It’s About Time: Open APIs Finally Burst onto Healthcare’s Sluggish Scene


Nuviun Blog, June 9, 2014 — Sue Montgomery
In the midst of the struggles that we face with interoperability, efforts that support open API use may well hold the keys to the HIT Kingdom…

Advisory Committee Kickoff a Success


The SMART Advisory Committee had a high-energy kickoff meeting on May 15. Below are some scenes from the day, which featured presentations by Joshua Mandel and Clayton Christensen as well as demonstrations of apps to be deployed in the near future.
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Forbes Adds to Advisory Committee News Coverage


Today Forbes published Who’s Who Of Health Care Join Forces For SMART Technology, the latest in recent news coverage of the SMART Advisory Committee launch.


Other pieces include:
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Aneesh Chopra’s New Book Points to Launch of SMART Project


Aneesh Chopra, America’s first Chief Technology Officer and member of the SMART Platforms Advisory Committee, has published a new book called Innovative State: How New Technologies Can Transform Government. The SMART Project’s kickoff ITdotHealth meeting in 2009 is among the formative events he describes in Chapter 4, “Opening the Playbook.” Here he is seen with Ken Mandl at the Harvard Book Store, where he discussed the book on May 21. A video of the talk is provided by WGBH.


Introducing the SMART Advisory Committee


Our new advisory committee, made up of member organizations with strategic interest in transforming how the healthcare enterprise uses data, will play a critical role in guiding the SMART Platform toward broad adoption and use.

Learn more

SMART Advisory Committee

Disturbing state of EHR Security Vulnerability Reporting


Last week I reported on a set of security vulnerabilities that affected multiple EHR vendors and other Health IT systems.

I initially discovered the vulnerability in a single Web-based EHR system and successfully reported it directly to that vendor.

But my subsequent journey into the world of EHR vulnerability reporting left me deeply concerned that our EHR vendors do not have mature reporting systems in place. Patient health data are among the most personal, sensitive aspects of our online presence. They offer an increasingly high-value target for identity theft, blackmail, and ransom. It’s time for EHR vendors to take a page from the playbook of consumer tech companies by instituting the same kinds of security vulnerability reporting programs that are ubiquitous on the consumer Web.

HL7 and EHR Vendors must address security reporting

I’ll lead with the key message here, and provide supporting evidence below: HL7 and EHR vendors need to institute security vulnerability reporting programs!
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Case study: security vulnerabilities in C-CDA display


For background, see my previous blog post describing the details of three security vulnerabilities in C-CDA Display using HL7′s CDA.xsl.

Last month I discovered a set of security vulnerabilities in a well-known commercial EHR product that I’ll pseudonymously call “Friendly Web EHR”. Here’s the story…

The story: discovery and reporting

I was poking around my account in Friendly Web EHR, examining MU2 features like C-CDA display and Direct messaging. I used the “document upload” feature to upload some C-CDAs from SMART’s Sample C-CDA Repository. At the time, I was curious about the user experience. (Specifically, I was bemoaning how clunky the standard XSLT-based C-CDA rendering looks.) I wondered how the C-CDA viewer was embedded into the EHR. Was it by direct DOM insertion? Inline frames? I opened up Chrome Developer Tools to take a look.
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Security vulnerabilities in C-CDA Display using CDA.xsl


TL;DR: If you’re using XSLT stylesheets to render C-CDAs in your EHR, make sure you understand the security implications. Otherwise you could be vulnerable to a data breach.

This blog post describes security issues that have affected well-known 2014 Certified EHRs.. Please note that I’ve already shared this information privately with the Web-based EHR vendors I could identify, and I’ve waited until they were able to investigate the issues and (if needed) repair their systems.

Last month I observed a set of security vulnerabilities in XSLT “stylesheets” used to display externally-supplied C-CDA documents in many EHRs. To be specific: the CDA.xsl stylesheet provided by HL7 (which has been adopted by many EHR vendors) can leave EHRs vulnerable to attacks by maliciously-composed documents.
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HIMSS14: Health IT’s Next Boom Cycle



InformationWeek Healthcare, February 25, 2014 — Mark Braunstein
We’ve seen health informatics booms and busts before — will this one be different?
I’ve been attending HIMSS for decades, and in my view, the exhibit hall is the place to get a true pulse of the industry and the field in general. Over the years we’ve seen booms and busts. I remember HIMSS in my hometown of Atlanta during the heyday of health information exchange in the 90s, when the regional phone companies (remember them?) had huge exhibits touting their entry into the health informatics space…

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Top Ten Tech Trends: Catching FHIR



Healthcare Informatics, February 19, 2014 — David Raths
A New HL7 Draft Standard May Boost Web Services Development
Standards development work in healthcare is a challenging, often thankless task, and definitely more of a marathon than a sprint. It isn’t often that a proposed standard garners genuine enthusiasm among people working on interoperability issues, but that is what is happening with HL7 Fast Healthcare Interoperability Resources (FHIR)…

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How does FHIR express uncertainty and negation?


Last week I received an e-mail asking how FHIR expresses Uncertainty and Negation. It was a general inquiry, but also asked how FHIR might express a specific clinical statement like “Intolerant to opiods, no known other medication ADEs, and no known environmental/food allergens”.

Here’s what I said…
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UConn Health Video Vouches for Value of Meducation


The winner of the 2011 SMART Apps for Health Challenge is in the spotlight once again.

Polyglot Systems’ medication instruction app, Meducation, was implemented at UConn Health Center in March 2013. By August the software had significantly improved patient satisfaction scores on certain HCAHPS measures, according to a report in BioPortfolio.

Now UConn’s own news site, UConn Today, features a video of hospitalist Dr. Wendy Miller describing in further detail how valuable the app has been to patients and caregivers at the center.

Screen shot 2014-01-24 at 4.15.37 PM

The Power of Shared Data


SMART, i2b2, and other open-source technologies made possible by the federal $48B investment in health IT will soon be used as the foundation of SCILHS: the Scalable Collaborative Infrastructure for a Learning Health System. Read the full report from the Harvard Medical School news office.

Based at Harvard Medical School and operating out of 10 health care sites from Massachusetts to Texas, SCILHS will be one of 29 networks in the national Patient-Centered Clinical Research Network (PCORnet). Pictured below are members of the network who made it through the snow to attend the official kickoff meeting held January 22–23 in Washington, D.C.

PCORnet Kickoff Attendees

C-CDA Endoscopy, or
Improving Clinical Document Exchange

SMART C-CDA infographic -- click to enlarge

Click infographic for full-size PDF

By David Kreda and Joshua Mandel

2014 will see wide-scale production and exchange of Consolidated CDA documents among healthcare providers. Indeed, live production of C-CDAs is already underway for anyone using a Meaningful Use 2014 certified EHR. C-CDA documents fuel several aspects of meaningful use, including transitions of care and patient-facing download and transmission.

This impending deluge of documents represents a huge potential for interoperability, but it also presents substantial technical challenges. We forecast these challenges with unusual confidence because of what we learned during the SMART C-CDA Collaborative, an eight-month project conducted with 22 EHR and HIT vendors.

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PCORI Award Will Support SMART/i2b2 Efforts Toward a Learning Health System


The Patient-Centered Outcomes Research Institute (PCORI) announced today that it will fund an exciting new venture for SMART and collaborators. The Scalable Collaborative Infrastructure for a Learning Health System—SCILHS (pronounced “Skills”)—will use SMART-enabled i2b2 at the following ten sites to help build a National Patient-Centered Clinical Research Network:

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Understanding “whitelists” in Direct Project secure e-mail


What’s a “Whitelist”?

As a follow-on to the last post about Direct messaging, I want to distinguish the Mass Medical Society’s vision of a “whitelist” from another concept that confusingly shares the “whitelist” moniker. Below, I’ll introduce two distinct terms and try to clarify the distinction:

“OR-gate whitelists” expand the communication pool

Mass Medical Society envisions a kind of per-physician “whitelist” that I’ll call an OR-gate whitelist. The basic premise of an OR-gate whitelist is that a physician can add any Direct address to her OR-gate whitelist via a UI in her EHR or HISP. By doing so, she’d be able to send secure e-mail to that address — regardless of CAs, trust bundles, or pre-existing local policy. An OR-gate whitelist acts like a logical “OR gate,” meaning that a message will be sent if institutional policy allows it, or if a physician’s personal OR-gate whitelist allows it.  With OR-gate whitelists, physicians can send to any Direct endpoint in the world, full stop.

“AND-gate whitelists” restrict the communication pool

The current Massachusetts HIWay has a deployed a different kind of “whitelist” functionality that I’ll call an AND-gate whitelist. Mass HIWay maintains a state-wide AND-gate whitelist of acceptable Direct addresses to which HIWay users are allowed to send Direct messages. An AND-gate whitelist acts like a logical “AND gate,” meaning that a message will be sent only if institutional trust bundles allow it (i.e. the recipient’s cert is signed by a CA that the organization trusts) and the institution’s AND-gate whitelist allows it. So Mass HIWay’s state-wide AND-gate whitelist is a way to avoid allowing, say, “all eClinicalWorks users across the whole country” into the pool at once. Instead, access can be restricted to the intersection of two sets: “All eClinicalWorks users across the whole country” and “Users on the Mass HIWay AND-gate whitelist.”

Direct Project: Secure e-mail in MU2


MU2 is here, and with it: secure e-mail

As Meaningful Use 2014 EHRs come online this winter, clinicians across the country gain access the host of new features included in the MU 2014 Certification Requirements. In this post, we’ll dig into one of these features: EHR-based secure e-mail capabilities that operate using the “Direct Project” specification. (If you’re new to this world: when you hear “Direct Project,” you should think “secure e-mail for healthcare.”)

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Our First Foray into Health Foo


josh-ken-healthfoo-DSC02925Josh Mandel (left) and Ken Mandl took the opportunity at this past weekend’s Health Foo (friends of O’Reilly) 2013 to exchange ideas about SMART, APIs, health data, and more. Like many of the unconference-style breakout sessions, theirs attracted a small group geared up for a more intimate and spontaneous discussion than the average healthcare/HIT conference. The talk also got a boost from the participation of thought leaders such as Tim O’Reilly, founder of O’Reilly Media and host of the original Foo Camps from which Health Foo evolved; and John Lumpkin, Director of the Health Care Group at Robert Wood Johnson Foundation, which funded the event.

It may be held indoors at the NERD Center, but as the bare feet in this photo’s background suggest, Health Foo still manages to retain the campground flair of its predecessors—complete with drummingdancingmicrobiome sharing, and Smart Bell-ing. For more highlights, see Wen Dombrowski’s whole Storify recap.

Mandl and Mandel to Attend 2013 Health Foo Unconference



This weekend promises to be an exciting one for SMART trailblazers Ken Mandl and Josh Mandel, who have been invited to Health Foo 2013, December 6–8 at the Microsoft NERD Center in Cambridge. Health Foo (friends of O’Reilly) is an invitation-only “unconference focused on innovation in health and healthcare, sponsored by O’Reilly Media and the Pioneer Portfolio of the Robert Wood Johnson Foundation” (RWJF).

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SMART, FHIR, and a Plan for Achieving
Healthcare IT Interoperability


Since 2010, the SMART team has been privileged to work on an exciting frontier of health data liberation, exposing structured patient-level data through an open API. We’ve striven for simplicity, with a constrained set of well-described data models, fixed vocabularies, a clean REST API, and Web-based UI integration. And we’ve endeavored to use existing standards where they fit the bill: that is, when existing standards were openly available and met our own subjective criterion of developer-friendliness.

When we launched our first preview of the SMART API back in 2010, there was no structured data content standard that fit the bill, so we rolled our own. We started with simple models for Patient, Medication, and Fulfillment, and over time we’ve expanded the collection to encompass over a dozen top-level clinical statements. Building and maintaining these data models was never our core goal, but until recently, there hasn’t been a suitable alternative on the horizon.
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A Quick Payoff for SMART-Enabling an EHR System


Over the summer, a European EHR vendor took quick advantage of SMART-enabling its EHR system, adding in the SMART API to enable it to offer both the SMART Pediatric Growth Chart and SMART Blood Pressure Centiles apps. Marand, provider of the Think!Med Clinical™ EHR system, adopted SMART, incorporating it into their openEHR-based system along with these initial apps, which were promptly made available for users at the 200-bed Children’s Hospital of Ljubljana University Medical Centre in Slovenia.
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Kohane Commentary on Grande et al Findings


JAMA Int Med: Secondary Use of Health Information: Are We Asking the Right Question?A report on “Public Preferences About Secondary Uses of Electronic Health Information” has just been published by a group of researchers led by Dr. David Grande at UPenn’s medical school. The publishing journal, JAMA Internal Medicine, also invited SMART Co-Director Zak Kohane to comment. His remarks appear in Secondary Use of Health Information: Are We Asking the Right Question? and may be read in their entirety by enlarging the image on the right. (A subscription is required to access the articles’ full texts.)

