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

Don Fluckinger, News Director

BOSTON -- 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.

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Kohane and Children's Hospital colleague Dr. Kenneth Mandl are leading a four-year project funded by a $15 million Strategic Health IT Advanced Research Projects grant, one of four awarded by the Office of the National Coordinator for Health Information Technology (ONC) earlier this year. Kohane presented his project to attendees at the Massachusetts Health Data Consortium's 2010 annual meeting, held last week in Boston, and said that although it is funded for four years, he is optimistic his group can get the open source application platform up and running in two.

"We're holding ourselves to a very, very tight timeline," Kohane said. "Although [it] might seem revolutionary, visionary and therefore unrealizable, we're actually quite convinced we can get it done in a two-year time frame."

Dubbed "SMArt" (Substitutable Medical Applications, reusable technologies), Kohane and Mandl first articulated the idea of an open source app store for health care in a 2009 New England Journal of Medicine (NEJM) article. The plan, Kohane said, is not to create an alternate iPhone app store, but to create a health care-specific, open source clearinghouse for inexpensive applications that can be used on a number of devices, not just smartphones. As with the Apple app store, programs would retail for a few dollars each.

As for who would run the store, Kohane said, "For prototyping, it will be hosted by our team, but we are going to be in consultation with ONC regarding what the right place is. The best would be a dispassionate third party."

At the time the NEJM published the piece, there were 10,000 iPhone apps; now there are more than 200,000. Apple's store, Kohane noted, has attracted many new developers to the health care space. He added that he hopes they will develop for his open source platform, too.

Systems available in the health care open source app store could do as little as track individual quality measures, or as much as serve as an EHR system, in Kohane's view. In-between applications include medication and disease management, doctor-patient communications, research, and decision support.

Which order-entry system can you rip out and pull down without a raft of IT specialists doing it? It should be possible, technically, but they're never built that way. That's what we're about.

Dr. Isaac Kohane, pediatrician, Children's Hospital Boston

Invoking the analogy of the Toyota Corona, Kohane likened the current EHR market to the U.S. auto market of the 1960s, when the Japanese carmaker came out with its bare-bones automobile. "When the Toyota Corona was first built, the Big Three manufacturers felt absolutely no threat from it, because it didn't have the basics they thought all Americans believed they were entitled to in their car -- such as a car radio or air conditioning," he said. "Nonetheless, there was a large enough community of people for whom a car only had to bring [them] from point A to point B and nothing more. … Enough people bought it that a decade later, they had a cash-rich company delivering a very unfeatured product to a large user base that competed well with the Big Three."

That principle, Kohane said, will fuel the development of software on the SMArt platform and disrupt the health IT software market. For example, changing computerized physician order entry systems is currently an expensive process. He envisions the open source app store as a place where providers could swap out those modules like iPhone users swap out to-do-list programs -- for a very low price -- until they found one they liked.

"Which order entry system can you rip out and pull down without a raft of IT specialists doing it?" Kohane said. "It should be possible, technically, but they're never built that way. That's what we're about."

Kohane's team of open source programmers wants to make such a system by building a platform that supports core services and networked data through a common application programming interface. With simple applications running off this common platform, he and his team also hope to build a more interoperable platform, something commercial vendors are struggling to pull off, he pointed out.

The platform will provide a common interface for the Indivo open source personal health record system developed by Kohane and his colleagues, as well as open source platforms created by other subcontractors on the ONC grant. These include Partners HealthCare System's i2b2 analytic platform and the Regenstrief Institute's Careweb EHR system.

Let us know what you think about the story; email Don Fluckinger, Features Writer.


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