SMART Platform and API for Clinical Genomic Apps Gil Alterovitz Director, Biomedical Cybernetics Laboratory Assistant Professor, Harvard Medical School

100 Most Influential People of the Millennium 1 Johann Gutenberg (mass media- movable type) 2 Isaac Newton (gravity) 3 Martin Luther (Protestant Reformation) 4 Charles Darwin (evolutionist writer) 5 William Shakespeare (Renaissance playwright) 6 Christopher Columbus (explorer) 7 Karl Marx (19th c. political writer) 8 Albert Einstein (physicist) 9 Nicolaus Copernicus (astronomy) 10 Galileo Galilei (astronomy)

Movable type Allows for large populations to be able to absorb knowledge via books, newspapers, etc.

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 same o 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 API o Geared toward developers and users Integration with clinical data

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 Nov2012 Got Statins? Cardiac Risk BP Centiles SMART-Enabled PCHR SMART-Enabled EMR SMART-Enabled HIE

Substitutable Apps Needs SMART - AMIA Nov2012 API Resource oriented, everything a URL Data Model Context (container, user, patient) Medical (problems, allergies, …) Authentication Consistent delegation, web standards (OAuth) UI Standards-based integration (HTML5)

Platfor m App

SMART-Enabling i2b2 SMART - AMIA Nov2012 Ontology SMART Cell Mapper Cell i2b2 Hive CRC Any SMART App Patient-Centric View App Add:SMART cell Mapper cell Patient-Centric View app

Cerner EMR SMART - AMIA Nov2012 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 Nov2012

Example App: Dbear SMART EMR Problem: 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.

Genomics Advisor Another app using the SMART API Gives analysis based on genetics