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SMART Medication Adherence App in i-JMR


Just published in interactive Journal of Medical Research: “Scalable Decision Support at the Point of Care: A Substitutable Electronic Health Record App for Monitoring Medication Adherence”

Democratizing Data: Two New SMART iOS Apps


The Harvard Medical School (HMS) news office reports on DB EMR and Genomics Advisor, soon to be released on iTunes.

SMART’s Ramoni on Panel at Fjord Kitchen NYC (Video)


While collaborating with Fjord on our award-winning growth chart app, SMART Executive Director Rachel Ramoni spoke at a Fjord Kitchen Event, which they host to “dish out inspiration” on digital technology from creative minds across industries. Looking back on the experience, Rachel said, Read more

SMART Platform Integral to Kohane’s TEDMED Pitch for Putting Our Health Data to Work


Visit TEDMED for more on these and other talks.

How can every clinical visit be used to advance medical science? (13:05)

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SMART Growth Chart Wins 2013 Red Dot Design Award


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Introducing the SMART C-CDA Collaborative



With support from ONC, the SMART Platforms team is working with Lantana Consulting Group to simplify and improve data exchange based on the HL7 Consolidated Clinical Document Architecture (C-CDA) standard for health summary data. We are working to ensure that real-world Health IT software can consistently produce and consume C-CDA documents, which will be a Meaningful Use Stage 2 (MU2) requirement for transitions of care between providers and for patients’ access to their own data. To this end, we’re formulating clear, “fill-in-the-gaps” implementation guidance for MU2 certification and beyond.

We’ve assembled a team of Health IT organizations for lightweight participation in a pioneering interoperability collaboration. We will identify and address “grey areas” in at least seven key domains of the C-CDA specification: demographics, medications, problems, allergies, vital signs, lab results, smoking status.
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Blue Button+ Hands-on Developer Tutorial


Building applications that will receive patient data via the Blue Button? Join Josh Mandel and Ryan Panchadsaram at an upcoming free Blue Button Plus Developer Forum for their hands-on implementation tutorial.

Friday, July 12, 2013
Autodesk, Inc.
San Francisco, CA

Monday, July 22, 2013
The Graduate Center, CUNY
New York, NY

Forum Agenda and Registration

Tutorial Wiki

Kohane on Health Record Surveillance


Why You Should Demand More Surveillance—Of Your Health Records

Today on WBUR’s CommonHealth:

“Your medical data—the records of your doctors’ visits and operations and drug purchases—is already not as private as you might like to imagine. Dozens of agencies, commercial and governmental, routinely have access to it, ostensibly for the purpose of ensuring efficient and accurate payment.

Yet the vast majority of your health care data remains unused, discarded and ignored. It sits idle when it could be applied today to improve the delivery of health care—including yours—and advance medical science.…”


SMART Networking at Health Datapalooza IV


Shown above (from left), SMART architects Nikolai Schwerter and Arjun Sanyal, co-director Ken Mandl, and advisor Mark Frisse all attended the fourth annual conference to liberate health data in Washington D.C. on June 3–5, hosted by the Health Data Consortium.
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Mandel on RDF Panel at SemTechBiz


Josh Mandel (second from right) spoke on a panel this week at the Semantic Technology & Business Conference, held June 2-5 in San Francisco’s Union Square. His group was there to discuss RDF as a Universal Healthcare Exchange Language, following a workshop earlier in the week that had prepared what came to be called the “Yosemite Manifesto” on the topic.

Like the other four speakers on the panel, Josh is in the business of addressing what the President’s Council of Advisors on Science and Technology stated in its 2010 report on health IT:

The best way to manage and store data for advanced data-analytical techniques is to break data down into the smallest individual pieces that make sense to exchange or aggregate.

RDF—the Resource Description Framework—plays a key role in the SMART API. Details are provided in our developer documentation.

For more on the panel session, see the write-up on, who presented the conference along with parent company WebMediaBrands, Inc.

SMART Reverberations from Health:Refactored


Reflecting on his recent experience at the first-of-its-kind Health:Refactored conference, SMART lead architect Josh Mandel (left) said:

Health:Refactored convened a vibrant mix of doers in Health technology, with a clear focus on designing, building, and iterating on better health tools.  It was an exciting chance to meet and scheme with the broader developer community about SMART, BlueButton+, and the burgeoning marketplace of health APIs. A key theme for me: the critical importance of breaking down silo walls so patients (consumers!) and clinicians can—to echo Zak Kohane’s TEDMED mantramake their data count for them.

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How An Age-Old Chart Is Redefining Health Care


Fast Company Co.DESIGN, May 24, 2013 — Mark Wilson
In a world where organ transplants and MRIs are commonplace, pediatric growth charts don’t sound very exciting. But after spending 30 illuminating minutes on the phone with Harvard researcher Dr. Isaac Kohane, a passionate intellectual who speaks with an infectious urgency, I’m a convert…

Universal EHR? No. Universal Data Access? Yes.


Informatics Professor, May 15, 2013 — William Hersh
A recent blog posting calls for a “universal EMR” for the entire healthcare system. The author provides an example and correctly laments how lack of access to the complete data about a patient impedes optimal clinical care. I would add that quality improvement, clinical research, and public health are impeded by…

Conversations on Health Care: Dr. Kenneth Mandl, Director of the Intelligent Health Lab, Boston Children’s Hospital


Community Health Center, Inc., May 1, 2013 — Mark Masselli and Margaret Flinter
PODCAST: This week, Mark and Margaret speak with Dr. Kenneth Mandl, Director of the Intelligent Health Lab at Boston Children’s Hospital. Dr. Mandl is a pioneer in consumer information technologies and biosurveillance, creating platforms for sharing big health data as well as assisting the…..

Progress toward interoperability in healthcare remains slow


SearchHealthIT, April 30, 2013 — Ed Burns
Recent months have seen a number of initiatives intended to advance interoperability in healthcare. Some see these moves as being—at best—baby steps toward solving the system’s connectivity challenges, while others say they continue to push the industry down a misguided path….

Query Health: Interoperability for Population Data


One of our fellow travelers on the ONC’s interoperability journey is Query Health. Like the SMART platform architecture, Query Health defines a standard framework for looking at medical record data. While SMART focuses on a single-patient view of that data, Query Health is designed to ask questions about a broad swath of patients so that clinical quality trends can be observed.
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Global Design Studio Adds SMART App to Portfolio


Doctors and parents alike are frustrated by today’s standard growth charts. For a fresh look at how to fix this, the SMART team turned to the New York studio of Fjord, a global service design consultancy. Read their case study to see how they worked with a panel of pediatric specialists to turn medical intuition into design thinking, integrating “multiple graphs into a single view to gain a detailed, all-encompassing picture of a child’s health.”

Health IT’s Manhattan project


Government Health IT, April 27, 2010 — Brian Robinson
With all the talk about the politics of health reform, it’s easy to forget that a major driver of the landmark legislation will be the expanded use of health IT. The award in early April of four $15 million contracts seeking health IT research “breakthroughs” was a timely reminder of its importance…

Medical Informatics: Apps, not data warehouses, are wave of future


“We need apps to solve specific problems, not warehouses to store data,” said Jon D’Amore, founder of Clinfometrics, echoing the SMART approach at the Medical Informatics World Conference on April 8. Story in Clinical Innovation + Technology by Laura Pedulli.

6 Big Data Analytics Use Cases for Healthcare IT


CIO, April 23, 2013 — Brian Eastwood
Making use of the petabytes of patient data that healthcare organizations possess requires extracting it from legacy systems, normalizing it and then building applications that can make sense of it. That’s a tall order, but the facilities that pull it off can learn a lot…

Webinar Video with Transcript: Getting SMART about C-CDA


Enjoy this interactive transcript of Josh Mandel’s popular webinar about SMART’s open-source tools, synchronized to the video recording. Now you can:

  • Follow along in the text as the video plays
  • Click any word in the transcript to jump to its location in the video
  • Search for a specific keyword and then jump to each occurrence of that word
  • View the transcript in “scan view,” similar to a word cloud
  • Print the transcript
  • Download the transcript

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Two Contrasting Approaches to Health Care’s API Revolution


The Health Care Blog, April 11, 2013 — Andy Oram
As the health care field inches toward adoption of the computer technologies that have streamlined other industries and made them more responsive to users, it has sought ways to digitize data and make it easier to consume. I recently talked to two organizations with different approaches to sharing data: the SMART platform and the Apigee corporation. Both focus on programming APIs and thus converge on a similar vision off health care’s future. But they respond to that vision in their own ways. Differences include…

Medical Informatics: Apps, not data warehouses, are wave of future


Clinical Innovation + Technology, April 8, 2013 — Laura Pedulli
Beware of the perils of data warehouses, Jon D’Amore, MS, founder of Clinfometrics advised an audience at the Medical Informatics World Conference on April 8.
Providers are still a long way off from meeting Stage 2 Meaningful Use (MU) that requires the achievement of advanced clinical processes and better population health management through EHR information capture and exchange, said co-speaker Dean Sittig, PhD, professor…

Five Questions With: Dr. Kenneth D. Mandl


Providence Business News, April 8, 2013 — Richard Asinof

Posted to with permission

One of the big missing pieces in the build out of the health IT infrastructure now underway as part of health care reform is the development of an underlying programming interface system that will allow for the creative introduction of downloadable apps, similar to what smart phone users can employ.

Dr. Kenneth D. Mandl, a physician and researcher in the Boston Children’s Hospital Informatics Program, where he directs the hospital’s Intelligent Health Laboratory, has been working with software developers to bridge that gap and create apps that allow interface with electronic health records (EHRs), both proprietary and open source.

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Experts disagree on value of electronic health records


Covering Health (Association of Health Care Journalists Blog), April 2, 2013 — Richard Asinof
Electronic health records are a tool, the bottom floor on creating standards to move from mere billing and data collection into a platform to change the way health care is delivered, the way it is paid for, and the manner in which patients are engaged, according to Farzad Mostashari, M.D., Sc.M., the national coordinator of health information technology at the U.S. Department of Health and Human Services…




Getting Data to Patients: Technology + Policy


ABBI and BlueButton+

Over the past six months, I’ve had the privilege of working with the Automate Blue Button Initiative on BlueButton+ specifications for sharing data with patients.  Since ABBI’s core goal of enabling automated patient access to health data is so closely aligned with SMART’s vision, it was exciting to see the initial (Push-based) BlueButton+ specifications implemented at HIMSS 13 this month.

Progress in ABBI’s Pull Workgroup has been slower.  We’re hashing out the details of an OAuth2-based framework that puts patients in control over when and how apps can fetch health data.  An important question has been: how can we enable an ecosystem where thousands of apps connect to providers across the country in a trusted way?

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Health IT innovations, value of EHR systems discussed


KHI News Service, March 19, 2013 — Phil Cauthon
“The children of doctors should not be using better technologies in the third grade than the doctors are using in a hospital,” said Dr. Ken Mandl, co-director of the SMART project, speaking last week to a group of about 40 journalists at the Association of Health Care Journalists national conference

Free Webinar: SMART C-CDA Tools for MU2


Getting SMART about C-CDA: 
Faster Meaningful Use with Clinical Benefits

Tuesday, April 2, 2013
12:00–1:00 p.m. EDT


Join the SMART Platforms team at noon EDT on April 2 for a roll-up-your-sleeves webinar to kick-start/speed-up your Consolidated CDA implementation for MU2. These tools will help you:

  • Generate high-quality C-CDA data exports that are easier to consume
  • Ensure your C-CDA imports flow smoothly on data from other vendors
  • Test your implementation and support end-users with clinical apps

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Beyond HIT Interoperability: Open Platforms are the Key


Open Health News, March 14, 2013 — Edmund Billings
I want to begin by sharing well-known information for the sake of comparison. Both the Apple and Google Android platforms welcome the introduction of new and (sometimes) highly valuable functionality through plug-n-play applications built by completely different companies…

Value of SMART Discussed in Video from HIMSS13


In this video interview recorded yesterday at the 2013 HIMSS annual conference, Doug Fridsma, Director of the ONC’s Office of Standards and Interoperability, tells MedCity News how SMART fits into the ONC’s accountable care strategy.


How do apps for patient data exchange fit into the ONC’s strategy for accountable care? (video)


MedCity News, March 5, 2013 — Stephanie Baum
The multitude of approaches to improve the exchange of patient data is a big trend at HIMSS 2013. One facet of the government’s drive towards achieving that is through the SMART project. Short for Substitutable Medical Apps and Reusable Technologies, it’s made up of a group…

Is Interoperability Possible in HIT? And if it Is, Do We Even Want it?


The Health Care Blog, February 15, 2013 — Edmund Billings
Anyone who understands the importance of continuity of care knows that health information exchange is essential. How are we supposed to cut waste and duplication from the healthcare system and truly focus on patient welfare if doctor B has no idea what tests doctor A conducted, or what the results were?…

Another step forward for data liberation; Check out the SMART C-CDA Scorecard!


Family Health Guy, January 23, 2013 — Sean Nolan
My job at HealthVault is to be a pragmatist. If somebody has information they want to get into HealthVault, my #1 job is to get it there—no matter what format it’s in. That means we accept hand-entered data, scans, uploaded files, CDs and DVDS, Blue Button files, structured CCR and CCD documents, device formats, you name it….

Introducing the SMART C-CDA Scorecard


The SMART team is proud to introduce the C-CDA Scorecard, a web-based tool to help vendors, providers and other health data holders produce high-quality clinical summaries for Meaningful Use Stage 2.

Get ready for Meaningful Use Stage 2

Consolidated Clinical Document Architecture (C-CDA) is the specification cited by Meaningful Use Stage 2 for creating structured clinical summary documents. C-CDA documents are required by MU2 to support transitions of care, to enable patient-driven “view/download/transmit” objectives, and to promote medical record data portability.

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Congratulations, SMART-Indivo Challenge Winners!


Also read about Meducation, winner of our 2011 SMART Apps for Health Challenge.

Thanks to the winning entries in the SMART-Indivo App Challenge, patients may one day find themselves using tools like these within the Indivo personally-controlled health record (PCHR):

  • Webnotes—to clip, organize, and share health information snippets from the web with their care networks.
  • My Health Plus—to view and update their personal health information through a dashboard that adds visualizations of vital signs and integrates disease prevention information from sources on the web.
  • rxInfo—to visualize their data in graph form, download their records according to the VA’s Blue Button protocols, or search government directories for health centers, drug labels, drug interactions, or clinical trials.

Read more

Top 10 science and innovation trends for 2013


Vector, January 16, 2013 — Tom Ulrich
Vector has been deliberating about its predictions for 2013, consulting its many informants. Here’s where we’re putting our money this year; if you have other ideas, scroll to the bottom and let us know.
Genome sequencing scaling up at health care institutions
Last year we predicted genome sequencing’s entry into the clinic; this could be the year it goes viral….

TEDMED 2013 Announces First 10 Speakers and Launches Two New Initiatives to Drive Innovation and Collaboration


PR Newswire, January 14, 2013 — Rogers & Cowan for TEDMED
TEDMED to Host “Great Challenges Day” and “The Hive,” Gathering of Entrepreneurs and Innovators in Health, Medicine — 50+ Speakers and 1,500 Delegates to Explore the Future of Medicine, Healthcare and Technology in Washington, DC, April 16-19, 2013; Event to be Simulcast Globally
TEDMED, the annual multi-disciplinary gathering where leaders from all sectors of society come together to explore the promise of technology and potential of human achievement in health and medicine, has announced the first 10 of its speakers and two new collaboration and innovation initiatives for 2013…

How’s TEDMED 2013 shaping up? Here are the first 10 speakers


MedCity News, January 4, 2013 — Chris Seper
Jay Walker’s TEDMED has started to unveil what 2013′s Davos of Healthcare will look like. The first 10 TEDMED speakers have been revealed. The list shows TEDMED 2013, which is set for April 16 through 19, will stick with its theme of mixing hot-button current events and 50,000-foot thinking with medical rock stars and creatives from the arts and other disciplines. And at least two topics look to get special attention: health and wellness and big data…

A glimpse of what’s ahead in medicine


The Boston Globe, December 31, 2012 — Chelsea Conaboy
Plenty has been written this year about the history of medicine through the lens of the New England Journal of Medicine, which celebrated its 200th anniversary.
The journal created a website chronicling medical advancements through the past two centuries, many of which were highlighted during a symposium held in June.
In an editorial published Thursday on the journal’s website, two top editors join Dr. Isaac Kohane of…

Better Systems for Clinical Data Collaboration: Innovation in Systems and Software


Koa Lab, November 19, 2012 — Andy Palmer
In my last two posts, I wrote about the need for more liquidity in clinical research data.  As a foundation for sharing this new more-liquid clinical research data, we need more patient-centric systems, where patients can create, consume and maintain relevant medical information…

AMIA 2012 Proceedings


AMIA members, if you missed the symposium in Chicago but want to learn more about the SMART team’s presentations, our materials are now published in the Proceedings. (If you are not an AMIA member, you will have access to a limited number of pages.)

Apps to display patient data, making SMART available in the i2b2 platform

Building the SMART Platforms Ecosystem: Toward an Apps-Based Health Information Economy

Supporting Population Queries and Clinical Trials in i2b2 with SMART

Integrating Substitutable Medical Apps, Reusable Technologies (SMART) in the i2b2 Platform

Guiding the Design of Evaluations of Innovations in Health Informatics: a Framework and a Case Study of the SMArt SHARP Evaluation

Did policymakers choose the wrong path?


EHRWatch, November 13, 2012 — Jeff Rowe
How’s that country song go?  “Looking for love in all the wrong places”?
If you don’t mind us channeling our inner Waylon Jennings, that’s what came to mind when we read an article about one health IT observer, who has argued that “Healthcare quality and efficiency could move forward 20 years in a matter of months if only there were true interoperability of…

Interoperability: Quick Route To Better Care


InformationWeek Healthcare, November 12, 2012 — Neil Versel
Critic chides policymakers for downplaying standards and usability in Meaningful Use Stage 1 at American Medical Informatics Association meeting.
Healthcare quality and efficiency could move forward 20 years in a matter of months if only there were true interoperability of electronic health information, according to a noted critic of the health IT industry.
In the opinion of University of Pennsylvania sociologist Ross Koppel, interoperability would help unlock…

AMIA: Why interoperability is ‘taking so darn long’


Healthcare IT News, November 8, 2012 — Neil Versel
CHICAGO – Hospitals can have hundreds of IT systems. Vendors have built proprietary databases. Not everyone follows the same standards. Health systems fear sharing data with competitors. Policymakers have not focused on health information exchange or EHR usability.
These are just a few of the reasons why true interoperability of health information remains so elusive, according to a panel of informatics luminaries….

Spotlight on OSEHRA


We recently posted about Ken Mandl’s participation in a panel at the OSEHRA 1st Annual Open Source EHR Summit and Workshop. Audio and slides are now available to those with OSEHRA user accounts; scroll to Day One, 3pm, “Open Source Best Practice and Business Models.”

OSEHRA logoNow we’d like to back up and talk briefly about OSEHRA itself, and share links that highlight its relationship to SMART.

Read more

Late-Breaking AMIA 2012 Session on Interoperability


Follow the AMIA 2012 Twitter feed in their chat room – no account necessary. Or use hashtag #AMIA2012.

SMART Lead Architect Josh Mandel and Evaluator Ross Koppel will speak in the following late-breaking session.

LB05: Interoperability: Why is it Taking so Darn Long?
Tuesday, November 6 3:30 p.m. – 5:00 p.m. Room: Continental A

Gil Kuperman, New York Presbyterian Hospital; Harry Solomon, GE Healthcare; Ross Koppel, University of Pennsylvania; Charles Jaffe, HL7, Joshua Mandel, Children’s Hospital Boston, Douglas B. Fridsma, Office of the National Coordinator for HIT

Questions abound around why it’s taking so long to achieve practical interoperability in the US health system? Patients and their advocates wonder why can’t the records of care at one institution easily be merged with the records of care somewhere else? Or why can’t health information interoperate on the Internet the way that so many other types of industries do? Those in the industry debate the level of difficulty around technical problems and standards.

AMIA 2012 SPC Chair Bill Hersh, MD, asked recently “is it something inherent in the nature of clinical data, such as concern for privacy or the economic aspects of healthcare that lead to organizations not wanting to share data?”

This panel will examine the potential for interoperability to improve care, the role of standards organizations in advancing interoperability and what is needed beyond standards per se to support interoperability-based use cases. Whoever or whatever is at fault, the problem is that in the eyes of many, including AMIA members, interoperability is not happening fast enough. In other words “why is it taking so darn long?”

SMART on the Agenda at AMIA 2012


The AMIA 2012 Annual Symposium begins today in Chicago, where it is currently “Informatics Week” as declared by Mayor Rahm Emanuel.

SMART will be highlighted in Scientific Sessions S27 & S33 on Monday and S94 & S99 on Wednesday, as well as in Poster Session 2 on Tuesday.

Read more

“ITdotHealth II” 2012 Materials Now Posted


A section of our site is now devoted to coverage of the meeting held on September 10-11, including video and slides from keynotes, talks and panels, and a summary report from the meeting.

The meeting brought together over 100 thought leaders and affirmed the importance of developing and maintaining a standard programming interface to underpin an “app store” for health. We began to outline the actions required to create an ecosystem of health IT apps that use EHR data and enable a nimble and constantly evolving health system. Collaborations will soon be underway to define the technical approach and governance for supporting an API standard similar to the SMART Platforms alpha releases.

Mandl at OSEHRA 1st Annual Summit


Yesterday, SMART’s Ken Mandl sat on a panel discussing “Open Source Best Practice and Business Models.” He was joined by US CTO Todd Park, FDA CIO Eric Perakslis, and Netspective CEO Shahid Shah. The session was moderated by BIDMC CIO John Halamka.

The panel was part of OSEHRA’s 1st Annual Open Source EHR Summit and Workshop, taking place October 17-18. OSEHRA, the Open Source Electronic Health Record Agent, “supports an open, collaborative community of users, developers, and companies engaged in advancing electronic health record software and health information technology.”

Source: Dan Housman

User feedback is key to improving EHR systems


American Medical News, October 10, 2012 — Pamela Lewis Dolan
A report by an Institute of Medicine panel calls for a central, public database featuring insights from health information technology users.
Practices shopping for an electronic health record system or seeking to improve an existing system should have a central clearinghouse of reviews, feedback and tips from other users, says an Institute of Medicine discussion paper. The paper, published in September, is intended to foster discussion of a recommendation the IOM made in an earlier report that examined ways EHRs can be improved. The institute recommended that the Dept. of Health…

“HealthVault SMART Patient” App Built in Under a Week


After attending last week’s Harvard Health IT Meeting (“ITdotHealth II”), HealthVault’s Sean Nolan got right to work on an app that enables providers to send their patients a copy of their clinical information as a Continuity of Care Document.

Medicine 2.0 Impressions from Pew Internet Panelist


Susannah Fox, an Associate Director of the Pew Internet & American Life Project, was at Medicine 2.0 over the weekend. In addition to speaking on a panel, she shared her impressions of Day One on the blog, including a reference to the SMART Platforms presentation and enthusiasm about our clinician-facing apps.

Summary of “ITdotHealth II” – the 2012 Harvard Health IT Meeting


The following is an overview of the conference, held September 10-11, 2012. In several weeks, we will post a complete executive summary, as well as videos and slide presentations from the event.

The concept of substitutable apps has become a reality, as multiple examples illustrate—such as the blood pressure app, now in live clinical use on the Cerner System at Boston Children’s Hospital: Read more

SMART at Medicine 2.0 Boston Tomorrow


Medicine 2.0, the World Congress on Social Media, Mobile Apps, and Internet/Web 2.0 in Health, Medicine and Biomedical Research, has landed in Boston for its 5th annual conference! The agenda will feature two SMART-related presentations:

Both presentations are part of the session on Web 2.0 approaches for clinical practice, clinical research, quality monitoring to be held in the large auditorium tomorrow (Saturday, 9/15) at 2:00-2:45 p.m. (see page 13 of the final program).

