SMART Platform and API for Clinical Genomic Apps

Gil AlterovitzDirector, Biomedical Cybernetics LaboratoryAssistant Professor, Harvard Medical School

http://genomics-advisor.smartplatforms.org:4000/

Vendor-specific apps: calendar, calculator, etc.

Apps did not work with other systems and did not evolve much over time.

No long-tail/custom applications- e.g. family history app

Independent apps

Developer and user community is engaged

Long-tail apps available

Plug does not fit

Issues in Communicating Genetic Information

• No simple standard API (Application Programming Interface)

• Contents are essentially the sameo Sequences (ATGC..) and genetic files

• But, data are structured differently

• Different approaches of authentication

SMART Provides a Solution

• Substitutability Medical Applications Reuseable Technology

• Simple design of APIo Geared toward developers and users

• Integration with clinical data

Three Crystallizing Events

eMERGE Network (Electronic Medical Records and Genomics)

SMART Platform (Substitutable Medical Apps Reusable Technology)

CCDA/MU 2.0 (Consolidated Clinical Document Architecture/Meaningful Use 2.0)

eMERGE Network

Electronic Medical Records and Genomics (eMERGE)

What is SMART? • Substitutable Medical Apps Reusable

Technology

• Accelerate medical application innovation and research

• Develop medical app community• Remove developer roadblocks

Substitutability = Re-Use

SMART - AMIA 2012 - 04Nov2012

Got Statins?

CardiacRisk

BP Centiles

SMART-EnabledPCHR

SMART-EnabledEMR

SMART-EnabledHIE

Substitutable Apps Needs

SMART - AMIA 2012 - 04Nov2012

APIResource oriented, everything a URL

Data ModelContext (container, user, patient)Medical (problems, allergies, …)

AuthenticationConsistent delegation, web standards (OAuth)

UIStandards-based integration (HTML5)

Platform

App

SMART-Enabling i2b2

SMART - AMIA 2012 - 04Nov2012

Ontology

SMARTCell

MapperCell

i2b2 Hive

CRC

AnySMART

App

Patient-Centric View App

Add: SMART cellMapper cellPatient-Centric

View app

Cerner EMR

SMART - AMIA 2012 - 04Nov2012

Boston Children’s Hospital

16 Months

SMART Genomics API

• Enables integration of genomic data from heterogeneous sources

• Enables integration of clinical and genomic data

• Re-usability eliminates developer barriers

• Promotes the use of genetic data for research

SMART Genomics Platform

SMART Genomics Advisor App Integration 24Oct2012

Top-Level Genomics Advisor Displays

Pop-Up→

SMART Genomics Advisor App Integration 24Oct2012

Genomics Advisor: Detailed Pop-Up

SMART - AMIA 2012 - 04Nov2012

Example App: Dbear SMART EMRProblem: High cost of chronic disease management

and issues with long-term patient compliance in

diabetes, especially in pediatric cases.

Solution: Increase compliance by integrating toy

bear from Sproutel with SMART EMR for physicians

and to provide parent/child feedback.

Details: Integrated bear with the Telecare glucose

meter / pump technology to provide clinical data to

SMART EMR

* Provides kids with a “fun” way to measure glucose

and take insulin. Provide live data for

clinicians/patients to view.

* Interactive bear avatar gives feedback to patients.

* Engages patients to increases their likelihood to

comply with their diabetes treatment.

iPad Apps

DB EMR

First program to integrate genomic, device, EMR/Personal Health Record information.

First program to integrate patient, patient devices (e.g. bear/glucose meter), care giver, and physician data into a unified view to facilitate collaboration on patient care.

First mobile app to integrate genomics/sequence information and clinical information.

What is FHIR

• FHIR is an API that allows for exchange of health records

• Resources are exchanged using XMLs and JSON, for ease of parsing, and ease of implementation

• Enables document sharing, and documents can be stored on the server

• It is a draft specification undergoing development, and will ballot as a full HL7 Standard

Why Integrate into FHIR

• Faster adoption It is easier for

developers to handle XMLs and JSON without a incorporating a whole suit of libraries

• Open source, extensible API

• To create a more complete standardo FHIR is developing for

medical record exchange, and lack model representations for clinical genomics

SMART FHIR Resource Examples

• New resources to add to FHIR, with automatically generated graphs, documentation, XML and JSON objects, and backend C# and Java for server

SMART FHIR Resource Examples

SMART FHIR Resource Examples

• These newly created resources easily integrates into the existing FHIR framework

Integrating DAM to FHIR Resources

• Translates rather smoothly• Speeds up the information transfer between

the DAM Stakeholder Groups

Example - DAM

• DAM’s object model of elements contained within the genetic results message

Example - FHIR

Example - FHIR

Example - FHIR

• Automatically generated XML and JSON templates created along with example objects

• Automatically generated C# and Java for server

• Automatically created documentation

AcknowledgementsRachel Ramoni, David Kreda, Josh Mandel, Isaac Kohane, Tom Chen,

Jason Evans, Jenny Cheng, Ziou Zheng, Yao Chen, Yidan Pan, Karen Xin

Office of National Coordinator Grant:

- Strategic Health IT Advanced Research Project (Kohane)

NIH Grants:

- 5R21DA025168-02 (G. Alterovitz)

- 1R01HG004836-01 (G. Alterovitz)

- 4R00LM009826-03 (G. Alterovitz)

Email Contact: gil@mit.edu