HARVARD COLLEGE, PRESIDENT & FELLOWS OF
In a New England Journal of Medicine essay “No Small Change for the Health Information Economy”, Mandl and Kohane cautioned that the US is unlikely to achieve the true promise of HIT reform without a new paradigm by which the grassroots of the community –
patients, physicians, and small but agile software vendors – can continuously drive innovation. We suggested that a platform with “substitutable” apps constructed around core services is a promising approach to driving down HIT costs and supporting standards evolution. We propose
the SMArt (Substitutable Medical Apps, reusable technologies) platform architecture, with two major goals. The first is a user-facing component architecture that allows “iPhone-like” substitutability for medical apps based on scalable core service building blocks. The second is a
set of network services for medical data and transactions, scalable to the national level but nonetheless respecting institutional autonomy and patient privacy. These two goals subsume four projects. PROJECT 1 focuses on the networked services that are required for the SMArt
platform and how they scale from the practice to the nation. PROJECT 2 is an investigation of the SMArt platform architecture including testing a small number of apps such as medication management transactions across many of the stakeholders. PROJECT 3 investigates how to
retrofit existing commercial and non-profit, open source health IT platforms so that SMArt apps can be substituted on all of them, as needed. PROJECT 4 lays down the sustainable infrastructure for a SMArt ecosystem whereby apps and platforms can be rapidly tested, shared,
and substituted in a SMArt exchange. This will provide for an agile substrate for national experiments of different approaches to meaningful use.
We have formed strong, strategic relationships with industrial partners such as Microsoft, CVS/Caremark, SureScripts, Cerner and Athena Health, to enable timely and impactful transition to real world practice through cross-platform compatibility of extant open source and proprietary systems with the SMArt platform. Anticipated outcomes are foundational knowledge and useable, testable prototypes for a national-scale SMArt platform with a burgeoning ecosystem, robust and scalable network data services, and advanced data analytics.