The conference is sold out, but you can still register for the Webcast.

Growth of SMART health care apps may be slow, but inevitable


O’Reilly Radar, September 13, 2012 — Andy Oram
Harvard Medical School conference lays out uses for a health data platform.
This week has been teeming with health care conferences, particularly in Boston, and was declared by President Obama to be National Health IT Week as well. I chose to spend my time at the second ITdotHealth conference, where I enjoyed many intense conversations with some of the leaders in the health care field…

Harvard Health IT Meeting: O’Reilly Radar Coverage


In his piece Growth of SMART health care apps may be slow, but inevitable,” Andy Oram sums up this week’s Harvard Health IT Meeting, aka ITdotHealth II.

Stay tuned to the SMART Platforms site over the next several weeks for complete, in-depth coverage of the conference.

New app distills the fine art of interpreting a child’s blood pressure


Vector, September 12, 2012 — Nancy Fleisler
The Affordable Care Act, now the law of the land, mandates free blood pressure screening for children as part of their health care coverage. Yet often hypertension in children is missed, while other children get evaluated and sometimes treated for high blood pressure readings that turn out to have been transient (often induced by kids’ fear of doctors). That has cardiologists like Justin Zachariah, MD, MPH, concerned…

Halamka Recaps Participation in ITdotHealth II


On his Life as a Healthcare CIO blog, John Halamka gives a synopsis of his contribution to ITdotHealth II. He was among the panelists speaking Monday on “Apps and APIs: Innovating Around Vendor and Homegrown EHRs.” His summary addresses the issue from federal, state, and local perspectives.

How to Build a Successful API


In Suddenly it’s all about the APIs, Microsoft HealthVault’s Sean Nolan outlines six key challenges to building an API that is desirable to developers—whose adoption of it, or lack thereof, will make or break its survival in the marketplace.

Lilly’s “Open Clinical Intelligence Network” Aligned With Substitutability


Tom Krohn, an attendee to the recent Health IT Meeting at Harvard (“ITdotHealth II”), is the business lead for the Eli Lilly Clinical Open Innovation team. Leading up to the meeting, he wrote about the ways his team’s approach aligns with SMART.

Inflexible, Big-Box EHRs Endanger the QI Movement


The Hospitalist, September, 2012 — Win Whitcomb
In “The Lean Startup,” author Eric Ries notes that in its early stages, his gaming company would routinely issue new versions of their software application several times each day. Continuous deployment—the process Ries’ company used—leveraged such Lean principles as reduced batch size and continuous learning based on end-user feedback to achieve rapid improvements in their product…

Moving Health IT Innovation forward: A vision for substitutable components


Eli Lilly Clinical Open Innovation, September 4, 2012 — Tom Krohn
In the March 2009 edition of the New England Journal of Medicine, Drs. Kenneth Mandl and Isaac Kohane of Harvard Medical School introduced the idea of a health information technology platform that works more like the iPhone than a traditional system.  Entitled “No Small Change for the Health Information Economy,” the paper suggests a simplified platform approach where innovation is spurred through substitutable components…

Semantic Web for Health Care and Life Sciences Summer School August 27-30


Next Monday-Wednesday, August 27-30, the W3C will host a “Summer School” at the MIT CSAIL Stata Center for those interested in learning about the Semantic Web as applied to Health Care and Life Sciences.

Visit the wiki of the event, also known as the HCLS Hackathon, or download the flyer (PDF).

Also be sure to register.

Webinar on SMART-Indivo App Challenge: Slides Posted


As Health 2.0 News recently reminded the community, the SMART-Indivo App Challenge is underway.

On August 7, a webinar provided an in-depth review of the challenge and allowed interested participants to ask questions to the challenge hosts. Slides from the webinar are available on the challenge website and hosted on Slideshare.

Advance registration for the challenge is recommended. Final submissions are due on September 28, 2012. The first place team will be awarded with $10,000. The second and third place teams will receive awards of $2,000 and $1,000, respectively.

CCD: Show me the codes!


In my 7/24/2012 post, I observed that exchanging uncoded lab results is the state of the art.

Why worry? SMART is pushing to enable third-party apps on disparate health IT systems, and codes are the glue holding meaning together. Without coded data, apps can’t tell a Hemoglobin A1c measurement from a monocyte percentage!

In the USA we have substantial infrastructure to promote the flow of coded data. So where do things break down?

Read more

New SMART Partner: Fjord


Introducing another partner in our mission to bridge the doctor-developer-designer divide: Fjord. This digital service design consultancy’s New York office will be helping the SMART team create an open-source, web-based, interactive pediatric growth chart application. Embracing a design-led approach to clinical end-user needs, this collaboration aims to develop a new way to present pediatric growth charts so they can be easily read, understood, and shared among clinicians and other medical professionals, as well as used in communication with parents.

The collaboration will start with an immersive phase of interviewing pediatric and medical informatics specialists to help establish current content, context, and usage of the pediatric growth chart. This targeted usability research will surface insights and understanding of how pediatric growth charts are actually used and how they should be changed to enhance their utility for different clinical and communication purposes. The Fjord team will then create detailed designs that will be tested and refined with clinicians and parents.

After the design has been completed, the Fjord and SMART Project teams will collaborate to complete a full development, implementation, and launch of the design, resulting in an end-to-end web app experience to be introduced to, and shared with, the medical and clinical informatics community.

Fjord Logo

Clinical summary export: What is a CCD for?


At last week’s Redwood MedNet HIE Conference, I had the chance to attend an “Interoperability Exhibition” demonstrating the data exchange capabilities of several EHRs. Two themes emerged around clinical summary export. I’ll focus on CCDs (Continuity of Care Documents), but the themes apply to CCRs (Continuity of Care Records) as well:

  1. “What is a CCD for?” Providers use EHRs to generate the patient summary records they share with patients and other providers. But it’s unclear what (exactly) should go into these documents, and whether/how the provider should have a say.
  2. “Where are the codes?” Even though certified EHR products are capable of generating CCDs with appropriate codes (LOINC-encoded labs, for instance), this doesn’t mean that providers’ systems are configured to do so. The demonstrations I saw exchanged CCDs with uncoded labs!

Today’s post focuses on #1. In a future post, I’ll investigate the interplay between certification and meaningful use to understand where LOINC codes disappear to.

Read more

SMART i2b2 “Patient-centered View” and App Bundle to Be Presented July 25


Next Tuesday and Wednesday, July 24-25, the i2b2 Academic Users’ Group will host its second annual conference at the Joseph B. Martin Conference Center in Boston. Wednesday’s 9:30-10:00 a.m. segment will be a demonstration of the patient-centered view and app bundle developed using the SMART i2b2 cell. The full agenda of the conference, which will be preceded by an NLP workshop, can be found on the i2b2 website.

SMART i2b2 patient-centered view

New SMART Partner: Sermo Online Physician Community


The SMART team is pleased to announce a new partnership that will break down barriers between developers, designers, and doctors. Sermo, the largest online physician community in the United States, will connect us with their network of over 130,000 members for feedback on SMART apps as they are created.

“We are excited to be working with the SMART project,” said Jon Michaeli, VP, Marketing and Membership. “It’s no secret there are major obstacles associated with the implementation and widespread adoption of an efficient IT infrastructure in the US healthcare system today. Physicians in the Sermo community are constantly exchanging war stories, from how EMR incompatibilities cripple their work streams to how they compromise rather than improve patient care. This project presents a great opportunity for them to share their opinions with leading researchers and technologists who are well positioned to make a difference.”

An example of the kind of insights that Sermo has gathered from its members is the Physician Sentiment Index™ (PSI), conducted annually since 2010 along with athenahealth, a cloud-based physician software and billing firm. The 2012 PSI was just released in June.

Sermo mobile and desktop interfaces

ONC, Health 2.0 Open Contest for Consumer-Focused Health Apps


iHealthBeat, July 12, 2012 — Andy Oram
On Wednesday, Health 2.0 and the Office of the National Coordinator for Health IT launched a contest — called the SMART-Indivo App Challenge — inviting developers to create consumer-focused health applications, Healthcare IT News reports. SMART — which stands for Substitutable Medical Apps, Reusable Technologies — is one of four Strategic Health IT Advanced Research Projects funded by ONC. Indivo is a personal health record platform…

Calling all innovators: Health 2.0 contest makes eHealth a priority


Healthcare IT News, July 12, 2012 — Erin McCann
SAN FRANCISCO – On Wednesday, officials at the Office of the National Coordinator for Health Information Technology (ONC) and Health 2.0 announced the launch of a collaborative venture that aims to spur health information technology innovation among software developers. The Investing in Innovation (i2) Initiative competition seeks to foster the use of technology to drive improved health outcomes, officials say, driving patient participation in their own health and wellness data…

SMART-Indivo App Challenge


The SMART-Indivo App Challenge is now Live!

This contest is a call to developers to build an Indivo app that provides value to patients using data delivered through the SMART API and Indivo-specific extensions. The top 3 submissions will win cash prizes, with the top one taking home $10,000 and the opportunity to exhibit at an upcoming conference.

We look forward to seeing what innovative ideas are enabled by Indivo and its integration with SMART, so check out the contest details, read the Indivo Documentation, visit the Indivo Sandbox, and start hacking!

Health2.0 Developer Challenge logo

July 11: Remote Seats Left for HANDI’s SMART/OpenEHR Meeting


HANDI–the Healthcare App Network for Development and Innovation–will host a meeting on the SMART platform and OpenEHR on Wednesday, July 11.

This meeting will include expert presentation of the two technologies and an opportunity to explore their further use in the UK and/or possible collaboration at a global level.

  • The SMART Platform – Rob Tweed will lead on this with input from US colleagues who will hopefully join virtually – Rob is a UK based developer who has worked with SMART on the creation of a SMART wrapper for VistA open source EHR
  • OpenEHR – Dr Ian McNicoll and Seref Arikan will lead on this. Ian is a former GP and experienced informatician who has worked on OpenEHR in the UK, Europe and Australia. Seref is also an experienced health informatician and is currently working on OpenEHR at UCL London (one of the founders of the OpenEHR Foundation).

Registration is required, and remote seats are still available.

O’Reilly Media Editor Calls Indivo-SMART-i2b2 Trio a Powerful Combination


Among the attendees of last week’s Indivo conference was Andy Oram, who writes regularly about the societal effects of Internet policy and technical innovation. His piece in the O’Reilly Radar summarizes Monday’s talks and explains the significance of the “historical” SMART-enabled Indivo v2 release. It also mentions Tuesday’s hackathon, shown below, where developers tried their hands at app creation and integration.

Indivo hackathon 2012

Indivo hackathon 2012

Clinician, researcher, and patients working together: progress aired at Indivo conference


O’Reilly Radar, June 21, 2012 — Andy Oram
While thousands of health care professionals were flocking to the BIO International Convention this week, I spent Monday in a small library at the Harvard Medical School listening to a discussion of the Indivo patient health record and related open source projects with about 80 intensely committed followers. Lead Indivo architect Daniel Haas, whom I interviewed a year ago, succeeded in getting the historical 2.0 release of Indivo out on the day of the conference. This article explains the significance of the release in the health care field and the promise of the work being done at Harvard Medical School and its collaborators…

SMART-Enabled Indivo X Release a Highlight of Users’ Conference


A key topic at this year’s Indivo Users’ Conference was the release of version 2.0, which provides “deep integration with the SMART data models and API.” In other words, the Indivo personal health platform is now a full-fledged SMART container. Visit the Indivo site to learn more about

  • What SMART adds to Indivo
  • What Indivo adds to SMART
  • The SMART-Indivo Portal

Conference presentations included a keynote from Farzad Mostashari, National Coordinator of HIT, ONC; Indivo–SMART integration by Daniel Haas, Indivo Lead Architect; the SMART API by Nikolai Schwertner, Senior SMART Developer; Indivo–i2b2 integration by Shawn Murphy, Partners HealthCare; Indivo iOS framework by Pascal Pfiffner, Children’s Hospital Informatics Program; and lightning talks from the MIT Media Lab, Novartis, Childhood Arthritis & Rheumatology Research Alliance, and MuleSoft.

Ken Mandl also premiered the new Indivo Film, an animated “story of what’s to come” in Health IT, voiced by Amy Madigan.

