Smart-Indivo App Challenge Webinar

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  • Ask about users of Microsoft’s HealthVault framework
  • Talk about objects Walk through these three objects
  • Hint at the callback block
  • addDocumentOfClass: IndivoMedication
  • If you tell a medication to replace another one, it has all the information it needs to create the correct REST method (if you tell it which medication to replace)
  • Providing education and resources to help reduce fat and salt intake, increase exercise, lose weight, stop smoking, or increase medication adherence (e.g., to improve control of high blood pressure) Using GPS technology to recommend nearby walks or places to eat healthier Recommending to the high risk patient to see a primary care doctor if not on aspirin or cholesterol-lowering medication Linking to online communities dedicated to improving heart health


  • 1. SMART-Indivo App Challenge Webinar Presentation Tuesday, August 7
  • 2. On today’s call: Hemali Thakkar Kenneth Mandl Nikolai Schwertner Pascal Pfiffner Adam Wong Manager, Developer Director Lead Software Postdoctoral FellowManagement and Engineer ChallengeProgram Analyst Boston Children’s Hospital Intelligent SMART ONC SMART Health 2.0 Health Lab
  • 3. Agenda for Today’s MeetingONC and the Investing in Innovation (i2)ProgramAnIntroduction to the SMART-IndivoChallengeQ&A About the Challenge
  • 4. ONC and i2
  • 5. i2 Goals• Better Health, Better Care, Better Value through Quality Improvement • Further the mission of the Department of Health and Human Services • Highlight programs, activities, and issues of concern• Spur Innovation and Highlight Excellence • Motivate, inspire, and lead• Community building – Development of ecosystem• Stimulate private sector investment
  • 6. Indivo and Personal Health Platforms• Portals: –A static view into the EHR• PCHRs: –Apps platform, and a patient copy of the data
  • 7. Ecosystem
  • 8. The Verbs of PCHRSUBSCRIBE
  • 9. New Approachesto Data Liquidity
  • 10. The Verbs of PCHRSHARE
  • 11. VA Survey• 79% of Veterans are willing to share personal health information with those outside their health system –62% with a spouse or partner –23% with a child –15% with another family member –25% with a non-VA health care provider
  • 12. The Verbs of PCHRADD AN APP
  • 13. “We cannot overstate howimportant PHRs are to theefficient functioning of a low-cost, high quality health-caresystem . . . . We think that theINDIVO system, or somethinglike it is a good place to start.”--Clayton Christensen Harvard Business School
  • 14. • Trust issues • No app developers • No data
  • 15. The App Store for HealthONC Funded Research Project under the “SHARP” program
  • 16. We imagine EMRs as an iPhone-like platform wherean innovator can create and widely distribute an app across many disparate EMRs and PHRs
  • 17. A en sign ss D andle ir ed cC sp e M e) In av D lice nsfrom (cc
  • 18. 1 Design + 1 Developer + 1 Week 1 De v el o per in 1W eek
  • 19. EHR as an “iPhone-like” Platform
  • 20. SMART BP Centiles AppRunning on Cerner 23
  • 22. VocabularyAppsAPIContainers
  • 23. SMART Components
  • 24. Apps needUI Standards-based integration, flexibilityAuthentication In-browser, server-to-serverData Context, Medical Record Elements
  • 25. Container UI
  • 26. AuthenticationEach container implements a consistentmechanism for delegating access: OAuth.The app only needs to speak OAuth.
  • 27. SMART data80/20 approach concentrate on common outpatient dataConsistent coding systems Medications: RxNorm (SCD, SBD, Packs) Problems: SNOMED CT Labs: LOINCExtensible representations in RDF
  • 28. Architecture SummarySMART Containers supply Apps with UI integration Authenticated API Access DataContainers shoulder significant responsibility!Data models are critical to enable app developers Keeping developer experience in mind Data need to be predictable, (relatively) simple
  • 29. Indivo and SMARTWhat SMART adds to Indivo• Standardized Application Programming Interface that can run across diverse instances of health information technology• SMART app developed for an EHR can run unmodified on Indivo. Or, can be tweaked for a patient-facing experience• The Indivo data model will continue to track the evolution of the SMART standard
  • 30. Indivo and SMARTWhat Indivo adds to SMART• Rich write capability• Consumer-facing features including authentication, carenets/sharing, and auditing• Consumer-facing data-types which are not yet ratified as part of the SMART model• Indivo apps can be either purely SMART- compliant or take advantage of hybrid functionality, with graceful degredation to SMART compliance in non-Indivo containers
  • 31. Indivo iOSframework
  • 32. The iOS Framework Makes your life easy™• Handles authentication (OAuth)• Provides Indivo objects (automatic XML handling)• Knows where an object comes from (REST paths)• Provides messaging functionality
  • 33. Basic Approach Abstract logic into Cocoa objects selectRecord:Server Record addDocumentOfClass: fetchReportsOfClass: push: Docs replace: archive: ...
  • 34. App Flow Setup server = [IndivoServer serverWithDelegate:self];#define kIndivoFrameworkServerURL @“”#define kIndivoFrameworkUIServerURL @“”#define kIndivoFrameworkAppId @“”#define kIndivoFrameworkConsumerKey @“nkd8cg02mgo34sntkao9”#define kIndivoFrameworkConsumerSecret @“1acgk9804wkmraoceu02”
  • 35. App Flow Logging in[server selectRecord:^{ }];server.activeRecord
  • 36. App Flow Adding a medicationMedication *med = [record addDocument:Medication];med.drugName = [INCodedValue new];med.drugName.title = @“Tylenol”;med.drugName.system ... [med push:^{ }];
  • 37. App Flow Sending a message[med.activeRecord sendMessage:@“New medication added” withBody:@“See medlist app” ofType:INMessageTypePlaintext severity:INMessageSeverityMedium attachments:nil callback:^{ }];
  • 38. Documentation• Take a look at• Checkout the sample medication app• Technical documentation available online:•
  • 39. Playing with Medications
  • 40. Portal-PCHR Hybrid• SMART Platform Apps Have access to EHR data in a vendor agnostic fashion (from an Epic system, a Cerner system, or an complementary system with data warehoused from the EHR)• So, one can readily create a patient facing portal, which is an apps platform
  • 41. Portal-PCHR Hybrid SMART SMART Clinician Patient -Facing EHR Connector Indivo App -Facing Apps AppsThe best of both worlds:•A local portal, with lots of data from the EHR•A personal health platform with patient control,sharing, and apps
  • 42. The Challenge:“Build an Indivo app that provides value to patients using data delivered through the SMART API and its Indivo-specific extensions”•These should be patient facing web or mobile apps, and run against theIndivo Developer Sandbox•They should be of importance to clinical medicine or public health•Examples include: a medication manager, a health risk detector, a patient-friendlylaboratory visualization tool, or an app that integrates external data sources withpatient records in real time.
  • 43. Resources•Indivo: • • • • ••SMART •
  • 44. Judging Criteria1. Usefulness to patients2. Importance to clinical medicine or public health3. Interface and presentation4. Use of the Indivo and SMART APIs5. Creative use of data from the sandbox and (optionally) from open health data sources
  • 45. TimelineSubmission Period Ends September 28, 2012 Winner Notified October 18, 2012
  • 46. For More Information Contact Hemali: