ITdotHealth II, 2012


Kenneth Mandl

Co-Director, SMART Platforms
Director, Intelligent Health Lab, Boston Children’s Hospital Informatics Program
Associate Professor, Harvard Medical School

Making EHR Apps Substitutable: Theory & Experience

Joshua Mandel

Lead Architect, SMART Platforms
Research Faculty, Boston Children’s Hospital Informatics Program
Instructor, Harvard Medical School

Apps & APIs: Innovating With and Around Vendor and Homegrown EHRs

Moderator: Brian Athey

Chair, University of Michigan Medical School, Department of Computational Medicine and Bioinformatics
Professor, UM Medical School

Howard Goldberg

Senior Corporate Manager, Partners Health Care
Lecturer, Harvard Medical School

John Halamka

Chief Information Officer, Beth Israel Deaconess Medical Center
Co-Chair, National Health IT Standards Committee
Professor, Harvard Medical School

John Hutton

Director of Biomedical Informatics, Cincinnati Children’s Hospital
Professor, University of Cincinnati College of Medicine

John Mattison

Chief Medical Information Officer, Kaiser Permanente

Keynote Address: “Data, Predictions, and Decisions: On Computational Futures for Evidence-Based Healthcare”

Eric Horvitz

Distinguished Scientist & Deputy Managing Director, Microsoft Research

Apps & APIs: Meeting Customer Demand for Physician and Patient Users

Moderator: Isaac Kohane

Co-Director, SMART Platforms
Henderson Professor, Harvard Medical School
Director, Boston Children’s Hospital Informatics Program
Co-Director, HMS Center for Biomedical Informatics

Stanley Crane

Chief Innovation Officer, Allscripts

Sean Nolan

Chief Architect and General Manager, Microsoft Health Solutions Group

Marc Overhage

Chief Medical Informatics Officer, Siemens Healthcare

Observations from Day 1

Kenneth Mandl

Co-Director, SMART Platforms
Director, Intelligent Health Lab, Boston Children’s Hospital Informatics Program
Associate Professor, Harvard Medical School

Keynote Address: “The Future of Healthcare”

Clayton Christensen

Kim B. Clark Professor of Business Administration, Harvard Business School

SMART-Enabled Platforms

Moderator: David Kreda

Business Translation Consultant, SMART Platforms

Joseph Dal Molin

President, E-Cology Corporation
Chairman, WorldVistA

Travers Franckle

Research Software Engineer, Indivo, Boston Children’s Hospital Informatics Program

Carl Kesselman

Professor, University of Southern California

Daniel Nigrin

Senior VP for Information Services & CIO, Boston Children’s Hospital
Assistant Professor, Harvard Medical School

Sims Preston

CEO, Polyglot Systems

Nich Wattanasin

Team Leader & Project Manager, i2b2, Partners Healthcare

Apps, Meaningful Use, and Accountable Care

Moderator: Kenneth Mandl

Co-Director, SMART Platforms
Director, Intelligent Health Lab, Boston Children’s Hospital Informatics Program
Associate Professor, Harvard Medical School

Ken Majkowski

Vice President of Strategy and Innovation, Surescripts

Joshua Mandel

Lead Architect, SMART Platforms
Research Faculty, Boston Children’s Hospital Informatics Program
Instructor, Harvard Medical School

Shawn Murphy

Medical Director of Research Computing and Informatics, Partners HealthCare Research Computing
Associate Professor, Harvard Medical School
Associate Neurologist Massachusetts General Hospital

Jonathan Perlin

President, Clinical and Physician Services and Chief Medical Officer, Hospital Corporation of America

Claudia Williams

Senior Advisor, Health IT at White House Office of Science and Technology Policy

ITdotHealth II montage - click to enlarge
The concept of substitutable apps has become a reality, as multiple examples illustrate—such as the blood pressure app, now in live clinical use on the Cerner System at Boston Children’s Hospital:

  • Compelling, useful health care apps can be developed relatively quickly and inexpensively.
  • There is interest in the idea of an “app store for health.” Some EMR companies have been exploring this idea.
  • A focus on developers is key: make app development easy.
  • Tremendous progress has been made in the development of the SMART platform, with many success stories and organizations adopting/using.
  • Integrating apps with EHRs is difficult and time consuming. (At Boston Children’s Hospital, an app was developed in 8 weeks; integrating with the EHR took 11 months.)
  • There was great enthusiasm for the SMART platform and for SMART apps—the SMART platform is part of creating a new ecosystem in health care.
  • Major organizations committed to explore establishing a consortium to support the SMART API as a robust interface between health system data and an ecosystem of apps.

Key ingredients for success

  • Encouragement to accelerate adoption of the SMART platform, particularly among the many EHR vendors
  • Getting many more apps developed (developers go where critical mass and opportunity are)
  • Making apps not just read-only, but with writing capability
  • Creating a common API
  • Creating a common UI; if too many different apps with different UI’s, will cause confusion
  • Ensuring privacy and security
  • Having data available during development for testing

Clay Christensen, in his keynote address, shared the following:

  1. Technological innovations cause industries from being centralized to decentralized. Centralization means a technology (like mainframes) is used only by those with skill and money; decentralization results in simpler, lower cost technologies used by more people. Health care is centralized, with care in hospitals. Technology needs to be used so care can be delivered in lower cost venues by lower skilled labor.
  2. Industries evolved from vertically integrated to modular. Early on a company must do everything (think Ford in the early days, which made its own steel). As a technology matures and exceeds customers’ expectations, the architecture becomes modular and the component makes (like Intel) capture the value. Currently, EHRs are closed systems; they aren’t modular or open.
  3. Don’t just market products to people with certain attributes. Understand the “jobs” that people need to get done and develop a product/service they will hire to do their job.

Eric Horvitz, in his keynote address, emphasized these points:

  1. Data from electronic health records can and is beingaggregated, used to make predictions (like which patients are most likely to be readmitted to a hospital within 30 days), and drive decisions are interventions. (Participants suggested that while CMS plans to penalize hospitals with high readmission rates for delivering inadequate quality, the quality of care may not be the key driver of readmission; it may be social,economic, and personal factors.)
  2. As a result of the capability, Eric Horvitz articulated a vision of a “General Predictive Platform.”
  3. As a result, decision support will become more sophisticated – always running in the background and always predicting.
  4. Apps will be developed that look at data for anomalous events.

Download/view a PDF of the meeting’s program book

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Here’s what I suggested…