EHR Innovation Gap Threatens Healthcare Progress


InformationWeek Healthcare , June 19, 2012 — Nicole Lewis
Electronic health records suffer from a lack of innovation that thwarts physicians’ attempts to advance healthcare processes and workflow. Unlike word-processing programs, search engines, social networks, and mobile phones and apps, EHRs are stuck in the pre-Internet world where EHR vendors not only control the data, but also resist improvements to functionality while reaping huge financial rewards, concludes a…

HIT Expert Contends That EHR Vendors are Curbing Innovation (Part 2)


Healthcare Informatics Magazine, June 18, 2012 — Gabriel Perna
A recent piece by two Boston Children’s Hospital informatics researchers in the New England Journal of Medicine, Kenneth Mandl, M.D. and Isaac Kohane, M.D., made the argument that EHR vendors are holding back innovation in the health IT industry. This controversial opinion comes from the duo’s belief that many vendors have failed to adopt basic Internet-era sources for their systems such as private cloud-based storage and secure communication protocols, as well as modern consumer technologies such as word processing and search engines…

HIT Expert Contends That EHR Vendors are Curbing Innovation (Part 1)


Healthcare Informatics Magazine, June 15, 2012 — Gabriel Perna
In a recent piece for the New England Journal of Medicine, two Boston Children’s Hospital informatics researchers, Kenneth Mandl, M.D. and Isaac Kohane, M.D., make the argument that EMR and EHR vendors are holding back innovation in the health IT industry. Many vendors, the duo insists, have failed to adopt basic Internet-era sources for their systems such as private cloud-based storage and secure communication protocols, as well as modern consumer technologies such as word processing and search engines…

The EMR Race is Over, Long Live EMR Extender Tools!


Change Doctor, June 15, 2012 — Lyle Berkowitz
I’ve been increasingly talking about the concept that the EMR race is over, and that EMRs now serve as the infrastructure and platform upon which innovative companies will develop “EMR Extender Tools“, in areas such as: Physician Productivity (e.g. healthfinch), Decision Support (e.g. Zynx), Business Intelligence (e.g. DrEvidence), and Patient Outreach (e.g. Healthloop).  This seems to resonate well with mature EMR users since they often feel like the….

In the New England Journal of Medicine:
Letting the Air out of EHRs


Mandl and Kohane in the New England Journal of Medicine: Escaping the EHR Trap — The Future of Health IT [PDF]. It is a widely accepted myth that medicine requires complex, highly specialized information technology (IT) systems. This myth continues to justify soaring IT costs, burdensome physician workloads, and stagnation in innovation — while doctors become increasingly bound to documentation and communication products that are functionally decades behind those they use in their “civilian” life.

EHR design: A mold in need of breaking


FierceEMR, June 13, 2012 — Marla Durben Hirsch
Editor’s Corner: Apparently I struck a nerve with last week’s commentary on making the transition to electronic health records. The editorial generated quite a few comments, and every one of them were against EHRs.  They’re expensive, become a crutch for the lazy or less-trained, and deter from direct patient-physician communication…

Fierce Q&A: EHR vendors propagating a myth about their products


FierceEMR, June 13, 2012 — Marla Durben Hirsch
Electronic health record system vendors are “entrenched” in a legacy mindset that hampers innovation, preferring to propagate the myth that EHRs require specialized IT systems in order to protect their prices and block new entrants into the industry, according to an article published this week in the New England Journal of Medicine. EHRs can and should be redesigned and adopt modern…

UK Collaborators Build SMART Proof of Concept at NHS Hack Day


The UK’s National Health Service held its first NHS Hack Day on May 26-27, a weekend marathon of disruptive innovation, largely inspired by the open source culture and hackathon trend in the US. One of the 14 teams to submit an app at the end of the session used SMART, implementing a portion of the SMART API to expose the HES dataset. The result was a modest data grid and radar chart for patient problems (image below). But the strategic ramifications, said co-developer Rob Tweed, are far-reaching. “The technology clearly works and is applicable to use in the UK just as in the US. This is a set of wheels that the NHS can avoid re-inventing.”

The demo app has also added momentum to a specific goal that Tweed and colleague George Lilly are helping us realize: to SMART-enable VistA, the open source EHR created at the US Dept. of Veterans Affairs. The two will be presenting on just that topic next Tuesday, June 5, at the 25th VistA Community Meeting in Fairfax, VA. Their talk will follow shortly after Lead Architect Josh Mandel presents an overview of the SMART architecture.

screenshot of SMART demo using patient problems from HES dataset

“CCD export” doesn’t solve interoperability


At yesterday’s Health 2.0 conference, Farzad Mostashari asked why SMART isn’t using CCD export (as specified by Meaningful Use) to extract data from EMR systems. This is a great question, in part because it separates out two important aspects of SMART:

  1. Getting data out of today’s EHRs
  2. Presenting those data to apps in a natural, convenient, developer-friendly way.

—and focuses on #1. (I don’t think many would argue that CCD is fit for #2. And to be clear: for developers building a SMART app, the details of #1 are almost irrelevant. SMART app developers get one clear-cut API to work with, and consistent SMART data elements)

Read more

National Coordinator Cites SMART as #1 Approach for Government Improving HIT


As reported in the Boston Globe, Farzad Mostashari, at the Health 2.o conference, observed that “The investments in research and development that are going on in the consumer technology space are now dwarfing the investment and innovation that are happening in, say, the military.” As an approach the government can take to promoting improvements in HIT, he cites the SMART project “where Zak Kohane and Ken Mandl are developing a system of “iPhone-like” medical apps designed so that they can be easily swapped out when better ones are developed but that allow for easy saving and transfer of data to a new program.”

Farzad Mostashari, National Coordinator for HIT, to keynote 2012 Indivo X Annual User’s Conference


Farzad Mostashari, MD, ScM, National Coordinator for Health Information Technology , will keynote the 2012 Indivo X Annual User’s Conference at Harvard Medical School June 18th-19th.

The 2012 Indivo X Annual User’s Conference to be held on June 18th-19th at Harvard Medical School’s Countway Library. Details and registration are available below. This meeting will have a technical focus, but will be of interest if you are:

  • Considering adopting Indivo for your health system
  • Integrating Indivo into your business offerings
  • Using Indivo for your research
  • Adding Patient Reported Outcomes to your registries or trials
  • Deeply in the Indivo X codebase
  • Interested in developing apps for Indivo X
  • Adopting the SMART platform and looking to add patient-facing apps

The Main Conference hours are Monday, June 18, from 1-5:30pm. Topics will include:

  • The Indivo X Release
  • Integration of Indivo X with
  • Integration of Indivo X with
  • Indivo X iOS Framework
  • The upcoming Indivo Challenge
  • Lightning talks by Indivo implementers

On Tuesday, June 19th from 8am-3pm, we will run an all-day hackathon to design and begin implementing innovative patient-facing apps on top of Indivo. The morning will be spent brainstorming, connecting with teams around shared interests, and designing apps, and the afternoon will be devoted to implementation. This event is NOT limited to developers—health professionals, innovators from industry, or anyone with a good idea for an app will be invaluable for making the most of the hackathon. The Indivo team will be on hand to provide support and advice throughout the day.

Space is limited—please register here: Users’ Conference and Hackathon Registration Form

If you have any questions about the event or registration please contact

Looking forward to seeing you there!

How SMART is your health IT system?


EHR Intelligence, March 27, 2012 — Kyle Murphy
Over the past few weeks, a debate has broken out between a team of researchers and the National Coordinator for Health Information Technology, Farzad Mostashari, over the former’s findings in a recently published study in Health Affairs. Dr. Mostashari used his government-hosted blog…

SMART platform ‘promising’ for EHRs


FierceEMR, March 21, 2012 — Marla Durben Hirsch
The Substitutable Medical Applications, Reusable Technologies (SMART) platform appears to be a “promising approach” to improve electronic health records now that phase one of the project has been completed, according to its developers. The creators report this week in the Journal of American Medical Informatics Association that unlike current proprietary EHR systems, the SMART platform operates as a standard base platform to which users can add or subtract modular third-party applications, similar to the methodology used by iPhone or Android…

How do You Promote Open App Development in Health IT?


Healthcare Informatics Magazine, March 20, 2012 — Jennifer Prestigiacomo
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 JAMIA: The SMART Platform: early experience enabling substitutable applications for electronic health records


The team has published a technical paper on the SMART platform in JAMIA: The SMART Platform: early experience enabling substitutable applications for electronic health records [PDF].

Boston Health Technology Meetup


The SMART team recently had a chance to to interact with the Boston area health IT community. On March 6th executive director Rachel Ramoni and others joined The Greater Boston Health Technology Meetup to discuss the SMART platform. The evening’s proceedings consisted of presentations, demos and a spirited Q&A session focused heavily on how SMART can facilitate commercial app development and strategies for fostering SMART adoption.

SMART Health Information Exchanges


The SMART team is happy to announce that it’s working with Mirth Corporation, a global leader in commercial open source healthcare information technology, to SMART-enable the HealthBridge and Redwood MedNet Health Information Exchanges. The SMART API and the growing selection of SMART applications offer a great way to enhance the utility of the health data shared within these two networks. Stay tuned to for updates on this and other exciting projects.

About Mirth Corporation

Mirth is a global leader in commercial open source products and services powering healthcare interoperability and community-based care management. Mirth delivers information technology consulting, and hosts high availability secure applications. Mirth solutions are used daily by thousands of health professionals and institutions worldwide to streamline care management processes and to securely exchange health information across enterprises, communities and broad geographies. For more information visit

OpenMRS releases SMART Module


SMART and OpenMRS are proud to announce the initial release of a SMART module for OpenMRS.

This module expands the reach of the SMART API by allowing apps to run (unmodified!) on the open-source Open Medical Record System. It also provides a lightweight interface for developers who want to extend the functionality of OpenMRS.

Work on this module began as a Google Summer of Code project and continued through the fall with support from the OpenMRS team.

The initial release provides developers access to the SMART Connect API in OpenMRS. SMART REST API support is planned for a future release.

SMART @ the ONC Annual Meeting


Josh Mandel, lead architect for the SMART team, will be presenting at this year’s ONC Annual Meeting on November 17th. The focus of his presentation will be on SMART’s efforts to engage the developer community in support of the platform. You can get a front row seat to by joining the webcast.

SMART Preview Release v0.3


The SMART team has published a new preview release (v0.3) of the SMART platform. With this release, we are rolling out a number of API changes incorporating feedback from the $5K challenge, simplifying some of the infrastructure, and adding some new data types. We have already updated the public sandbox with the v0.3 code, as well as the developer’s guide.

One of the main changes with v0.3 is that SMART apps are no longer required to have a bootstrap.html. The apps are now launched directly from index.html with the oauth tokens passed as a get parameter. For a more complete run-down on updating your SMART application code, please see:

We are looking forward to hearing your thoughts and suggestions about the new release.

What Killed Google Health?


Ken Mandl interviewed by WBUR’s Carey Goldberg for the Common Health Blog. He reflects on the demise of Google Health, lessons learned for the health system and for personal health records.

Challenge Winners Applaud SMART


“Polyglot Systems has developed a number of products that can improve health outcomes and decrease costs.  Despite these benefits, achieving widespread adoption is extremely difficult if the products cause any interruption in provider workflow.  This makes EMR/EHR integration essential.  The SMART Platform offers Polyglot a way to quickly and affordably integrate its products across multiple EMR and EHR systems.  By doing so, the SMART Platform lets Polyglot and other innovators deploy their solutions much more broadly and quickly than would otherwise be the case.”

Meducation SMART app could be a lifesaver


SmartPlanet, June 28, 2011 — Stacy Lipson
Now more than ever, iPhone app developers are offering iPhone applications that will improve patient safety. Polyglot Systems created the Meducation SMART app, which calculates medication lists and offers patients the ability to print and view medication instructions for prescription medications in a dozen languages…

SMART to be presented at i2b2 user’s meeting on June 29


SMART and i2b2 investigator Shawn Murphy will be presenting SMART at the June 29th i2b2 Academic User’s Group meeting!

