The 2017 ITdotHealth IV—SMART Decisions meeting, hosted by The Computational Health Informatics Program and Harvard Medical School Department of Biomedical Informatics, was attended by leaders across healthcare interested in driving AI and genomic medicine into the decision making process at the point of care, through the evolving connected apps ecosystem. Senator Bill Cassidy and Congressman Michael Burgess opened the meeting, reinforcing the importance of the open API language we worked with them on getting into the 21st Century Cures Act last year. We heard from two extraordinary keynote speakers—the renowned surgeon and writer Atul Gawande, and Jeffrey Dean, one of Google’s most influential engineers since 1999, and co-founder of Google Brain. Dr. Don Rucker, the national coordinator for health information technology, confirmed that interoperability and open APIs are at the top of the list of priorities at the ONC.
ITdotHealth brings together a community of leaders in health, policy, & technology that can steer a national conversation. We introduced the idea of a standard healthcare API in a 2009 paper in the New England Journal of Medicine suggesting that electronic health record systems should look a lot more like an iPhone than they currently did. The iPhone and Android platforms separate the system from the functionality provided by the applications. And the applications are substitutable: a consumer can download a calendar reminder system, reject it, and download another one instead. The consumer is committed to the platform, but the applications compete on value and cost.
With a $15M grant from HHS, we have developed a model for such a system—SMART Health IT, described in technical detail here, from which we have learned important lessons about the technical, regulatory, and business implications of this transformative and rapidly evolving trend. Because of SMART Health IT, an app written one time, can now run widely in healthcare, including at leading institutions including Duke Medical Center, Intermountain Healthcare, Partners Healthcare, Geisenger, and Boston Children’s Hospital. A critical difference between SMART apps and the tens of thousands of apps in the Google and Apple stores, is that SMART on FHIR apps are built into the workflow of clinicians and patients at home, and have full access to health system data to drive functionality including decision support. The the 21st Century Cures Act, just passed by Congress, has instantiated this core principle requiring that APIs that provide access to all data elements of a patient’s electronic health record.
Top EHR vendors are implementing SMART through a project called Argonaut. The CMS meaningful use stage three regulations require a SMART-like API for patients to download their own data. The All of Us initiative is promoting Sync for Science, a SMART extension enabling patients to connect an app to an EHR to download and direct their data to the project. SMART is supporting the ecosystem in developing standardized protocols for launching third party decision support services and associated apps from within HIT workflows (CDS-Hooks). HHS made a grant to our team resulting in the recent launch of an updated SMART App Gallery, also serving FHIR.org
Download the full meeting program
June 26, 2016
- Distinguished Keynote Panel, Senator Bill Cassidy and Representative Michael Burgess
- SMART Extensions: SYNC for Science, CDS Hooks, Josh Mandel
- The last Mile: Delivering apps and services to the point of care
- Current State: Native EHR API Capabilities and Business Models
- Tools and services for marshaling data at scale
- Moderator: Andy Palmer, Koa Labs, Tamr
- William Crawford, Fitbit
- Len D’Avolio, Cyft
- Shawn Murphy, Partners Healthcare
- Jason O’Meara, Quest Diagnostics, LLC
- John Shon, Illumina
June 27, 2016
- Open or shut case? Open standards in commercial systems
- The Role of consensus, law and regulation
- Moderator: Ken Mandl, Boston Children’s Hospital
- Aneesh Chopra, Nav Health
- Natalie Kates, Digital Health Service
- Donald Rucker, ONC
- John Wilbanks, Sage Bionetworks
- Hooks for Decision Support. Can we get there fast?
- Preparing the Enterprise
- Moderator: Arnaub Chatterjee, McKinsey & Company
- Charles Bach, Kaiser Permanente
- James Buntrock, Mayo Clinic
- Keith Dreyer, Partners Healthcare
- Alistair Erskine, Geisinger Health System
- William Gregg, HCA
- Adam Landman, Partners Healthcare
- Hiten Patel, Advisory Board Company
- Closing Keynote, Atul Gawande
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