Modular EHR apps initiative SMART adds advisors to scale up adoption

By Jonah Comstock
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Blood pressure centiles, a SMART app. Blood pressure centiles, a SMART app.

The SMART platform (Substitutable Medical Apps and Reusable Technology), an ONC-funded, Boston Children's Hospital-led effort to encourage the development of modular apps for EHRs, has announced an advisory committee to help support the growth of the platform.

The committee includes representatives from The Advisory Board Company, AARP, BMJ, Canadian Institutes of Health Research, Centers for Medicare and Medicaid Services, England National Health Service, Hospital Corporation of America, Eli Lilly and Company, MyHealthBook, Polyglot Systems, and Surescripts, as well as Harvard Business School professor Clayton Christensen. In addition to advising on how to scale adoption, each member of the committee will be required to use SMART themselves in their businesses or institutions.

"The advisory committee is a number of companies, and a few individuals, and a couple of government agencies, that have within their strategic interest to see something like the SMART API emerge," Dr. Kenneth D. Mandl, a Professor of Pediatrics at Harvard Medical School and a faculty member in the Children's Hospital Informatics Program at Boston Children's, told MobiHealthNews. "And they're working with us to help create the environment where SMART is pulled into use as a standard of sorts, so we can have a demand for this kind of economy of scale you get from a SMART API." 

SMART grew out of a paper published by Mandl and Isaac Kohane in 2009, calling for a shift in the healthcare system to get electronic health records to mirror the open ecosystem of Apple's iPhone. Since then, the project has received a $15 million grant from ONC and sponsored a contest which generated several apps for the ecosystem. The contest winner, Polyglot, is one of the companies on the new advisory board.

"The goal of the project all along has been to ensure that an app developer who has an innovation can have a large market for that innovation, can run that app anywhere unmodified -- and when we say anywhere, we mean at least a lot of places. We think that contrasts very sharply with the current environment where innovative companies have a very hard time getting their products in front of end users and often will have a startup that dies on the vine waiting to get into a particular hospital deployment or get integrated from a one-off perspective."

Mandl said the technology involved in the project is always iterating, but it's basically in good shape and starting to be adopted. The SMART API, which allows a number of existing health IT platforms and EHRs to connect to specially designed HTML5 or iOS apps, is already freely available along with a number of charter apps. At HIMSS this year, five different booths -- including SMART, Cerner, Intermountain, Harris, and Hewlett Packard -- all displayed SMART apps on their system, and some were a surprise to the SMART team.

"So that's where we are right now," Mandl said. "Right now we've demonstrated the use, we've got excitement and vendors we don't even know about starting to use the SMART platform, and now we think there are tremendous opportunities to realize the potential. Some EHRs have an app model of their own, but no one is achieving this idea of you build an app once and use it everywhere. There's tremendous public utility in that. There's over 700 certified EMR vendors and a few of them hold the majority of the market share. So if you've got an app, say it has great public utility, like a way to manage medications well. In order to deploy that app, you have to convice the big vendors all to implement it, and then you have to implement it 700 more times. And that's not cost-efficient."

The API is secure, Mandl said, but the SMART group doesn't plan to take responsibility for the security of particular apps on the platform.

"We are unlikely to become a certifying body for apps ourselves, because that's an awful lot of work," he said. "But we'd like to support certifying bodies that might emerge through professional organizations or other mechanisms so that a CIO or a practice administrator has a seal of approval on that app about proper security technology."

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