SMART Health Apps: Children’s Hospital, Harvard Medical Announce Contest Winners


BostInno, June 23, 2011 — Cheryl Morris
New opportunities for innovations in the health industry are everywhere, thanks in part to more sophisticated smartphones like the iPhone and Android devices. In early March we highlighted a mobile health app contest being put on by Children’s Hospital Boston and Harvard Medical School. Winners were announced earlier this week, working to help welcome a new wave of apps to hospitals, patients and physicians…

SMART App Challenge Winner Announced


On June 16th and 17th, 2011, our judges convened and deliberated to score the apps for the SMART Apps for Health $5,000 Challenge, which opened back in March.

Meducation is the winner.
Meducation sample pages

The Meducation SMART app, created by Polyglot Systems, Inc. – a health IT company with a focus on improving care and access for underserved patient populations – provides multilingual, patient-friendly instructions for medications listed in a physician’s electronic medical record or the personally controlled health record of a patient. The app uses the SMART programming interface to obtain the medication list and then links out to a drug information database, which facilitates the generation of simplified medication instructions for patients, available in a dozen languages.

In addition to the winner, several selected as honorable mentions:

  • Clinical Research facilitates interoperability between an EMR system and a clinical electronic data capture system
  • MyNote provides an intuitive, interactive timeline of patient history with disease-specific schemes, and allows patients to annotate the timeline
  • Priority Contact enhances the work process of a clinician by managing contact with patients after they have left the clinic and new information relevant to their treatment plan has been obtained
  • DxSocial matches patients with doctors based on their experience treating patients similar to them matches patients with doctors based on their experience treating patients similar to them
  • Medications Risk Maps for SMArt helps identify and compare medication side effects and risk of adverse events across drugs
  • rxInfo is a suite of SMART apps to help identify patients for clinical trials, provide drug interaction information, FDA Label information about marketed drugs, and a listing of nearby federally funded health centers

You can view all the submitted apps at

Current-stage EMRs decide if, when, and how you will view the data trapped in their systems. The SMART Platform Apps Challenge was designed to demonstrate what can happen when electronic health information becomes liberated and can be readily consumed by computer applications. iPhone and Android app developers have been very successful because the address book and GPS data in those platforms is clearly and consistently presented by the platform. Our goal is to present health data in as useful and consistent format. Based on the submissions we received, we think we have demonstrated that this approach can be successful.

That we had so many excellent applicants reflects the hunger and need felt in the community to deliver innovative healthcare applications directly to doctors and patients without having to learn the details of a large, monolithic EMR

Congratulations to our winner and honorable mentions!

SMART in the Indivo X Webinar


SMART in the Indivo X Webinar, June 3 2011 from SMART Platforms on Vimeo.

SMART app receives clinician praise


The SMART team is working on creating a blood pressure centiles SMART app for initial deployment at Children’s Hospital, Boston.  There aren’t standard cutoffs for normal pediatric blood pressures.  For kids, the normal blood pressure depends upon height and gender.  Unfortunately, looking up these normal blood pressures is pretty time consuming.  Thus, we’re working with a great, transdisciplinary group of docs at Children’s to create an app that will do the calculating for them and give them more time with their patients.  One of those docs is cardiologist Justin Zachariah, M.D., M.P.H.  He said, “What you have already created is definitely a quantum leap forward compared to where we are now.”  Through SMART, we’ll be able to make this app available to other SMART-enabled systems.

15 SMART Apps for Health Submitted


We’re happy to announce that the SMART Apps for Health Challenge resulted in 15 apps being submitted.  These apps range from PriorityContact(TM), an app that manages contact with patients, to rxClinicalTrials, which helps to identify trials that a patient might be eligible for through  Our entrants each got their app working in the SMART Reference EMR in under 3 months, demonstrating the power of lowering the barriers to developer engagement in health IT.  The judging period is now underway, and we’ll announce the winner of the $5,000 on June 22nd. Stay tuned!

June 3 webinar call in details


Time: 12:00 pm, Eastern Daylight Time (New York, GMT-04:00)
Meeting Number: 714 847 971
Meeting Password: (This meeting does not require a password.)

To join the online meeting (Now from mobile devices!)
1. Go to
2. If requested, enter your name and email address.
3. If a password is required, enter the meeting password: (This meeting does not require a password.)
4. Click “Join”.

To view in other time zones or languages, please click the link:

To join the audio conference only
To receive a call back, provide your phone number when you join the meeting, or call the number below and enter the access code.
Call-in toll-free number (US/Canada): 1-866-699-3239
Call-in toll number (US/Canada): 1-408-792-6300
Global call-in numbers:
Toll-free dialing restrictions:

Access code:714 847 971

For assistance
1. Go to
2. On the left navigation bar, click “Support”.

Indivo Users Webinar, June 3rd, 2011


The development team for Indivo X, the SMART-enabled, open source personally controlled health record platform, is going to conduct a webinar on June 3rd. 2011. Topics will include: the current state of the platform and API; ongoing projects in the Indivo X ecosystem, including the use of Indivo X in a patient portal and in an online social network; a proposed roadmap for upcoming features and enhancements, such as plans to support the Direct Project.

Please register here if you plan to join us on June 3rd. We’ll send you an invitation with instructions to join the webinar shortly before the event. An in person meeting will be planned for sometime thereafter. Please go to to learn more about Indivo X.

Indivo Users Webinar Agenda

Friday, June 3, 2011

12Noon Welcome and Intro

12:15pm Indivo X

12:25pm Indivo X Ecosystem

1:05pm Indivo X Roadmap

  • Pluggable Schemas
  • Enhanced Database Support
  • Event Encapsulation
  • API Support
  • Direct Implementation

1:40pm Q&A

2:00pm Adjourn

Indivo X at OSCON 2011


Indivo X is the SMART-enabled, open source personally controlled health record platform. Daniel Haas, the platform’s lead architect, will be delivering a talk on the architecture of and security implications of Indivo X, its place in the open source community, its prospects for future development, and its relationship to SMART Platforms. Details about his talk can be found here:

You can learn more about Indivo X at

SMART Health App $5000 Challenge


The SMART $5K Apps Challenge is now closed to entries, but you can still learn about it at our page!

Our panel of judges are currently reviewing the entries, and winners will be announced on June 22nd.

SMART wishes to thank our eminent panel of judges:

Susannah Fox
Director of Health Research at the Pew Internet & American Life Project

Regina Herzlinger
Nancy R. McPherson Professor of Business Administration, Harvard Business School

David Kibbe
Director, Center for Health Information Technology, American Academy of Family Physicians
The Kibbe Group LLC

Ben Shneiderman
Professor of Computer Science at the Human-Computer Interaction Laboratory at the University of Maryland, College Park

Doug Solomon
Chief Technology Officer at IDEO

Edward Tufte
Professor Emeritus of Political Science, Statistics, and Computer Science at Yale University

Jim Walker
Chief Health Information Officer, Geisinger Health Systems

April 27th Webinar: How to Become a SMART Container


SMART Webinar April 27

Learn how your health IT system can harness the power of the developer community.

The SMART (Substitutable Medical Apps, Reusable Technologies) project is working to lower the barriers for external developers to create innovative healthcare apps. A SMART-enabled health IT system will be positioned to take advantage of these innovations and make them available to its users.

Attend our webinar and learn how your health IT system can become SMART.
April 27, 2011 2:00 – 3:00 P.M. Eastern
MxMQ%3D%3D Meeting Number: 716 280 736 Meeting Password: SHARP

To join the audio conference only:
Call-in toll-free number (US/Canada): 1-866-699-3239
Call-in toll number (US/Canada): 1-408-792-6300
Access code: 716 280 736

SMART Platforms Screencast available


A concise overview of the project is available here in video form.

Open Source in Good Health and Vice Versa


ComputerworldUK, April 5, 2011 — Glyn Moody
Last week I wrote about the UK government’s “new” IT strategy, which is designed in part to avoid some of the costly mistakes of the past. And as far as the latter go, there aren’t many bigger or costlier than the NHS National Programme for Information Technology (NpfIT)…

Smart Apps for Health Challenge – Nudging You to Participate


New Media Medicine (MIT Media Lab), March 29, 2011
We want to spread the word about the Smart Apps for Health Challenge and encourage you to participate. The SMART (Subsitutible Medical Apps, reusable technologies) platform is a project funded by The Office of the National Coordinator for Health Information Technology through the Strategic Health IT Advanced Research Projects (SHARP) program. Its goal is to provide a common API for developing applications across multiple health information technology platforms…

SMART + OpenMRS: Google Summer of Code


OpenMRS has been funded for its fifth consecutive Google Summer of Code!

Among a host of exciting projects, SMART is working with OpenMRS to propose:

Enabling SMART Apps in OpenMRS

SMART challenge and P4: open source projects look toward the broader use of health records


O’Reilly Radar, March 23, 2011 — Andy Oram
In a country where doctors are still struggling to transfer basic patient information (such as continuity of care records) from one clinic to another, it may seem premature to think about seamless data exchange between a patient and multiple care organizations to support such things as real-time interventions in patient behavior and better clinical decision support. But this is precisely what medicine will need for the next breakthrough in making patients better and reducing costs. And many of the building blocks have recently fallen into place…

Hospital Designs a Development Platform for Medical Web Apps


Government Technology, March 14, 2011 — Sarah Rich
Web app contests like NYC BigApps continue fostering new ways to access public data — and these challenges are now making their way into the medical field. But before these medical apps get too far along, they need the proper platform and interface. That’s where the Substitutable Medical Applications, reusable technologies (SMART) platform comes in. In April 2010, the Office of the National Coordinator for Health Information Technology awarded $15 million to researchers at the Children’s Hospital Boston and Harvard Medical School to design SMART…

US CTO Aneesh Chopra Blogs SMART Challenge


Read Mr. Chopra’s White House blog here. He states, “This development will dramatically expand the market for health IT by offering applications that can meet any niche and any need – from individual consumers to small practices to large organizations—thereby making the transformative power of health IT felt more fully and broadly.”

Ecosystems for Innovation: An interview with U.S. CTO Aneesh Chopra


Deloitte Review, 2011 — Vikram Mahidhar
The fast-moving frontier of new technologies and business models is challenging traditional models of innovation. Historically, larger companies, universities or government agencies with deep pockets have often brought forth the ideas that shape business and society. More recently, though, the advent of new digital infrastructures such as cloud computing, mobile and online social networks is enabling small groups of individuals with small investments to create big impact…

Researchers Unveil Platform To Kick Off Contest for Health Apps


iHealthBeat, March 10, 2011
Researchers at Children’s Hospital Boston and Harvard Medical School recently announced the public release of an interoperability platform and interface designed to support the development of innovative health-related Web applications, Modern Healthcare reports…

SMArt Prize for Patients, Physicians, and Researchers


The White House, March 10, 2011 — Aneesh Chopra
This week a research team at Children’s Hospital of Boston and Harvard Medical School launched a prize to encourage innovative app developers to build new products and services that benefit patients and providers. The prize was created with funding from the Office of the National Coordinator for Health IT within the Department of Health and Human Services, and constitutes just the latest in a growing number of examples of the Federal government fostering R&D collaboration through open innovation…

SMArt platform needs ‘iPhone-like’ health apps


Government Health IT, March 10, 2011 — Mary Mosquera
Programmers and developers can win $5,000 for creating online tools that offer specific functionality for patients, physicians and public health on an “íPhone-like” health IT platform model, which is now publicly available…

Race is on for iPhone-like health IT apps


Healthcare IT News, March 10, 2011 — Bernie Monegain
A new platform created specifically to boost healthcare IT innovation is now available to the public, kicking off a $5,000 competition that challenges developers to create Web applications for patients, physicians and public health…

Harvard, Boston Children’s open $5,000 app challenge to free EHR data


mobihealthnews, March 10, 2011 — Neil Versel
Researchers at Children’s Hospital Boston and Harvard Medical School this week opened a previously announced competition to develop “iPhone-like” applications to help unlock data stored in electronic health records. While the focus is on Web apps, the federally funded contest is encouraging submissions for mobile tablets, with a promise of “further optimization for smaller screens” such as smartphones by summer…

Boston researchers develop app platform


Modern Healthcare, March 9, 2011 — Joseph Conn
Federally funded researchers at Children’s Hospital Boston and Harvard Medical School have released a healthcare interoperability platform and interface “to support a flexible health information technology environment and promote innovation,” according to a news release…

SMART: A Facebook-like platform for medical apps


The Healthcare IT Guy, March 9, 2011 — Shahid Shah
Today, Wil Yu (Special Assistant, Innovations) over at ONC wrote about a new innovation challenge that is giving out money to developers who can create micro apps that run in the new SMART architecture containers. If you’re not familiar with SMART and want a technical introduction, head over to the SMART Wiki; if you just want a quick overview from the business side, check out the home page…

A SHARP Milestone – A New Innovation Challenge


Health IT Buzz, March 8, 2011 — Wil Yu
Today one of the recipients of the ONC’s Strategic Health IT Advanced Research Projects (SHARP) announced a major milestone Exit Disclaimer.  Researchers at Children’s Hospital Boston and Harvard Medical School, leaders of the Healthcare Applications and Networking Platforms SHARP award, announced a major breakthrough having developed a first of  kind platform architecture to support a flexible health information technology (IT) environment and promote innovation…

Children’s Hospital, Harvard Medical School Aim to Create Health App Store; Launch $5k App Competition


BostInno, March 8, 2011 — Cheryl Morris
New opportunities for innovation in healthcare are everywhere thanks in part to more sophisticated smartphones like the iPhone. And Children’s Hospital Boston and Harvard Medical School have laid the ground to welcome such innovation, announcing today a $5,000 health app competition alongside release of the equivalent of a health app store…

The SMART Apps Challenge is Live!


