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Download/View The Meeting at Harvard on a Health Information Technology Platform “ITdotHealth II” — September 10–11, 2012 Executive Summaries Sponsors The 2012 Harvard Meeting on a Health IT Platform September 10-11, 2012 SMART Platforms Table of Contents Session Speakers Page Key Themes from ITdotHealth II Kenneth Mandl 4 Director, Intelligent Health Lab, Boston Children's Hospital Informatics Program; Associate Professor, Harvard Medical School Making EHR Apps Substitutable: Joshua Mandel 6 Theory & Experience Lead Architect, SMART Platforms; Research Faculty, Boston Children's Hospital Informatics Program; Instructor, Harvard Medical School Apps & APIs: Moderator: Brian Athey 8 Innovating With and Around Chair, University of Michigan Medical School, Department of Vendor and Homegrown EHRs Computational Medicine and Bioinformatics; Professor, UM Medical School Presenters: 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: Data, Predictions, and Eric Horvitz 11 Decisions: On Computational Futures Distinguished Scientist & Deputy Managing Director, Microsoft Research for Evidence-Based Healthcare Apps & APIs: Moderator: Isaac Kohane 13 Meeting Customer Demand for Henderson Professor, Harvard Medical School; Director, Boston Children's Physician and Patient Users Hospital Informatics Program; Co-Director, HMS Center for Biomedical Informatics Presenters: 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 Keynote: Clayton Christensen 15 The Future of Healthcare Kim B. Clark Professor of Business Administration, Harvard Business School 2 © 2012 Harvard Medical School Created for SMART by BullsEye Resources The 2012 Harvard Meeting on a Health IT Platform September 10-11, 2012 SMART Platforms Session Speakers Page SMART-Enabled Platforms Moderator: David Kreda 17 Business Translation Consultant, smartplatforms.org Presenters: 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 Christine Park Project Manager, Mirth Corporation Sims Preston CEO, Polyglot Systems Nich Wattanasin Team Leader & Project Manager, i2b2, Partners Healthcare Apps, Meaningful Use, and Moderator: Kenneth Mandl 21 Accountable Care Director, Intelligent Health Lab, Boston Children's Hospital Informatics Program; Associate Professor, Harvard Medical School Presenters: 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 THESE SUMMARIES REFLECT BULLSEYE RESOURCES, INC.’S SUBJECTIVE CONDENSED SUMMARIZATION OF THE 2012 HARVARD HEALTH IT MEETING, AND THERE MAY BE MATERIAL ERRORS, OMISSIONS, OR INACCURACIES IN THE REPORTING OF THE SUBSTANCE OF THE SESSIONS. IN NO WAY DOES SMART, HARVARD MEDICAL SCHOOL OR BULLSEYE RESOURCES ASSUME ANY RESPONSIBILITY FOR THE INFORMATION CONTAINED HEREIN, OR ANY DECISIONS MADE BASED UPON THE INFORMATION PROVIDED IN THIS DOCUMENT. 3 © 2012 Harvard Medical School Created for SMART by BullsEye Resources The 2012 Harvard Meeting on a Health IT Platform September 10-11, 2012 SMART Platforms Key Themes from ITdotHealth II Speaker: Kenneth Mandl, Director, Intelligent Health Lab, Boston Children's Hospital Informatics Program; Associate Professor, Harvard Medical School solutions for these niche use cases. Also, sharing data Overview from EHRs across organizations or with other caregivers (such as pharma-cists) is difficult or nonexistent. Substitutable apps that run across diverse HIT platforms are feasible, as the experience of the first two years of the . The SMART project envisions complementing SMART Platforms project has shown. Several platforms have existing EHRs with SMART containers and apps. become SMART-enabled and several SMART apps that run While proprietary EHRs are well positioned today, as these across HIT platforms have been developed and are now in products improve and eventually become “good enough,” use. The challenge at this time is to scale this concept and a modular architecture is likely to become preferred. broaden adoption. This will create a market and will unleash the creativity of innovative app developers. One key step is There are already many problems for which modular app- building an easy-to-use API, which has been done. lications can provide an elegant solution. Among the Improvements are underway to add write capabilities. examples shared were the BP Centile app and the Diabetes Another important step is to explore forming a SMART con- Monograph. These relatively simple-to-create apps with sortium which would maintain the SMART API standard, compelling user interfaces can easily be integrated with a which will underpin an app store (or stores) for health. provider’s existing EHR and can provide clinicians important data in real time. Context The simplicity and success of the BP Centiles app, where On September 10 and 11, many of the leading thinkers in a prototype that has been enthusiastically embraced by the world of health information technology came together clinicians was created in less than three months, shows to review the role and importance of substitutable apps, to what is possible. discuss a standard that will underpin an “app store” for health, and to determine what actions are required to create Several other apps were described that have been or are an ecosystem for such apps. A few of the key themes are being developed. These presentations showed that substi- summarized below, and summaries of each session follow. tutable apps are feasible and this concept is on its way to becoming a reality. The key challenge is increasing the Key Themes concept’s scale and adoption. Important steps to increasing adoption include: . At this time, EHR vendors have great power and momentum. Adopting the SMART API. The SMART API is the language through which SMART apps talk to SMART- As Professor Clayton Christensen explained, early in the enabled containers. The current API is read only, but development of any new technology, the winners are the adding the ability to write is on the roadmap. An companies that have a proprietary, interdependent archi- important goal is making the SMART API extremely easy tecture. His theory is confirmed by the positions of large to use for developers. One participant posited that vendors such as Epic, Cerner, and Siemens. In the words perhaps 150 core functions are required to make an API of one participant, “Do not bet against the momentum of robust enough. the EHR vendors.” Attracting innovative developers. Just having an API is Several participants acknowledged that at this time, the not enough, as there will be many APIs. The key to EHRs that exist don’t provide rich functionality and that success is having a wealth of exciting, user-friendly EHR vendors generally lack the capability and/or interest applications that solve real-world problems, like the BP to rapidly develop or innovate clinical applications. It is Centiles app. Application developers will be attracted just not a priority for these vendors. Their resources are when there is a market with critical mass and a comm- focused on complying with meaningful use, responding to unity, and when their products can be used broadly. the requests of their customers, and on sales. Polyglot, which won the SMART app challenge, is an example of a small company with a compelling app that As a result, there are neglected specialties (like pediatrics had difficulty getting this app integrated with EHRs. The and oncology) where existing EHRs don’t provide rich SMART API provides a solution. functionality. Most providers lack the resources to design 4 © 2012 Harvard Medical School Created for SMART by BullsEye Resources The 2012 Harvard Meeting on a Health IT Platform September 10-11, 2012 SMART Platforms Having SMART-enabled platforms. In just the past few Benefits of membership would include voting rights on API years, considerable progress has been made in SMART- standards and early looks at API releases. Members would enabling several platforms, such as Indivo and i2b2. also receive information from a members-only website and Containers such as Mirth are SMART-enabled and mailings. Revenue might be generated through tiered vSMART provides a way for providers to connect to dues, grants, sponsorship,
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