EHR OpenNESS: Innovation and Uptake Kenneth D. Mandl, MD, MPH Director, Intelligent Health Laboratory Children s Hospital Informatics Program Center for Biomedical Informatics Harvard Medical School
To reform Health Care, we need to stay nimble. We don t always know the future.
The Learning Healthcare System
Intelligent Health Laboratory Children s Hospital Informatics Program
OpenNESS Open Data Many eyes on our biggest problems. (Need accessible, shareable data at least) Open Standards Allows open systems to exchange information; produces efficiencies Open APIs Allows building of applications on top of open systems and using open standards Open Source Allows compatible, modifiable deployments, crowd sourced bug detection
The App Store for Health ONC Funded Research Project under the SHARP program
APIs Application Programming Interfaces (APIs) give Software Developers Documented, Supported Ways to build better programs
Substitutability Substitutable apps. The purchaser of an application can replace one for another without being technically expert Substitutable containers. The application can run on any platform that has implemented the API Substitutability is an overarching principle to drive interoperability the data must be presented in the same precise format by the container each time
Business Model Underlying platform may have different business models: Open source and free (OpenVista) Highly proprietary (Epic) Intelligent Health Laboratory Children s Hospital Informatics Program
British Medical Journal 2009 Clinical Use Case 2 Domestic Abuse
Focus is on an API that enables a single apps store for Cerner Install Hospital with homegrown system Physician practice Open source EMR
Can EMRs behave like an iphone or Android in that innovators readily create and widely distribute apps across thousands of installs?
18.12 Issue
State-of-the-Art???
1 Design + 1 Developer + 1 Week
1 SMART App in 3 SMART Systems
Challenge
Well-publicized
BP Percentile Calculation
SMART BP Centiles App Running on Cerner
Medication adherence JAMIA 2011
Decision Support Integration
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Developer Sell app, give it away for free, open source it Health System Empowered to make its own apps EMR Vendor Business Model Adopt the API Push local customizations to the user, purchase or create best of breed proprietary apps Public Health Can rapidly distribute an app across multiple environments e.g., FDA, CDC Intelligent Health Laboratory Children s Hospital Informatics Program
i2b2
i2b2 Open source project at Harvard Opened up EHR data for analytics Initially for cohort identification Pulled into use at > 60 academic medical centers + Pharma Driving HIE SHRINE (PDO becoming a defacto standard) Intelligent Health Laboratory Children s Hospital Informatics Program
61 i2b2 sites Intelligent Health Laboratory Children s Hospital Informatics Program
Business Model Open Source integrators Pharma Health systems Government Query Health EHR vendors Cerner Universities UCSF $5M President s Office Research ready, reusable resource Intelligent Health Laboratory Children s Hospital Informatics Program
Intelligent Health Laboratory Children s Hospital Informatics Program ATSDR: Agency for Toxic Substances & Disease Registry FIC: Fogarty International Center NCBBB: Nat'l Center on Birth Defects & Developmental Disabilities NCCDPDP: Nat'l Center for Chronic Disease Prevention & Health Promotion NCI: National Cancer Institute NCPDCID: Nat'l Center for Preparedness, Detection, & Control of Infectious Diseases NCRR: Nat'l Center for Research Resources NEI: National Eye Institute NHLBI: Nat'l Heart, Lung, & Blood Institute NIA: National Institute on Aging NIAAA: Nat'l Inst on Alcohol Abuse & Alcoholism NIAID: Nat'l Institute of Allergy & Infectious Diseases NIAMS: Nat'l Institute of Arthritis & Musculoskeletal & Skin Diseases NIBIB: Nat'l Institute of Biomedical Imaging & Bioengineering NICHD: Nat'l Institute of Child Health & Human Development NIDA: Nat'l Institute on Drug Abuse NIDCD: Nat'l Institute on Deafness & Other Communication Disorders NIDCR: Nat'l Institute of Dental & Craniofacial Research NIDDK: Nat'l Institute of Diabetes & Digestive & Kidney Diseases NIEHS: Nat'l Institute of Environmental Health Sciences NIGMS: Nat'l Institute of General Medical Sciences Fig. 2: Cumulative Registry Funding* for FY 2009 Active Projects by Institute or Center (in millions, FY 2008 CPI adjusted dollars) NHLBI, $243.3 NIA, $458.9 NCCDPHP, $707.9 NIMH, $202.4 NIDDK, $185.5 NIAMS, $154.7 *NIH grants & contracts: FY 1992-2009; CDC grants & contracts: FY Other, $182.8 NCI, $790.3 NIAAA, $139.6 NINDS, $81.7 NIAID, $52.9 NIDA, $29.8 NCBDD, $28.3 NCRR, $25.0 NIDCD, $19.3 NICHD, $16.5 NIDCR, $16.4 ATSDR, $16.0 NIGMS, $9.3 NIEHS, $9.2 NIOSH, $7.5 NCPDCID, $2.1 NIBIB, $1.6 NEI, $1.2 NLM, $0.5 FIC, $0.1 Grand Total: $3.2B
Intelligent Health Laboratory Children s Hospital Informatics Program
www.smartplatforms.org www.indivohealth.org www.i2b2.org