Kenneth D Mandl*, Children's Hospital Boston, Harvard Medical School, Boston, United States Joshua C. Mandel, Children's Hospital Informatics Program, Children's Hospital Boston, Harvard Medical School, Boston, United States Shawn N Murphy, Laboratory of Computer Science, Massachusetts General Hospital, Boston, United States Elmer Victor Bernstam, School of Biomedical Informatics, Department of Internal Medicine, THe University of Texas Health Science Center, Houston, United States Rachel L Ramoni, Center for Biomedical Informatics, Harvard Medical School, Boston, United States David D Kreda, Independent Consultant, SMART Platforms Project, Boston, United States J. Michael Mccoy, Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, United States Ben Adida, Mozilla, Mountain View, United States Isaac S. Kohane, Center for Biomedical Informatics, Harvard Medical School, Boston, United States Track: Practice Presentation Topic: other Presentation Type: Oral presentation Submission Type: Single Presentation Building: Joseph B. Martin Conference Center at Harvard Medical School Room: Auditorium Date: 2012-09-15 02:00 PM – 02:45 PM Last modified: 2012-09-11

If you are the presenter of this abstract (or if you cite this abstract in a talk or on a poster), please show the QR code in your slide or poster (QR code contains this URL).

Background. Most vendor electronic health record (EHR) products are architected monolithically, making modification difficult for hospitals and physician practices. An alternative approach is to re-imagine EHRs as iPhone-like platforms that support substitutable apps-based functionality. Substitutability is the capability inherent in a system of replacing one application with another of similar functionality.
Substitutability requires that the purchaser of an app can replace one application with another without being technically expert, without requiring re-engineering other applications that they are using, and without having to consult or require assistance of any of the vendors of previously installed or currently installed applications. A deep commitment to substitutability enforces key properties of a health information technology ecosystem. Because an app can be readily discarded, the consumer or purchaser of these applications is empowered to define what constitutes value in information technology. Apps necessarily compete with each other promoting progress and adaptability.
The Substitutable Medical Applications, Reusable Technologies (SMART) Platforms project seeks to develop a health information technology platform with substitutable apps constructed around core services. It is funded by a $15M grant from Office of the National Coordinator of Health Information Technology’s Strategic Health IT Advanced Research Projects (SHARP) Program. All SMART standards are open and the core software is open source.
Objective. To create a common platform to support an “app store for health” as an approach to drive down healthcare costs, support standards evolution, accommodate differences in care workflow, foster competition in the market, and accelerate innovation.
Methods. The SMART project focuses on promoting substitutability through an application programming interface (API) that can be adopted as part of a “container” built around by a wide variety of health technology platforms, providing read-only access to the underlying data model and a software development toolkit to readily create apps. SMART containers are health IT systems, that have implemented the SMART API or a portion of it. Containers marshal data sources and present them consistently across the SMART API. SMART applications consume the API and are substitutable.
Results. SMART has sparked an ecosystem of apps developers and attracted existing health information technology platforms to adopt the SMART API—including, traditional, open source, and next generation EHRs, patient-facing platforms and health information exchanges. SMART-enabled platforms to date include the Cerner EMR, the OpenMRS EMR, the i2b2 analytic platform, and the Indivo X personal health record. The SMART team is working with the Mirth Corporation, to SMART-enable the HealthBridge and Redwood MedNet Health Information Exchanges. We have demonstrated that a single SMART app can run, unmodified, in all of these environments, as long as the underlying platform collects the required data types.
Conclusion. A platform with substitutable apps constructed around core services has promise for supporting standards evolution and creating an environment for health information technology to dynamically and rapidly evolve. SMART has the potential to create a large market for health care apps, as they can run in multiple environments and on multiple technologies.