Can any SMART app run on Android / apple platform?

[Mayank]

Is SMART platform accessible via EHR, HIE infrastructure only, or is it available to conventional Android, Apple, Windows or BlackBerry platforms too.

If Yes, which app(s) ?

I maintain Microsoft's Health Vault PHR. Is their any role of FHIR as of now in HV?

[Josh Mandel]

Hi Mayank,

SMART is designed to support Web as well as native apps. We maintain an iOS library and samples (http://docs.smarthealthit.org/Swift-SMART/) and would be very enthusiastic about accepting community's code contributions for an Android equivalent. There are already some important building blocks in place for such a library, including the HAPI project which provides a Java FHIR client utility with hooks for OAuth.

As for other native platforms: we don't have out-of-the-box library support, but SMART on FHIR apps, at the core, just need to support OAuth and REST - so the stack is not too exotic and should implementable in the environment of your choice.

Best,

Josh

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[Wes Rishel]

Mayank, I see that Josh answered your question about mobile devices I'd like to make a few points about your HV question.

To the best of my knowledge Microsoft maintains and makes publicly available an interface designed for Internet-based suppliers and users of health data, including structured data. As I recall this was developed with participating vendors at the time when HL7 CDA was seen as a very difficult standard to learn, flawed in terms of interoperability, having overhead in terms of being oriented towards whole documents rather than scraps of data and evolving too slowly to support application development "at Internet speed." I understood the HV API to be a reaction to that those issues.

At the time I thought the HV approach carried its own risk of complexity. If there is little attempt to rationalize an approach to different bits of structured data the result is hundreds to thousands of "almost alike" objects with no understanding of how to reuse data. How is the weight from a treadmill the same or different than the weight from an Internet weight scale? How can the pharmaceutical action of a nutriceutical be compared with a prescription method if each are described using different measures of frequency and timing?

So the race was on ... complexity by overgeneralization vs complexity by oversimplification. A separate race was the ability of a fast-moving vendor to with good relationships with its coterie of developers vs the ability of a slow-moving standards organization to aggregate the wisdom of a different collection of vendors and informaticists.

You may want to candidly assess how the race has come out. I wouldn't expect Microsoft to ever publicly describe negative information about its approach, but it needs an object assessment for internal use.

If your assessment is that there is a need to reach out to innovative developers in the healthcare space then you might want to consider FHIR, the new entry in the race. It stacks up somewhat differently against the concerns that drove HV off way back when. It is designed to find a middle ground between the two forms of complexity ... be simple enough to be understood by new developers and still have the abstractions that are necessary to avoid complexity by oversimplification. Has it succeeded? I don't know; early adoption seems promising. 

Are your marketing goals for HV consistent with reaching out to the secondary healthcare market of "sidecar applications" that seems to be having success using FHIR as a tabula rosa for accessing major EHRs with fewer shims? 

I can't answer for your company, although I clearly think that the market for really intelligent amalgamation of data about a patient relies on the middle-level complexity of FHIR. It may be harder to convince whatever vendor will become the "next FitBit" that the intermediate level of complexity is important but they have their own marketing decisions to make. If they want to make the step from dresserdrawerware to a market where interactions with healthcare provider systems drive demand, they may come around too.

One person's opinion.

Regards,

Wes Rishel

Retired Healthcare Computer Nerd

____

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-- Mike Tyson

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[Adrian Gropper]

Wes,

I'm no HealthVault expert, but my impression is that HV is too much of a walled garden to be broadly applicable for managing health records via FHIR. My preferred API model at this time would be Google because it implements OAuth2 and OpenID Connect across most, if not all, of their APIs and allows anyone to register any app they want to access the API as long as they can figure out the developer console. Google also offers "account passwords" for much less sophisticated access. Hopefully, Google will offer dynamic client registration soon in order to improve the user experience even more. 

A custodian of important personal data should not exert absolute control over the subject's right of access.

This issue is now squarely in front of OCR and the API Task Force.

Adrian

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Adrian Gropper MD

PROTECT YOUR FUTURE - RESTORE Health Privacy!
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[Wes Rishel]

Adrian, are you saying that Google is supporting FHIR? Why would a Google proprietary interface be any less of a walled garden than a Microsoft proprietary interface?

Regards,

Wes Rishel

Retired Healthcare Computer Nerd

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"People couldn’t become truly holy, he said, unless they also had the opportunity to be definitively wicked."

Terry Pratchett

Good Omens

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[Mayank]

Hi all,

Thanks for the detailed information and many leads. However I am confused about which google product are we referring here to? is this Google Health PHR? I sthis still available. Or am I still not getting to the core of the discussion?

Discontinuance[edit]

On June 24, 2011, Google announced that Google Health would be discontinued.^[21] Google stated that they were discontinuing Google Health because it did not have as broad impact as had been expected:

“	... with a few years of experience, we’ve observed that Google Health is not having the broad impact that we hoped it would.	”
— From The Official Google Blog

Google continued to operate the Google Health site until January 1, 2013, and offered options for users to download data or transfer data to Microsoft's HealthVault.

Adrian

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Adrian Gropper MD

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[Josh Mandel]

Allow me to (attempt to) clear up some misunderstandings. We'll see if I succeed, or just contribute to the  chaos :-)

1. Wes took Mayank's statement "I maintain Microsoft's Health Vault PHR" to indicate that Mayank works at MS as a HealthVault engineer. I don't think this is correct (though I'm puzzled about what "I maintain" was supposed to mean). Mayank, can you please clarify?

