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Intermountain CMIO on Building Interoperability, Building a Clinical App Store

April 29, 2015
by Gabriel Perna
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Whether it’s the CommonWell Health Alliance, the Healtheway initiatives, the Health Level Seven International (HL7)-led Argonaut project or something else, interoperability is the common thread tying together many strange bedfellows in the healthcare IT industry these days. 
The Healthcare Services Platform Consortium (HSPC), a nonprofit collaborative group of healthcare stakeholders led by integrated health system, Intermountain Healthcare out of Salt Lake City, is one such effort. While it’s not as publicly known as some of the other initiatives, its goals are just as big. The group is aiming to create an open services oriented infrastructure platform that will allow for the creation of source system agnostic clinical applications.
When a clinician opens up their electronic medical record (EMR) system, those at the HSPC want them to know clinical decision support (CDS) is just an app away.  
“At Intermountain, we have an interest in creating an app store for healthcare. We want higher quality, lower-cost applications that help us improve the care of our patients. The key to that is standards-based services. So when we, or anyone else for that matter, creates an app, it can run against anyone's back end, whether it’s Cerner, Epic, Vista, or Allscripts,” Stan Huff, M.D. CMIO at Intermountain told Healthcare Informatics at the 2015 Healthcare Information and Management Systems Society (HIMSS) Conference, held in Chicago. 
Intermountain teamed with Harris Healthcare (based in Herndon, Va.) to kickstart the project in 2013. Two years later, the HSPC has brought on a number of different stakeholders, including the Department of Veterans Affairs and LSU Health. The group has been involved in a pilot that is aiming to coordinate care for diabetic veterans in Louisiana and ensure the data from their different providers is not siloed. 
The pilot is a testing ground for the services oriented architecture platform and an overall attempt to create a plug-and-play atmosphere for interoperable healthcare applications. Dr. Huff at Intermountain says that in order to create an environment where thousands upon thousands of apps are available for clinicians to use for decision support and other functionalities, there has to be a fundamental paradigm shift. This is a multistep process, he notes. 
“What we're doing is trying to create an ecosystem. We’re defining the standards. Once you have the standards, you need a way to test against them so applications or services are compliant and adhering to them. The third thing is doing the work and creating the marketplace. You’ve got to get adoption by people that hold the data now through existing EMRs. You’ve got to create an education and business plan that explains why they would support this. You can have all the standards but if all of the data is in existing EMR systems and they're not supplying standards-based [application programming interfaces] to that, it means nothing. The fourth thing is establishing the real app store,” Huff says. 
Once the app store is in place, Huff envisions a place where clinicians will come and sort out the best of the best. Just like the Angry Birds of the world have become the cream of the Apple App Store crop, the market will decide the most viable clinical apps. 
Regulatory factors could play a big role in the success of this kind of endeavor. Currently, the Food and Drug Administration is trying to work with other government agencies as well as Congress to determine the right level of oversight for mobile medical apps. 
Not surprisingly, Huff is in favor of less regulation. He’d prefer peer-reviewed oversight of the apps rather than the kind of regulatory oversight you’d see for something like a pacemaker. 
The third thing on Huff’s list of building this ecosystem, generating a marketplace, is something the group is confident about. On top of the participating organizations, HSPC has gotten some early interest from the United Kingdom’s National Health Service agency, one representative says. Those participants, which have the reputable weight of an Intermountain or a VA, will drive the best apps to the marketplace, HSPC leaders say. 
“If you go to any hospital, a practicing clinician will say, ‘I wish I had an app that would set up a diet for a patient.’ I think the interest [for apps] is already there. People have needs and are willing to pay for solutions that help them,” Huff says.