Week

EHR as an “iPhone-like” Platform

23

SMARTBP Centiles App

Running on Cerner

ARCHITECTURE OVERVIEW

Apps

Containers

API

Vocabulary

SMART Components

UI Standards-based integration, flexibility

Authentication In-browser, server-to-server

Data Context, Medical Record Elements

Apps need

Container UI

Each container implements a consistentmechanism for delegating access: OAuth.

The app only needs to speak OAuth.

Authentication

SMART data

80/20 approach concentrate on common outpatient data

Consistent coding systems

Medications: RxNorm (SCD, SBD, Packs)Problems: SNOMED CTLabs: LOINC

Extensible representations in RDF

Architecture Summary

SMART Containers supply Apps with UI integration Authenticated API Access Data

Containers shoulder significant responsibility!

Data models are critical to enable app developers Keeping developer experience in mind Data need to be predictable, (relatively) simple

Indivo and SMARTWhat SMART adds to Indivo• Standardized Application Programming Interface

that can run across diverse instances of health information technology

• SMART app developed for an EHR can run unmodified on Indivo. Or, can be tweaked for a patient-facing experience

• The Indivo data model will continue to track the evolution of the SMART standard

Indivo and SMARTWhat Indivo adds to SMART

• Rich write capability

• Consumer-facing features including authentication, carenets/sharing, and auditing

• Consumer-facing data-types which are not yet ratified as part of the SMART model

• Indivo apps can be either purely SMART-compliant or take advantage of hybrid functionality, with graceful degredation to SMART compliance in non-Indivo containers

Indivo iOS

framework

• Handles authentication (OAuth)

• Provides Indivo objects (automatic XML handling)

• Knows where an object comes from (REST paths)

• Provides messaging functionality

Makes your life easy™

The iOS Framework

Abstract logic into Cocoa objects

Server Record

addDocumentOfClass:

fetchReportsOfClass:

selectRecord:

Docspush:

replace:

archive:

...

Basic Approach

Setup

App Flow

#define kIndivoFrameworkServerURL @“http://10.17.20.127:8000”#define kIndivoFrameworkUIServerURL @“http://10.17.20.127:8001”

#define kIndivoFrameworkAppId @“[email protected]”#define kIndivoFrameworkConsumerKey @“nkd8cg02mgo34sntkao9”#define kIndivoFrameworkConsumerSecret @“1acgk9804wkmraoceu02”

server = [IndivoServer serverWithDelegate:self];

Logging in

App Flow

[server selectRecord:^{ }];

server.activeRecord

Adding a medication

App Flow

Medication *med = [record addDocument:Medication];

[med push:^{ }];

med.drugName = [INCodedValue new];

med.drugName.title = @“Tylenol”;

med.drugName.system ...

Sending a message

App Flow

[med.activeRecord sendMessage:@“New medication added”

withBody:@“See medlist app”

ofType:INMessageTypePlaintext

severity:INMessageSeverityMedium

attachments:nil

callback:^{ }];

Documentation

• Take a look at README.md

• Checkout the sample medication app

• Technical documentation available online:

• http://docs.indivohealth.org/projects/indivo-x-ios-framework/en/latest/

Playing with Medications

Portal-PCHR Hybrid• SMART Platform Apps

Have access to EHR data in a vendor agnostic fashion (from an Epic system, a Cerner system, or an complementary system with data warehoused from the EHR)

• So, one can readily create a patient facing portal, which is an apps platform

SMART

EHREHR

SMART

IndivoIndivoConnector App

Connector App

Clinician-Facing Apps

Clinician-Facing Apps

Patient-Facing Apps

Patient-Facing Apps

The best of both worlds: •A local portal, with lots of data from the EHR•A personal health platform with patient control, sharing, and apps

Portal-PCHR Hybrid

The Challenge:

“Build an Indivo app that provides value to patients using data delivered through the

SMART API and its Indivo-specific extensions”

•These should be patient facing web or mobile apps, and run against the Indivo Developer Sandbox•They should be of importance to clinical medicine or public health•Examples include: a medication manager, a health risk detector, a patient-friendly laboratory visualization tool, or an app that integrates external data sources with patient records in real time.

Resources

•Indivo:

•http://indivohealth.org/smart-indivo-app-challenge

•http://docs.indivohealth.org

•http://sandbox.indivohealth.org

•https://github.com/chb/IndivoFramework-ios

•http://www.youtube.com/watch?v=qNWujzx46bI

•SMART

•http://smartplatforms.org

Judging Criteria

1. Usefulness to patients

2. Importance to clinical medicine or public health

3. Interface and presentation

4. Use of the Indivo and SMART APIs

5. Creative use of data from the sandbox and (optionally) from open health data sources

Timeline

Submission Period EndsSeptember 28, 2012

Winner NotifiedOctober 18, 2012

For More Information

http://www.health2challenge.org

Contact Hemali:

[email protected]