Health Care Transformation Through Collaboration on Open-Source Informatics Projects: Integrating a Medical Applications Platform, Research Data Repository, and Patient Summarization
Open Access
- 30 May 2013
- journal article
- Published by JMIR Publications Inc. in Interactive Journal of Medical Research
- Vol. 2 (1), e11
- https://doi.org/10.2196/ijmr.2454
Abstract
Background: The Strategic Health IT Advanced Research Projects (SHARP) program seeks to conquer well-understood challenges in medical informatics through breakthrough research. Two SHARP centers have found alignment in their methodological needs: (1) members of the National Center for Cognitive Informatics and Decision-making (NCCD) have developed knowledge bases to support problem-oriented summarizations of patient data, and (2) Substitutable Medical Apps, Reusable Technologies (SMART), which is a platform for reusable medical apps that can run on participating platforms connected to various electronic health records (EHR). Combining the work of these two centers will ensure wide dissemination of new methods for synthesized views of patient data. Informatics for Integrating Biology and the Bedside (i2b2) is an NIH-funded clinical research data repository platform in use at over 100 sites worldwide. By also working with a co-occurring initiative to SMART-enabling i2b2, we can confidently write one app that can be used extremely broadly. Objective: Our goal was to facilitate development of intuitive, problem-oriented views of the patient record using NCCD knowledge bases that would run in any EHR. To do this, we developed a collaboration between the two SHARPs and an NIH center, i2b2. Methods: First, we implemented collaborative tools to connect researchers at three institutions. Next, we developed a patient summarization app using the SMART platform and a previously validated NCCD problem-medication linkage knowledge base derived from the National Drug File-Reference Terminology (NDF-RT). Finally, to SMART-enable i2b2, we implemented two new Web service “cells” that expose the SMART application programming interface (API), and we made changes to the Web interface of i2b2 to host a “carousel” of SMART apps. Results: We deployed our SMART-based, NDF-RT-derived patient summarization app in this SMART-i2b2 container. It displays a problem-oriented view of medications and presents a line-graph display of laboratory results. Conclusions: This summarization app can be run in any EHR environment that either supports SMART or runs SMART-enabled i2b2. This i2b2 “clinical bridge” demonstrates a pathway for reusable app development that does not require EHR vendors to immediately adopt the SMART API. Apps can be developed in SMART and run by clinicians in the i2b2 repository, reusing clinical data extracted from EHRs. This may encourage the adoption of SMART by supporting SMART app development until EHRs adopt the platform. It also allows a new variety of clinical SMART apps, fueled by the broad aggregation of data types available in research repositories. The app (including its knowledge base) and SMART-i2b2 are open-source and freely available for download. [Interact J Med Res 2013;2(1):e11]Keywords
This publication has 34 references indexed in Scilit:
- The SMART Platform: early experience enabling substitutable applications for electronic health recordsJournal of the American Medical Informatics Association, 2012
- Clinical Summarization Capabilities of Commercially-available and Internally-developed Electronic Health RecordsApplied Clinical Informatics, 2012
- A method and knowledge base for automated inference of patient problems from structured data in an electronic medical recordJournal of the American Medical Informatics Association, 2011
- Serving the enterprise and beyond with informatics for integrating biology and the bedside (i2b2)Journal of the American Medical Informatics Association, 2010
- Distribution of Problems, Medications and Lab Results in Electronic Health Records: The Pareto Principle at WorkApplied Clinical Informatics, 2010
- Clinical Decision Support Capabilities of Commercially-available Clinical Information SystemsJournal of the American Medical Informatics Association, 2009
- The Relationship between Electronic Health Record Use and Quality of Care over TimeJournal of the American Medical Informatics Association, 2009
- No Small Change for the Health Information EconomyThe New England Journal of Medicine, 2009
- Automated Acquisition of Disease-Drug Knowledge from Biomedical and Clinical Documents: An Initial StudyJournal of the American Medical Informatics Association, 2008
- Physicians and Electronic Health RecordsArchives of Internal Medicine, 2007