Intelligent Health Lab

Indivo and SMART: enabling standardized, substitutable,

patient-facing appsDaniel Haas

Harvard Medical SchoolChildren’s Hospital Informatics Program

18 June, 2012

Intelligent Health Lab

What is SMART?

“SMART provides a unified mechanism for diverse applications to interact

with medical-record data.”

Intelligent Health Lab

What is SMART?

Apps

API

Containers

Intelligent Health Lab

What is SMART?

Apps

API

Containers

Intelligent Health Lab

Isn’t that Indivo?

Apps

API

Containers

Intelligent Health Lab

Nope.Unlike SMART, Indivo (pre-v2.0) supported:• A different API• Different data-models• A different authentication scheme• Patient-facing apps only• Extra functionality:

SharingWriting DataAuditingEtc.

Intelligent Health Lab

But they are similar…• Reading Medical Data:

Problems, Meds, Lab results, Vital Signs, etc.• Authentication: OAuth-inspired• Philosophy: substitutability

Intelligent Health Lab

So let’s take advantage of that!

Apps

API

Containers

Indivo App

Indivo-specific data models/APIs

Intelligent Health Lab

Goals• Enable existing (and future) SMART apps to

run against Indivo • Shift Indivo apps towards adopting SMART

standards• Enable hybrid SMART/Indivo apps that offer

additional functionality when run against Indivo

Intelligent Health Lab

Architecture: BeforeIndivo API

Data Read API

IndivoClinician-Facing AppsClinician-

Facing Apps

Pure SMART Apps

Clinician-Facing AppsClinician-

Facing AppsIndivo-Specific

Apps Sharing API

Data Write API

Admin API

Other Indivo Data

Models

Indivo Core Data

Models

Intelligent Health Lab

Architecture: AfterIndivo API

SMART API

IndivoClinician-Facing AppsClinician-

Facing Apps

Pure SMART Apps

Clinician-Facing AppsClinician-

Facing AppsIndivo-Specific

Apps Sharing API

Data Write API

Admin API

OtherIndivo Data

Models

SMART Data

Models

Intelligent Health Lab

Technical ImplicationsSMART Containers supply Apps with UI integration Authenticated API Access Data

Data models are critical to enable app developers Keeping developer experience in mind Data need to be predictable, (relatively) simple

Intelligent Health Lab

• Data Fidelity in Indivo• Coding Systems• Non-SMART data

What happened to ‘pluggable document processing?’

Technical Implications: Data

Intelligent Health Lab

Technical Implications: SMART app Developers

• Your apps will now run on Indivo!• If your apps are patient-facing (or might be

appropriate for patient eyes), you can add Indivo-specific calls to write data, share data, and more.

• Good coding practice: make sure to fail gracefully if Indivo calls aren’t available

Intelligent Health Lab

• Start learning SMART!APIsdata models

• Code your data Data in Indivo must be consistent with SMART standards

• When you build new Indivo apps, they will run on other SMART containersBut only if you fail gracefully when Indivo-specific APIs

aren’t available(Hint: Can you tell that I think this is important?)

Technical Implications: Indivo app Developers

Intelligent Health Lab

Future Directions: The SMART-Indivo Portal

• Mapping data from local EHR formats to other ontologies requires effort.Goal: If you’ve done it for any SMART container, you

shouldn’t have to do it for Indivo as well.• Obtaining data has been a primary obstacle for

personal health platformsGoal: If you have a SMART container exposing good medical

data, Indivo should be able to run apps against that data.• For instance: 60+ academic medical centers with i2b2

could all provide Indivo, running apps, simply by setting up the SMART-Indivo Portal.

Intelligent Health Lab

SMART API

SMART Container

Indivo API

IndivoSMART-Indivo

Connector App

Clinician-Facing Apps

Clinician-Facing Apps

Clinician-Facing Apps

Clinician-Facing Apps

Clinician-Facing Apps

Patient-Facing Apps

Local EHR

Future Directions: The SMART-Indivo Portal

Intelligent Health Lab

Summary• By deeply integrating Indivo with SMART technologies,

we have enabled Indivo to: consume apps written for other SMART platforms adhere to SMART standards for data models and data quality support hybrid apps that add patient-facing components

which are not yet ratified as part of the SMART model

Apps

API

Containers

Indivo App

Indivo-specific data models/APIs