"Maybe with all that ARRA money floating about in the HITECH Act, ONC should just go ahead and build such an 'open' platform that supports modular apps to meet specific needs wihin this highly fragmented market. Seriously, this needs some consideration," Chilmark Research Principal John Moore wrote last year after reading about a proposal by Boston researchers to create an "iPhone-like" platform for health IT.
"Are you listening, Washington?" Moore wrote last June. Yes, apparently they were.
Yesterday, HHS and the Office of the National Coordinator for Health Information Technology (ONC) have awarded Harvard Medical School and Children's Hospital a $15 million grant for a four year research project to "investigate, evaluate, and prototype approaches to achieving an 'iPhone-like' health information technology platform model." The grant monies came from the American Recovery and Reinvestment Act of 2009 as part of the Strategic Health IT Advanced Research Projects (SHARP) program, which was set up to address "key challenges in adoption and meaningful use of health IT." The Boston researchers were one of four groups to receive a $15 million grant from SHARP.
We have been tracking this concept of an "iTunes platform" for health IT since last year when Isaac Kohane, MD, PhD, and Kenneth Mandl, MD, MPH, the awardees of the $15 million grant, proposed it in a March 2009 New England Journal of Medicine article: "No small change for the health information economy."
Following what the authors called a positive reception for their proposal, the two researchers held a working group at the Harvard Medical School Center for Biomedical Informatics to determine next steps toward the creation of the platform. Among the half dozen participants was Dr. David Kibbe from The Kibbe Group. A few weeks later Kibbe presented the proposal to attendees at the Healthcare Unbound conference in Seattle, Washington, which Babyforyou.net.ua covered live:
Once EMR vendors begin to open up their APIs, the industry will begin to see thousands of new applications built on the EHR platform just like Apple’s AppStore, Kibbe predicted at the time. Those apps would include remote monitoring apps, he said. Kibbe also predicted that in the beginning a number of EMR platforms will emerge and some of them will come from outside of traditional healthcare incumbents, but the ones to succeed will be the ones that create clinical groupware that is interoperable, substitutable, low-cost and low risk.
Kibbe also referenced the work of Clayton Christensen, co-author of The Innovator's Prescription, and fellow participant in the workshop Kohane and Mandl held at Harvard Medical School. Kibbe explained that Christensen’s theory of Disruptive Innovation actually begins with disruptive innovations or technologies that are actually “crummy” in the beginning. The key is that they are good enough, open enough and substitutable to the point where they overtake the incumbents’ offerings, despite the obvious gap in quality.
In an effort to capture some of the key learnings from the workshop, Mandl and Kohane penned a follow-up article that explained "ten principles" that would be key to a successful launch of such a platform:
1. Technology platforms that support substitutable applications should be promoted.
2. Messages and protocols for data exchange should be allowed to emerge on demand in a market-driven approach, and specified transparently at every level.
3. Protocols and application programming interfaces should allow the possibility of multiple platforms co-existing.
4. Application programming interfaces should be open.
5. Substitutable application or platform vendors should not have control over what is installed on the platform.
6. Application installation should be turnkey.
7. The intellectual property of platforms and applications should be kept separate.
8. All applications should be removable and none should be required to run a platform.
9. The platform should have a highly efficient delivery mechanism for applications.
10. Certification requirements for platforms and applications should be kept minimal to maximize substitutability.
The Office of the National Coordinator for Health Information Technology (ONC) in the Department of Health and Human Services (HHS)
For more on the grant announcement, read the press release here
For John Moore's post about the proposal last year, For explanations about each of the "ten principles" listed above,