A SHARP Milestone – A New Innovation Challenge

Today one of the recipients of the ONC’s Strategic Health IT Advanced Research Projects (SHARP) announced a major milestone Exit Disclaimer.  Researchers at Children’s Hospital Boston and Harvard Medical School, leaders of the Healthcare Applications and Networking Platforms SHARP award, announced a major breakthrough having developed a first of  kind platform architecture to support a flexible health information technology (IT) environment and promote innovation. 

First described in a New England Journal of Medicine Perspectives article Exit Disclaimer, the SMArt architecture is an “iPhone-like” health IT platform model that aims to transform the way health IT supports health care by facilitating the development of medical applications that are scalable and substitutable.

Substitutability is the capability of a system to replace one application with another of similar functionality – it allows the administrator of a system to replace one application with another without being a technical expert, without requiring re-engineering of other applications they are using, and without having to seek assistance from any of the vendors of previously or currently installed applications. Substitutability allows developers to rapidly create a large marketplace of apps for consumers to choose from.

In essence, the SMArt team is researching how medicine might learn from the successful implementation of IT in other sectors. The iPhone, for instance, uses a software platform with a published interface. This interface needs the ability to have both core components and applications. On the iPhone, core components include cameras, geolocation, networking capabilities, etc. The platform functionally separates the core components from the apps, and the apps are substitutable. For instance, The result is that a consumer can download a calendar reminder system, reject it, and easily replace it with a new one.

The SMArt team’s architecture enables a health IT environment that may to be augmented by substitutable apps constructed around shared core components.  Such architecture could should theoretically drive down health care technology development costs, support standards evolution, accommodate difference in care workflow, foster competition in the market, and accelerate innovation. While not meant to replace existing application architectures, the SMArt project researches the technical viability of an alternative model that may be appropriately integrated within the existing commercial marketplace.

To kick off the start of this new platform and to promote open innovation, the SMArt team is holding a $5,000 competition, challenging developers to create web applications that provide specific functionality for patients, physicians, or for public health.  Developers interested in learning more about the SMArt project and app challenge may visit www.smartplatforms.org/challenge Exit Disclaimer for complete details.

Future developments in health IT should always be driven by empowering physicians and improving patient care.  To this end, the SHARP program is tasked with achieving breakthrough innovation to address the major barriers to health IT adoption.  I personally challenge the development community to help test the potential success of projects such as SMArt, in search of new, exciting pathways to a rich and diverse health ecosystem.


  1. Eve Fain RN CDE says:

    I am excited to see this move to help everyone share info without all of us having to buy new phones, new I PADS, or other peripheral. I worked with the Health Buddy back in 2005 and because it is simple, used the telephone line (landline) it had real potential for caregivers, patients, and doctors, to view patient info.

    I work in home healthcare and I am a RN who retired from the telephone company back in 1983!

  2. Jim Hansen says:

    Congrats to Ken Mandl MD, Zak Kohane MD and the rest of the SMArt team for reaching such an important milestone!

    From their early discussions, to the formalization of the vision at the Health Information Technology Platform meeting in September 2009, through to the progress made to date, this journey has inspired, and been inspired by, many of those touched by it. I believe years from now, history will look back on this initiative as the key catalyst that changed forever the way health and health care is delivered. Thank you ONC for supporting this important paradigm shifting initiative.

    Physicians today receive an overwhelming flow of research, best practices, new drug, and other data needed to practice high-quality medicine, requiring a fundamental change in the way they approach their practice, by leveraging technology to distill data into powerful contextual information. By the same token, health information technology solution providers equally cannot possibly be able to provide all, or even most, of the components required to meet these rapidly accelerating requirements.

    By being able to optimize a portfolio of say 30 substitutable applications by replacing 10-20% each year as needs change, superior feature/price solutions become available, etc., the physicians and their associated care teams will be able to incrementally optimize their tool set to deliver optimum outcomes while minimizing disruption and associated risk. Both physician professional and consumer/patient satisfaction will greatly benefit from this new ecosystem approach.

    Over the years many bright would-be health care software innovators have commented that the barriers to entry are just too high given the current state of an industry that is dominated by outdated, closed, monolithic and brittle architectures. This SMArt milestone will be remembered as the beginning of the “architectural phoenix” of health care information technology and the day when the welcome mat officially was put out to unleash our incredible American creativity, innovation and energy to address the challenges of today’s health care non-system.

    Sure, it will take time to move this innovation wave through the industry but I caution anyone who underestimates the dramatic acceleration possible when you level the playing field for entrepreneurs to take on the challenge of the largest industry that is ripe with problems to fix.

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