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 Fellow
Management and Engineer
Challenge
Program 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-Indivo
Challenge
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 PCHR
SUBSCRIBE

11. New Approaches
to Data Liquidity

12. The Verbs of PCHR
SHARE

13. 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

14. The Verbs of PCHR
ADD AN APP

15. “We cannot overstate how
important PHRs are to the
efficient functioning of a low-
cost, high quality health-care
system . . . . We think that the
INDIVO system, or something
like it is a good place to start.”
--Clayton Christensen
Harvard Business School

17. http://commonhealth.wbur.org/2011/07/killed-google-health
• Trust
issues
• No app
developers
• No data

18. The App Store for Health
ONC Funded Research Project under the
“SHARP” program

19. We imagine EMRs as an iPhone-like platform where
an innovator can create and widely distribute an app
across many disparate EMRs and PHRs

20. A en sign ss
D andle
ir ed cC
sp e M e)
In av
D lice ns
from (cc

21. 1 Design + 1 Developer + 1 Week
1 De
v el o
per
in
1W
eek

22. EHR as an “iPhone-like” Platform

23. SMART
BP Centiles App
Running on Cerner
23

24. ARCHITECTURE OVERVIEW

25. Vocabulary
Apps
API
Containers

26. SMART Components

27. Apps need
UI
Standards-based integration, flexibility
Authentication
In-browser, server-to-server
Data
Context, Medical Record Elements

28. Container UI

29. Authentication
Each container implements a consistent
mechanism for delegating access: OAuth.
The app only needs to speak OAuth.

30. SMART data
80/20 approach
concentrate on common outpatient data
Consistent coding systems
Medications: RxNorm (SCD, SBD, Packs)
Problems: SNOMED CT
Labs: LOINC
Extensible representations in RDF

31. Architecture Summary
SMART Containers supply Apps with
UI integration
Authenticated API Access
Data
Containers shoulder significant responsibility!
Data models are critical to enable app developers
Keeping developer experience in mind
Data need to be predictable, (relatively) simple

32. Indivo and SMART
What 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

33. Indivo and SMART
What 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

34. Indivo iOS
framework

35. 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

36. Basic Approach
Abstract logic into Cocoa objects
selectRecord:
Server Record
addDocumentOfClass:
fetchReportsOfClass:
push:
Docs replace:
archive:
...

37. App Flow
Setup
server = [IndivoServer serverWithDelegate:self];
#define kIndivoFrameworkServerURL @“http://10.17.20.127:8000”
#define kIndivoFrameworkUIServerURL @“http://10.17.20.127:8001”
#define kIndivoFrameworkAppId @“medsample@apps.indivo.org”
#define kIndivoFrameworkConsumerKey @“nkd8cg02mgo34sntkao9”
#define kIndivoFrameworkConsumerSecret @“1acgk9804wkmraoceu02”

38. App Flow
Logging in
[server selectRecord:^{ }];
server.activeRecord

39. App Flow
Adding a medication
Medication *med = [record addDocument:Medication];
med.drugName = [INCodedValue new];
med.drugName.title = @“Tylenol”;
med.drugName.system ...
[med push:^{ }];

40. App Flow
Sending a message
[med.activeRecord sendMessage:@“New medication added”
withBody:@“See medlist app”
ofType:INMessageTypePlaintext
severity:INMessageSeverityMedium
attachments:nil
callback:^{ }];

41. Documentation
• Take a look at README.md
• Checkout the sample medication app
• Technical documentation available online:
• http://docs.indivohealth.org/projects/indivo-x-ios-frame

42. Playing with Medications

43. 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

44. Portal-PCHR Hybrid
SMART SMART
Clinician Patient
-Facing EHR Connector Indivo
App -Facing
Apps Apps
The best of both worlds:
•A local portal, with lots of data from the EHR
•A personal health platform with patient control,
sharing, and apps

45. 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 the
Indivo Developer Sandbox
•They should be of importance to clinical medicine or public health
•Examples include: a medication manager, a health risk detector, a patient-friendly
laboratory visualization tool, or an app that integrates external data sources with
patient records in real time.

46. Resources
•Indivo:
•http://indivohealth.org/smart-indivo-app-challenge
•http://docs.indivohealth.org
•http://sandbox.indivohealth.org
•https://github.com/chb/IndivoFramework-ios
•http://www.youtube.com/watch?v=qNWujzx46bI
•SMART
•http://smartplatforms.org

47. Judging Criteria
1. Usefulness to patients
2. Importance to clinical medicine or public health
3. Interface and presentation
4. Use of the Indivo and SMART APIs
5. Creative use of data from the sandbox and
(optionally) from open health data sources

48. Timeline
Submission Period Ends
September 28, 2012
Winner Notified
October 18, 2012

49. For More Information
http://www.health2challenge.org
Contact Hemali:
hemali@health2con.com