Overview:
Today's health IT environment is largely populated by outdated one-size-fits-most systems; customization is difficult, expensive, and only a few established EHR vendor developers can innovate. In order to achieve the promise of health IT reform, the United States needs a platform by which the grassroots of the community—patients, physicians, and small agile software vendors—can continuously drive innovation.

To achieve this goal, medicine needs to learn from the successful implementation of information technology in other sectors. The iPhone, for instance, uses a software platform with a published interface. This interface needs the ability to have both core components and applications (apps). On the iPhone, core components include cameras, geo-location, networking capabilities, and more. The platform functionally separates the core components from the apps, and the apps are substitutable. For instance, a consumer can download a calendar reminder system, reject it, and easily replace it with a new one.

Substitutability is the capability of a system to replace one application with another of similar functionality. As we define it, substitutability requires that the purchaser of an application can replace one application with another without: being technically expert, requiring re-engineering of other applications they are using, or having to seek assistance from any of the vendors of previously or currently installed applications. This allows developers to rapidly create a large marketplace of apps for consumers to choose from.

A health IT environment characterized by substitutable apps constructed around shared core components would drive down health care technology costs, support standards evolution, accommodate difference in care workflow, foster competition in the market, and accelerate innovation.  Competition on quality, cost, and usability would become fierce. With the cost of switching kept low, a physician using an EHR, a chief information officer running a hospital system, or a patient using a personally controlled health record (PHR) would all be empowered to readily discard an under-performing app and install a better one.

Program Goals:
The major deliverable of this project will be the SMArt (Substitutable Medical Apps, reusable technologies) platform architecture. SMArt will achieve two major goals:

• Develop a user interface which allows “iPhone-like” substitutability for medical apps based upon shared basic components.

• Create a set of services that enables efficient data capture, storage, retrieval and analytics, which are scalable to the national level and respectful of institutional autonomy and patient privacy. 

Projects:
Led by Harvard Medical School in collaboration with Children’s Hospital Boston, Partners Healthcare, the Regenstrief Institute, the University of Texas, and the University of Wisconsin, four projects will be completed.

The anticipated outcomes include foundational knowledge and useable, testable prototypes for a national-scale SMArt platform with a developing ecosystem, robust and scalable network data services, and advanced data analysis capabilities. Such a system should provide a mechanism to rapidly and flexibly serve the health of the nation.

Project One - Create a set of services for the SMArt platform that will enable efficient data capture, storage, retrieval, and analytics.

Project Two - (a) Generate the basic shared components and health care core service building blocks (HCSBB) to run across multiple platforms, (b) generate the basic SMArt platform to deliver HCSBBs and run apps in practices and hospitals which currently have limited health IT, and (c) lead to the creation of medication use apps which will be deposited into the App Exchange in collaboration with CVS/Caremark and SureScripts.

Project Three - Enable existing health IT platforms to become SMArt-ready.

Project Four - Generate the ecosystem for SMArt apps. This ecosystem will be characterized by inter-application integration, usability across multiple geographical sites, sustained responsiveness to health IT meaningful use criteria, and a one-stop shop for apps developers and consumers. 

Principal Investigators:
Dr. Issac Kohane, Harvard University
Dr. Kenneth D. Mandl, MD, MPH, Children's Hospital Boston

To Learn More:

1. See SMART Apps Challenge website or email SHARP.Platform@hhs.gov.