SMART Apps In The EHR --- This Is Progress!

Last week I had the opportunity to visit my old hometown while attending the SMART conference at Harvard Medical School (and as a bonus I got to catch up with my dad at the super-yummy Publick House in Brighton). I always have high expectations of the Ken and Zac show, but this one was even more notable than most. It was a bit of a sequel to the 2009 ITdotHealth conference that built on their NEJM article about “substitutable apps” --- since then they’ve received a SHARP grant to make their ideas into something akin to reality, and frankly have done a ton of cool stuff.

The concrete manifestation of this research is the evolving SMART platform --- an open source environment that creates an abstraction between “containers” (data sources like an EHR or clinical data warehouse) and “apps” (bits of end-user functionality) --- so that they can be mixed-and-matched at will, without additional integration or customization (for those of us keeping score, more evidence that every computer science problem is a normalization problem).

The clearest way to get a sense of the benefit here is to check out the Blood Pressure Centiles app that is actually deployed and being used in production at Boston Children’s. Determining “normal” for a child’s BP requires some math, incorporating age, gender, height, weight, etc. as inputs. Not rocket science, but also a somewhat specialized function that has been on the “to do” list for the EHR for years and never quite made the priority list. By conceiving this as a SMART app, they were able to “inject” the functionality directly into the EHR without any custom development. And to drive the point home, we saw the same app running without modification on an i2b2 data warehouse, the MIRTH results HIE client, and maybe another one I can’t remember. Pretty sweet...