Clinical summary export: What is a CCD for?

At last week’s Redwood MedNet HIE Conference, I had the chance to attend an “Interoperability Exhibition” demonstrating the data exchange capabilities of several EHRs. Two themes emerged around clinical summary export. I’ll focus on CCDs (Continuity of Care Documents), but the themes apply to CCRs (Continuity of Care Records) as well:

  1. “What is a CCD for?” Providers use EHRs to generate the patient summary records they share with patients and other providers. But it’s unclear what (exactly) should go into these documents, and whether/how the provider should have a say.
  2. “Where are the codes?” Even though certified EHR products are capable of generating CCDs with appropriate codes (LOINC-encoded labs, for instance), this doesn’t mean that providers’ systems are configured to do so. The demonstrations I saw exchanged CCDs with uncoded labs!

Today’s post focuses on #1. In a future post, I’ll investigate the interplay between certification and meaningful use to understand where LOINC codes disappear to.

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“CCD export” doesn’t solve interoperability

Meaningful Use mandates CCD export from EMRs. Here are some reasons why we’re still querying database tables and calling vendor-specific web services to extract the data we need to fuel apps.

At yesterday’s Health 2.0 conference, Farzad Mostashari asked why SMART isn’t using CCD export (as specified by Meaningful Use) to extract data from EMR systems. This is a great question, in part because it separates out two important aspects of SMART:

  1. Getting data out of today’s EHRs
  2. Presenting those data to apps in a natural, convenient, developer-friendly way.

—and focuses on #1. (I don’t think many would argue that CCD is fit for #2. And to be clear: for developers building a SMART app, the details of #1 are almost irrelevant. SMART app developers get one clear-cut API to work with, and consistent SMART data elements)

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SMART Preview Release v0.3

The SMART team has published a new preview release (v0.3) of the SMART platform. With this release, we are rolling out a number of API changes incorporating feedback from the $5K challenge, simplifying some of the infrastructure, and adding some new data types.

The SMART team has published a new preview release (v0.3) of the SMART platform. With this release, we are rolling out a number of API changes incorporating feedback from the $5K challenge, simplifying some of the infrastructure, and adding some new data types. We have already updated the public sandbox with the v0.3 code, as well as the developer’s guide.

One of the main changes with v0.3 is that SMART apps are no longer required to have a bootstrap.html. The apps are now launched directly from index.html with the oauth tokens passed as a get parameter. For a more complete run-down on updating your SMART application code, please see: http://wiki.chip.org/smart-project/index.php/Developers_Documentation:_Changelog

We are looking forward to hearing your thoughts and suggestions about the new release.

SMART + OpenMRS: Google Summer of Code

OpenMRS has been funded for its fifth consecutive Google Summer of Code!

Among a host of exciting projects, SMART is working with OpenMRS to propose:

Enabling SMART Apps in OpenMRS

How SMART addresses the PCAST Report on Health IT

A couple of months ago, The President’s Council of Advisors on Science and Technology issued its Report to the President on Realizing the Full Potential of Health Information Technology to Improve Healthcare for Americans. We want to tell you how SMART fits in.
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Tutorials: RDF and SPARQL

SMART apps receive patient data in RDF graphs that contain a set of assertions or “triples” such as:
{ <John Smith> <is-taking> <lipitor> }

We think RDF is a flexible and elegant way to represent all kinds of data.  But we recognize that RDF and SPARQL (a query language for RDF graphs) aren’t regular items in every Web developer’s toolkit. To help SMART developers get up to speed, we’ve written a pair of tutorials on our wiki:

  1. Quick Introduction to RDF and SPARQL:  Explains the basics of how RDF represents information as triples.
  2. SPARQL Examples for SMART:  Provides a live, hands-on interface to query sample SMART data from the reference container.

Please have a look, try out the live query tools, and let us know what you think!

Health 2.0

The fourth annual Health 2.0 conference is abuzz about “unplatforms” — loose collections of liquid data services and interlinked apps that allow for mix-ins, mash-ups, and rapid innovation. The unplatform is “un” becaues it doesn’t rely on a central service, repository, or framework. Instead, it’s a frothy milieu of various data and services: in other words, all right ingredients for apps to emerge.
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Resources from Developers Meeting

We now have several resources that were created and used for our developers meeting available.
SMART Architecture Slideshow
SMART Governance Slideshow
SMART Demo Screencast

SMART Developers Meeting Attended by 60+ People

On August 26th, we had our first Developer’s Meeting here at the SMART headquarters at the Center for Biomedical Informatics in the Countway Library of Medicine. Over 60 academic, vendor, and government representatives participated in the event. The conversation was so lively that we were shushed by one of the librarians, which we took to be a good sign. The presentations made by Ben Adida, our lead architect, and Josh Mandel, our lead developer, may be found here. If you would like to participate in one of our upcoming events, please let us know.