The Office of the National Coordinator of Health Information Technology has posted the SMART Apps Challenge on

BOSTON, March 8, 2011 /PRNewswire-USNewswire/ — Through a grant from the Office of the National Coordinator for Health Information Technology (ONC), researchers at Children’s Hospital Boston and Harvard Medical School have developed a first-of-its kind platform architecture to support a flexible health information technology (IT) environment and promote innovation. The SMArt (Substitutable Medical Applications, reusable technologies) platform and interface are being made publicly available today to kick off the start of a $5,000 competition challenging developers to create web applications that provide specific functionality for patients, physicians, or for public health.

First described in a March 2009 New England Journal of Medicine Perspectives article, the SMArt architecture is an “iPhone-like” health IT platform model that aims to transform the way health IT supports health care by facilitating the development of medical applications that are scalable and substitutable; that will drive competition, innovation, and increased efficiency in the functionality of technology for improved health care.

ONC awarded $15 million to the project in April 2010 through the Strategic Health IT Advanced Research Projects (SHARP) program. The SMArt project will enable the equivalent of an iTunes App Store for health and support an ecosystem of applications ranging from medication managers for patients at home to e-prescribing applications and decision support for physicians in the office.

“The goal of this model is to enable a substantial shift towards technologies that are flexible and able to quickly adapt to meet the various needs of their users on a variety of devices,” said Kenneth Mandl, M.D., MPH, of the Children’s Hospital Informatics Program and Harvard Medical School, and co-lead on the SMArt project. “As developers begin to compete on quality, value and usability, we expect to see the introduction of an array of innovative functions and a drop in the cost of healthcare technology. Just as staple applications of the iPad, Android, and Blackberry platforms constantly evolve and compete to meet user demands, the SMArt platform will enable health IT to do the same.”

In August, Mandl and Isaac Kohane, M.D., Ph.D., also of CHIP, Harvard Medical School and co-lead on the SMArt project, held a SMArt Developer Meeting which included more than 60 representatives from academia, government and business. Multiple prototypes of the SMArt platform were presented and feedback was collected from software developers and the health IT community. Following that meeting, the team built the SMArt platform architecture and interface that is being made publicly available today.

“There is an enormous talent pool available in our country’s developers and entrepreneurs to help drive new web and mobile health IT solutions that support health care functions,” said Kohane. “Through this competition we hope to excite this pool; to spark their imaginations and partner with them to move new ideas forward.”

“Future developments in health IT should always be driven by empowering physicians and improving patient care,” said Wil Yu, director of the SHARP program at the Office of the National Coordinator for Health IT.

Developers interested in learning more about the SMArt project and/or participating in the SMArt health app challenge may visit for complete details and an environment for development. Entrants are eligible to receive an award – $5,000 and release in an “App Store” – for best application.

A panel of industry leaders has been assembled to judge the challenge and will review submitted apps and announce winners in June 2011. Judges will include Susanna Fox, director of Health Research at the Pew Internet & American Life Project; Regina Herzlinger, the Nancy R. McPherson Professor of Business Administration at the Harvard Business School; David Kibbe, senior advisor to the American Academy of Family Physicians and principal at The Kibbe Group LLC; Ben Shneiderman, professor of Computer Science at the Human-Computer Interaction Laboratory at the University of Maryland, College Park; Doug Solomon, chief technology officer at IDEO; Edward Tufte, professor emeritus of Political Science, Statistics, and Computer Science at Yale University; and Jim Walker, chief health information officer at Geisenger Health Systems.

Children’s Hospital Boston is home to the world’s largest research enterprise based at a pediatric medical center, where its discoveries have benefited both children and adults since 1869. More than 1,100 scientists, including nine members of the National Academy of Sciences, 12 members of the Institute of Medicine and 13 members of the Howard Hughes Medical Institute comprise Children’s research community. Founded as a 20-bed hospital for children, Children’s Hospital Boston today is a 392-bed comprehensive center for pediatric and adolescent health care grounded in the values of excellence in patient care and sensitivity to the complex needs and diversity of children and families. Children’s also is the primary pediatric teaching affiliate of Harvard Medical School. For more information about the hospital and its research visit:

Harvard Medical School has more than 7,500 full-time faculty working in 11 academic departments located at the School’s Boston campus or in one of 47 hospital-based clinical departments at 17 Harvard-affiliated teaching hospitals and research institutes. Those affiliates include Beth Israel Deaconess Medical Center, Brigham and Women’s Hospital, Cambridge Health Alliance, Children’s Hospital Boston, Dana-Farber Cancer Institute, Forsyth Institute, Harvard Pilgrim Health Care, Hebrew SeniorLife, Joslin Diabetes Center, Judge Baker Children’s Center, Massachusetts Eye and Ear Infirmary, Massachusetts General Hospital, McLean Hospital, Mount Auburn Hospital, Schepens Eye Research Institute, Spaulding Rehabilitation Hospital, and VA Boston Healthcare System.


Keri Stedman
Children’s Hospital Boston

David Cameron
Harvard Medical School

How SMART addresses the PCAST Report on Health IT


A couple of months ago, The President’s Council of Advisors on Science and Technology issued its Report to the President on Realizing the Full Potential of Health Information Technology to Improve Healthcare for Americans. We want to tell you how SMART fits in.
Read more

12 mobile health stories from HIMSS


mobihealthnews, February 24, 2011 — Brian Dolan
A number of longtime HIMSS attendees, including my colleague Neil Versel, pointed out that this year’s event in Orlando, Fla. had renewed energy. The past two years’ events were more staid on account of the down economy. The magicians at vendor booths had less flourish, anyway…

Costs prevent doctors from adopting electronic health records


Nature Medicine / Spoonful of Medicine, February 24, 2011 — Michelle Pflumm
Two years ago, the US government set aside close to $20 billion in stimulus funds to encourage hospitals and physicians to digitize their patient records as a way to save time and reduce doctor mistakes. But according to a survey published this week, most physicians remain wary of the price of going electronic…

Some SHARP ideas for health IT


Healthcare IT News, February 22, 2011 — Mike Miliard
Several leaders of the Strategic Health IT Advanced Research Projects Program (SHARP) showed HIMSS11 attendees how they are – in the words of Charles Friedman, PhD, chief science officer of the ONC – “moving the needle forward” on breakthrough healthcare technology…

US CTO Aneesh Chopra announces the SMART Health App $5000 Challenge


On Tuesday, November 9, U.S. Chief Technology Officer Aneesh Chopra delivered a keynote address with Bill Gates at the 2010 mHealth Summit in Washington, D.C., featuring the efforts of Kenneth Mandl, MD, MPH, and Isaac Kohane, MD, PhD, of the Children’s Hospital Boston Informatics Program and Harvard Medical School, and the “SMART” (Substitutable Medical Applications, reusable technologies) project.

Mr. Chopra gave an overview of the project and announced a competition that will begin in March, challenging developers to create a health IT application that provides specific functionality for patients, physicians, or for public health, based on the Boston team’s SMART platform architecture and a common electronic medical record interface.

SMART seeks to recruit and support a new generation of innovators by providing a common interface to multiple HIT platforms. The SMART Health App $5,000 Challenge is to develop web apps that use the SMART API to provide value to patients, providers, researchers, and public health. Examples of such applications are medication management tools, health risk detectors, and e-prescribing applications.

A panel of acclaimed judges is being assembled to review submitted apps and will include Regina Herzlinger, the Nancy R. McPherson Professor of Business Administration at the Harvard Business School; David Kibbe of the The Kibbe Group LLC and Director of the Center for Health Information Technology at the American Academy of Family Physicians; Doug Solomon, Chief Technology Officer at IDEO; Edward Tufte, Professor Emeritus of Political Science, Statistics, and Computer Science at Yale University, and Jim Walker, Chief Health Information Officer at Geisenger Health Systems.

The challenge will open in March 2011.

Interested applicants can learn more and register their interest at

Tutorials: RDF and SPARQL


SMART apps receive patient data in RDF graphs that contain a set of assertions or “triples” such as:
{ <John Smith> <is-taking> <lipitor> }

We think RDF is a flexible and elegant way to represent all kinds of data.  But we recognize that RDF and SPARQL (a query language for RDF graphs) aren’t regular items in every Web developer’s toolkit. To help SMART developers get up to speed, we’ve written a pair of tutorials on our wiki:

  1. Quick Introduction to RDF and SPARQL:  Explains the basics of how RDF represents information as triples.
  2. SPARQL Examples for SMART:  Provides a live, hands-on interface to query sample SMART data from the reference container.

Please have a look, try out the live query tools, and let us know what you think!

Serving the enterprise and beyond with informatics for integrating biology and the bedside (i2b2)


Murphy, S. N., Weber, G., Mendis, M., Gainer, V., Chueh, H. C., Churchill, S., and Kohane, I. Serving the enterprise and beyond with informatics for integrating biology and the bedside (i2b2). J Am Med Inform Assoc 2010;17:124-30

Sharing Medical Data for Health Research: The Early Personal Health Record Experience


Weitzman E.R,, Kaci, L., and D., Mandl K. Sharing Medical Data for Health Research: The Early Personal Health Record Experience. J Med Internet Res 2010;e14

Health 2.0


The fourth annual Health 2.0 conference is abuzz about “unplatforms” — loose collections of liquid data services and interlinked apps that allow for mix-ins, mash-ups, and rapid innovation. The unplatform is “un” becaues it doesn’t rely on a central service, repository, or framework. Instead, it’s a frothy milieu of various data and services: in other words, all right ingredients for apps to emerge.
Read more

Update on Modular EHR Technology: Harvard’s SMArt Research


Kibbe and Klepper on Health Care, October 5, 2010 — David Kibbe and Brian Klepper
ONC awarded four Strategic Health IT Advanced Research Project (SHARP) grants earlier this year to ”…address well-documented problems that have impeded adoption of health IT and to accelerate progress towards achieving nationwide meaningful use of health IT in support of a high-performing, learning health care system.”…

Resources from Developers Meeting


We now have several resources that were created and used for our developers meeting available.
SMART Architecture Slideshow

SMART Governance Slideshow

SMART Demo Screencast

SMArt Health


The Huffington Post, September 9, 2010 — Ron Gutman
The remarkable report “Initial Lessons From the First National Demonstration Project on Practice Transformation to a Patient-Centered Medical Home,” in the May/June Annals of Family Medicine, makes this point about the state of primary care information technology (IT): “Technology needed for the PCMH [patient-centered medical home] is not plug and play. … The hodgepodge of information technology marketed to primary care practices resembles more a pile of jigsaw pieces than components of an integrated and interoperable system.”…

SMART Developers Meeting Attended by 60+ People


On August 26th, we had our first Developer’s Meeting here at the SMART headquarters at the Center for Biomedical Informatics in the Countway Library of Medicine. Over 60 academic, vendor, and government representatives participated in the event. The conversation was so lively that we were shushed by one of the librarians, which we took to be a good sign. The presentations made by Ben Adida, our lead architect, and Josh Mandel, our lead developer, may be found here. If you would like to participate in one of our upcoming events, please let us know.

Is Healthcare Ready for SMArt’er Applications??


