Moving one step closer to smartphone-like, interoperable EHR apps

Medical app buttons croppedToday, most people’s clinical records remain siloed at a single hospital or health network. For the most part, health apps can’t tap into these data, nor can medicine learn from them. Also, most electronic health records (EHRs) are unable to import the biometric data people are collecting from their own devices, much less interpret them.

In 2009, Kenneth Mandl, MD, MPH, and Isaac Kohane, MD, PhD, of Boston Children’s Hospital published a manifesto in The New England Journal of Medicine calling for health care information systems to have iPhone functionality. This would entail several key attributes: liquidity of data, modularity of applications, accommodation of both open-source and closed-source software through open standards, and the ability to support diverse applications.

In short, they envisioned a “plug and play” health IT platform. In a nod to that vision, as part of President Obama’s 2009 economic stimulus package, Mandl and Kohane were named to lead a $15 million federal research grant from the Office of the National Coordinator for Health Information Technology (ONC) in 2010.

A good app, distributed widely, could reshape practice overnight. The four-year grant led to the development of SMART, an open platform where innovators can create apps that can run securely across the healthcare system — rather than wait for an EHR vendor to create an app for them. SMART established a gallery of EHR-friendly health apps, analogous to the iTunes App Store, compatible with the emerging standards framework known as Fast Health Interoperability Resources (FHIR). About three dozen SMART apps have been created to date — covering everything from pediatric blood pressure measurement to genomics. Patients, clinicians and public health practitioners can tap the apps using any EHR system that supports the SMART standard.

Finally, SMART also created an Innovation Sandbox where developers can create and test new apps.

Now, Mandl and co-PI Joshua Mandel, MD, of Boston Children’s Hospital and Harvard Medical School, have received a one-year award of approximately $275,000 from ONC. ONC National Coordinator Karen DeSalvo, MD, MPH, and Andy Slavitt, Acting Administrator for the Centers for Medicare and Medicaid (CMS), announced the grant in a blog post today that lays out ONC’s goal of “coordinating open information about market-ready EHR app solutions.”

Under the new grant, Mandl and Mandel will take SMART to the next level, converting the App Gallery into a true “App Store” for health and creating a sustainable infrastructure for developing clinical health IT apps that leverage FHIR. The App Gallery would become a permanent resource for developers seeking to promote their apps across all of healthcare and for providers looking for apps relevant to their practice.

A selection of apps from the SMART App Gallery

“Our goal is to make the process of finding and evaluating an app and figuring out how to connect it to an EHR much more turnkey for providers and patients,” says Mandl, director of the Boston Children’s Hospital Computational Health Informatics Program. “Unlike most apps in the iTunes or Google Play stores, these apps will connect with healthcare information systems and put their data to work.”

With collaborators including, HL7, Geisinger Health System, the American Medical Association, the American Nursing Association, market research consultants and design companies, Mandl, Mandel and colleagues will build on SMART to create consumer- and provider-friendly tools. The tools would also enhance developers’ ability to test apps and conduct simulations using sample data.

As Mandl, Mandel and Kohane write in a recent article in Cell Systems, “A good app, distributed widely, could reshape practice overnight.”

“We have an unprecedented opportunity to transform the practice of medicine,” says Mandl. “We can change the way physicians make diagnoses and decisions, help them become aware of public health trends, and change the way patients manage their own diseases.”