2. Adrian was just saying that, in general, Google is an example of a company with well-thought-out API authorization schemes, including easy-to-register apps, well-documented APIs, the ability for consumers to review outstanding authorizations (i.e. list the apps you've approved to see your data -- with a "revoke" button too), and generate app-specific passwords for non-OAuth-style delegation/sharing. Adrian was making an analogy; Google does not in fact offer FHIR APIs, or a personal health record, today. (That said, Android Fit is an example of an API that begins to touch of health data -- see https://developers.google.com/fit/android/).

Adrian

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[Mayank]

Thanks Josh,

My apologies!, I shall be more specific in future with words. Yes, Wes Rishel mistook me as a MS Engineer. By "I maintain MSHV PHR", I was meaning to say that I 'maintain' my personal Health Information over a PHR platform offered by Microsoft Inc named Health Vault, which is free for the patient and researcher community like me. :)

I guess Sean Nolan was the principal architect of Health Vault who did wonderful work. I once connected with him over his blog and wondered if other systems of Medicine like AYURVEDA ( Indian Traditional Medicine), Traditional Chinese Medicine and Oriental systems, Unani medicine, Homoeopathy can leverage on Health Vault. With a global terminology ths might make greater sense so as to achieve holistic medicine approach to the care.

The dialogue is reproduced below"

Mayank - " I always wished Microsoft Health VAult could go global and as unified as possible. To my understanding, Health Vault s a repository of Modern Medicine or Allopathic Medicine. If a patient from India (who uses generally a mix of allopathy, homoeopathy, naturopathy, Ayurveda) wants to organise his non-allopathic records in the same Health Vault dashboard, he has no place except the documents placeholder section, where he can store such medical data in pdf and other unstructured formats. That can lead to cluttering and missed opportunity to glean information from other untapped sources. Any added column allowing parallel systems of medicine coming up in future releases of Health Vault?

Sean Nolan - " A key intent of HV is to allow folks to integrate their entire "health lives"...so the extent we're missing some key data types, etc. to support that --we would like to fix. It would be incredibly useful to understand more detail on what is important in these alternative modes, and unfortunately we are not experts on the core development team here. If you would be willing, we would very much appreciate your feedback along these lines; you can reach me directly using the "email blog author" link on the top-right of this page "

One observation that I am witnessing here in India is development of AYURGENOMICS and SNOMED CT. - Mayank

Regards,

Mayank Agarwal MBBS, New Delhi, India

Member, Society for Participatory Medicine

Volunteer Editor- HiMSS Dictionary of HIT terms and standards IVth edition (underway)

Research Associate - All India Institute of Medical Sciences, New Delhi, USA

Adrian

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Wes Rishel

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[Kevin Mayfield]

I've looked into this area a little. It's quite a lot of work to get my PHR into one database (or system) such as Healthvault. 

If I take my own PHR; it's stored on Withings (weight, Blood pressures, exercise information), Strava (cycling app - heart rates, exercise information) and a little bit of my doctors system. I could write a system to keep it all in sync and place it into HV but that takes a lot of work - it's better to leave data at the source. 

I was considering building a gateway that puts a FHIR facade on the Witthings/Strava API and can aggregate the results if needed. A SMART on FHIR app or other FHIR app can then call my gateway to work with the data.

From what I understand of healthvault it could be treated the same as my example Withing/Strava systems, i.e. create a FHIR facade to Heathvault's API (ideally healthvault would natively supply a FHIR api).

Alternatively if I just wanted a FHIR PHR database I'd probably look at the HAPI FHIR project, it has a sample project (JPA Server demo) to create a FHIR system using Apache Derby and Tomcat (it's simple to use other databases such as MySQL). This might be th

[Adrian Gropper]

Yes Kevin.

Keeping the data in-place is preferred for both privacy and provenance reasons. The nice thing is that User Managed Access (Kantara-UMA) has been developed on top of OAuth2 for exactly this purpose. By separating the OAuth Authorization Server operator from the Resource Server operator, it enables policy-driven exchange among FHIR-like resources.

Instead of a PHR, by using UMA, one can have a personal OAuth authorization server and leave their health records, including wearables, patient generated health data, as well as various EHRs, in-place ready for just-in-time access by anyone acceptable to the authorization server's policy. We call this architecture HIE of One.

A young physician, Michael Chen, and I have taken this concept one step further to create a patient-centered EHR. A true clinical EHR was split into two with FHIR-connected applications in separate clouds. As the provider selects a patient on a patient list, they single-sign-on to the specific patient's EHR. The patient EHR is the source of truth for those clinicans that choose to use it. Synchronization with their practice EHR creates a useable patient list and a forensic, write-only copy for compliance reasons. Clinicans can also sign-in directly into the patient's EHR and keep records however they want including FHIR-based connections to traditional institution-centered EHRs.

You can read more about this at http://thehealthcareblog.com/blog/2016/01/23/the-patient-centered-health-record/ and do watch the video for a demo. The UMA profiling for FHIR work is being done in the HEART workgroup of the OpenID Foundation. On this Monday's 4PM EST call, Dr. Chen will demonstrate the current state of our project. Please join us.

Adrian

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