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How do You Promote Open App Development in Health IT?

March 20, 2012
by Jennifer Prestigiacomo
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Licensing fees, lack of sample data seen as prohibitive to open source software

After attending a presentation at the HIMSS12 eCollaboration Forum, “Platform Innovation in an ‘Open’ Environment,” I got really excited for the upcoming SMART open app challenge.

For those who are unfamiliar with the SMART Health App Challenge, it was started by a research team at Children’s Hospital of Boston and Harvard Medical School that launched a prize to encourage innovative app developers to build open platform apps that benefit patients and providers. The $5,000 prize was funded from the Office of the National Coordinator for Health IT.

In the eCollaboration Forum session, Joshua Mandel, M.D., who serves as lead architect for the SMART Platforms team, Children’s Hospital Informatics Program and Harvard Medical School said, “What we’re doing is building an open platform to support the development of something we call ‘substitutable apps.’ The idea is that you can build an application that you run on top of multiple different electronic health records, personal health records, or an HIE.”

The first app winner was the Meducation SMART app, from Polyglot Systems, that processes medication lists from the patient record and then enables viewing and printing of simplified medication instructions in any of a dozen languages at a 5th grade literacy level.

The app is based on a drug information database developed in-house under a grant from the National Institutes of Health, National Center on Minority Health and Health Disparities, which was designed from the outset to facilitate the authoring and generation of medication instructions that support low health literacy and the language needs of patients. The database currently supports more than 1,700 prescription medications and 12 languages.

Mandel said that a key to innovation in health IT is to encourage open software. But just having published documentation and specifications out there isn’t enough. “You need lots of examples that app developers can use to get started. Application developers need some sample data and need code examples showing them some simple apps that they can augment with their own features and ideas,” he said.

Licensing standards, like for example from HL7, can be prohibitive to innovation and many times developers cannot use them to document their own work, said Mandel. “If you’re a little guy with a big IT head, or a medical student with a free weakened, and you’re looking to write some code, this is actually a significant barrier,” Mandel said. “It’s a silent barrier, because the people who get this far and don’t get any farther, you just don’t hear from them.”

Mandel also noted the difficulty for app developers to find sample data on the web. He said that a recent Google search for CCDs and CCRs examples came up with a top result from a 2009 forum. “I think innovation requires data, and it’s important to have lots of example data to work with and build innovative apps,” he said. “Your sample data needs to be real or highly realistic. It’s very hard to simulate sample data for developers to do real work. And I posit that the data need to be unrestricted.”

Not only am I excited for the announcement of the SMART App winners in June, but I’m also psyched to see who will be nominated for the Healthcare Informatics/AMDIS IT Innovation Advocate Award. The IT Innovation Advocate Award honors and recognizes teams of clinical informaticists in patient care organizations nationwide for improving patient care safety, quality, and operations in their organizations.

Last year Cecilee Ruesch, R.N., and her team at Providence Alaska Medical Center (in Anchorage, Alaska) were recognized for their groundbreaking electronic ICU (eICU) innovation. It would be great to see informaticist teams submit innovations that can be transformed to open platform innovations for the betterment of the industry. If EHR apps could be as prolific as Iphone or Android apps, then patients would be the winners in the end.