CONNECT Blog, September 2, 2010 — Greg Fairnak
The researchers at Harvard University think so and so do I. Last week I had the chance to attend the first developer’s conference for the Substitutable Medical Applications, reusable technologies, or SMArt. The architecture will provide a set of core services to facilitate substitutable healthcare applications, or plug-ins, similar to the App Store found in the iPad, iTouch or Droid. In attendance were open source solution vendors, healthcare IT thought leaders (Stan Huff and John Halamka), commercial healthcare application vendors, researchers, software developers and federal healthcare agency representatives (FDA, VA and DoD)….

Clinical Groupware: Platforms, Not Software


The Health Care Blog, April 24, 2010 — David Kibbe
Clinical Groupware is rapidly gaining acceptance as a term describing a new class of affordable, ergonomic, and Web-based care management tools. Since David first articulated Clinical Groupware’s conceptual framework on this blog early last year, we’ve been discussing Clinical Groupware with a growing number of people and organizations who want to know what it is, where it’s going, and what problems it may solve, particularly for small and medium size medical practices, their patients and their institutional/corporate sponsors and networks…

Health IT in the cloud: A long road


Mass High Tech, June 24, 2010 — James M. Connolly
Using cloud computing in the health information technology sector makes sense from a cost basis, but it could take years for health-care providers and patients to develop solid confidence in the security of patient data in cloud environments…

Health care open source app store slated to open in two years


SearchHealthIT (TechTarget), June 9, 2010 — Don Fluckinger
Want to download a 99-cent electronic health record (EHR) system from a health care open source app store? There’s not an app for that. But if Dr. Isaac Kohane, a pediatrician at Children’s Hospital Boston, professor at Harvard Medical School and self-described “pasty, pointy-headed nerd,” realizes his ambition, that could be a reality in two years…

The Harvard SHARP Grant


Life as a Healthcare CIO Blog, April 12, 2010 — John Halamka
Last week, ONC awarded $60 million to four institutions – Mayo Clinic, Harvard University, University of Texas Health Science Center at Houston and University of Illinois at Urbana-Champaign – through the Strategic Health IT Advanced Research Projects (SHARP) program…

SHARP Grant Awarded


Office of the National Coordinator for Health IT awards $15 million to Harvard Medical School to build the “app-store” for health.

Government Pushes To Create A New Health Internet


The Huffington Post, March 18, 2010 — Fred Schulte
Hoping to provide the backbone for a grand plan to put the nation’s medical records online, federal officials have been quietly retooling an obscure government data-sharing service into a robust new Health Internet. The concept has drawn intense interest from technology firms, including Microsoft and Google, which are scrambling to find new–and profitable–uses for digital medical records and the cyber health-care services they are starting to spawn…

Electronic medical records not seen as a cure-all


The Washington Post, October 25, 2009 — Alexi Mostrous
In a health-care debate characterized by partisan bickering, most lawmakers agree on one thing: American medicine needs to go digital. When President Obama designated $19.5 billion to expand the use of electronic medical records, former House speaker Newt Gingrich (R-Ga.) said it was one of only “two good things” in February’s stimulus package. But such bipartisan enthusiasm has obscured questions about the effectiveness of health information technology products, critics say. Interviews with more than two dozen doctors, academics, patients and computer programmers suggest that computer systems can increase errors, add hours to doctors’ workloads and compromise patient care…

The Shared Health Research Information Network (SHRINE): a prototype federated query tool for clinical data repositories


Weber, G. M., Murphy, S. N., McMurry, A. J., Macfadden, D., Nigrin, D. J., Churchill, S., and Kohane, I. S. The Shared Health Research Information Network (SHRINE): a prototype federated query tool for clinical data repositories. J Am Med Inform Assoc 2009;624-30

Acceptability of a personally controlled health record in a community-based setting: implications for policy and design


Weitzman, E. R., Kaci, L., and Mandl, K. D. Acceptability of a personally controlled health record in a community-based setting: implications for policy and design. J Med Internet Res 2009;e14

Substitutability: Why, What and How?


Substitutability is a property of software applications that allows the users of such systems fine grained choice and control of the way their computing environment works for them without. This is in marked contrast to existing healthcare applications, particularly electronic health records which are typically monolithic and do not allow substitution for functions by other vendors without extensive technical support, it at all possible. I review here early questions that follow from the adoption of a substitutability model in health care information technology.


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Emerging Consensus to Create a ‘Health Internet’ With Broad Consumer Engagement


Boston Children’s Hospital Newsroom, October 9, 2009 — Keri Stedman/Rob Graham
As government, industry and academic leaders work to transform the nation’s health information system, there is increasing interest in the notion of a national health information network in which consumers can actively engage, and which can provide the foundation for an “iPhone-like” ecosystem of applications to compete on price and value. In such an ecosystem, purchasers of applications–whether physicians and hospitals buying electronic health records, or patients and consumers buying technology to support wellness and disease management–would be able to easily substitute any application for any other…

Transforming US Healthcare and its Shadow Impact on Canadian Health Information Technology (HIT)


OSCAR Canada Users Society blog, October 3, 2009 — David Daley
The OSCAR community was privileged to be the sole Canadian delegation present at Harvard’s 2009 HIT Platform Meeting, chaired by Kennedth Mandl and Isaac Kohane, both of Harvard Medical School, and the launch of ITdotHealth (, a National Health Information Technology Forum…

Two big deals in Health 2.0


The Health Care Blog, October 2, 2009 — Matthew Holt
John Halamka writes about the small but important meeting this week at Harvard Medical School hosted by Zak Kohane and Ken Mandl. Because of the impending arrival of about 1,000 of my best friends next week at Health 2.0, I couldn’t go to that meeting. But it may be very important in putting the “cats and dogs” together to think about ways for new platforms with players like Halamka and David Kibbe (who have not been on the same side of these issues) both taking part…

NHIN: The New Health Internet?


Chilmark Research, October 1, 2009 — John Moore
Chilmark has not been a big fan of the National Health Information Network (NHIN) concept. It was, and in large part still is, a top heavy federal government effort to create a nationwide infrastructure to facilitate the exchange of clinical information. A high, lofty and admirable goal, but one that is…

Swiss Health Care Thrives Without Public Option


The New York Times, September 30, 2009 — Nelson Schwartz
ZURICH — Like every other country in Europe, Switzerland guarantees health care for all its citizens. But the system here does not remotely resemble the model of bureaucratic, socialized medicine often cited by opponents of universal coverage in the United States. Swiss private insurers are required to offer coverage to all citizens, regardless of age or medical history. And those people, in turn, are obligated to buy health insurance…

Open and Safe HIT Platforms


How much do you really want a HIT platform to be like an iPhone?


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The iphone, a poor HIT platform analogy


Fred Trotter Blog, August 30, 2009
Recently, a NEJM perspective article titled No Small Change for the Health Information Economy advocates that a Health IT platform should be created in imitation of some of the successful technology platforms in other areas. Specifically the iphone was mentioned. The relevant paragraph…

Toward a Modular EHR


Family Practice Management, July/August, 2009 — David Kibbe
The remarkable report “Initial Lessons From the First National Demonstration Project on Practice Transformation to a Patient-Centered Medical Home,” in the May/June Annals of Family Medicine, makes this point about…

Health Information Technology: The Case for a Sound Federal Policy


The Heritage Foundation, June 25, 2009 — Tevi Troy
Congress, through its enactment of the “stimulus” bill, is committed to spending $787 billion on various projects, including $20 billion to encourage doctors and hospitals to adopt electronic health records (EHRs). This new spending is a component of the Obama Administration’s health care agenda, which includes the promotion of health information technology (HIT)…

Ensuring Investment in Healthcare Information Technology Does Not Flatline


The Huffington Post, June 25, 2009 — John Kenagy
Given the $47 billion awarded in stimulus funding, it’s clear the government’s assumption is that healthcare information technology (IT) will deliver better care at lower cost. The IT industry and all the healthcare IT mavens are waving the flags and beating the drums…

Ten Principles for Fostering Development of an “iPhone-like” Platform for Healthcare Information Technology


Leading health care information technology researchers, physicians, and renowned experts in innovation released a set of core principles to guide the creation of a new health information infrastructure to better support the nation’s complex and evolving health system.

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Transcript: Health Info Tech Coordinator David Blumenthal


The Wall Street Journal, June 15, 2009 — Bob Davis
National Coordinator for Health Information Technology Dr. David Blumenthal spoke with The Wall Street Journal’s Bob Davis about how he plans to convince hospitals and doctors to computerize their records. Below is an edited transcript…

Catalyzing the app store for EHRs


Pioneering Ideas (Robert Wood Johnson Foundation), June 1, 2009 — Steve Downs and John Lumpkin
Recently, Steve posted about the idea, floated by Ken Mandl and Zak Kohane, that EHRs (or health IT more broadly) could move to a model of competitive, substitutable applications running off a platform that would provide secure medical record storage. In other words…

Electronic Medicine, iPhones and Path-Dependence


Health Reform Watch, May 18, 2009 — Michael Ricciardelli
Atul Gawande writes about “path-dependence” in his wonderfully thought out article on the evolution of health care systems. If you haven’t yet read it (it’s in the sidebar under “Best of Magazines” and here) I highly recommend…

Electronic Health Records Won’t Save Us


The Washington Post, April 26, 2009 — Tevi Troy
Are electronic health records the panacea for all our health-care ills? Congress seems to think so: With strong cheerleading from President Obama, it has approved $20 billion for EHRs as part of the stimulus package. Health information technology undeniably holds a lot of promise, but…


A Health Tech Monopoly – II


The Wall Street Journal, April 14, 2009
The New England Journal of Medicine is the holy scripture of the medical academic left, so it’s worth noting that the magazine has just punched a hole in the many blandishments about electronic medical records…

On the records


The Boston Globe, April 6, 2009 — Carolyn Johnson
In this wireless world, healthcare still has one foot in the digital dark ages. But the $19 billion investment in health information technology included in the federal stimulus package may change that, says Dr. Kenneth D. Mandl of …

Advances in Online Care and Telehealth


The Health Care Blog, April 6, 2009 — David Kibbe
At a recent symposium on Online Care in Hawaii, two Family Physicians and a primary care Internist participated in a panel in which they described their experiences with Online Care and Telehealth…

An App Store for Your EHR? Why Not?


Pioneering Ideas (Robert Wood Johnson Foundation), April 2, 2009 — Steve Downs
Up on the Project HealthDesign blog, Lygeia Ricciardi calls attention to Ken Mandl and Zak Kohane’s perspective article in the New England Journal on the need for a flexible information infrastructure in health care.  In the article,…

In the New England Journal of Medicine:
No small change for the health information economy


Mandl KD, Kohane IS. No small change for the health information economy. N Engl J Med. 2009 Mar 26;360(13):1278-81

Electronic Health Records: Lessons from the iPhone


Technology Review (MIT), March 30, 2009 — Emily Singer
Thanks to the $19 billion designated for health-care information technology in the recent stimulus bill, electronic health records (EHRs) have garnered a great deal of attention in the past few weeks. The bill sets aside $17 billion in…

Doctors Raise Doubts on Digital Health Data


The New York Times, March 25, 2009 — Steve Lohr
Now that the federal government plans to spend $19 billion to spur the use of computerized patient records, the challenge of adopting the technology widely and wisely is becoming increasingly apparent. Two articles, to be published on Thursday in the New England Journal of Medicine, point…

Mandl and Kohane on Health Care Information Technology


Mark Frisse’s New Policy Blog, March 25, 2009 — Mark Frisse
In a March 26, 2009 article in the New England Journal of Medicine entitled “No Small Change for the Health Information Economy,” Kenneth D. Mandl and Isaac S. Kohane emphasize that interoperability is not sufficient to achieve the results we need. What is required, they say, is…

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Tectonic shifts in the health information economy


Mandl, K. D. and Kohane, I. S. Tectonic shifts in the health information economy. N Engl J Med 2008;1732-7

Early experiences with personal health records


Halamka, J. D., Mandl, K. D., and Tang, P. C. Early experiences with personal health records. J Am Med Inform Assoc 2008;1-7

Evaluation of influenza prevention in the workplace using a personally controlled health record: randomized controlled trial


Bourgeois, F. T., Simons, W. W., Olson, K., Brownstein, J. S., and Mandl, K. D. Evaluation of influenza prevention in the workplace using a personally controlled health record: randomized controlled trial. J Med Internet Res 2008;e5