CardinalKit: open-source standards-based, interoperable mobile development platform to help translate the promise of digital health

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Abstract

Smartphone devices capable of monitoring users’ health, physiology, activity, and environment revolutionize care delivery, medical research, and remote patient monitoring. Such devices, laden with clinical-grade sensors and cloud connectivity, allow clinicians, researchers, and patients to monitor health longitudinally, passively, and persistently, shifting the paradigm of care and research from low-resolution, intermittent, and discrete to one of persistent, continuous, and high resolution. The collection, transmission, and storage of sensitive health data using mobile devices presents unique challenges that serve as significant barriers to entry for care providers and researchers alike. Compliance with standards like HIPAA and GDPR requires unique skills and practices. These requirements make off-the-shelf technologies insufficient for use in the digital health space. As a result, budget, timeline, talent, and resource constraints are the largest barriers to new digital technologies. The CardinalKit platform is an open-source project addressing these challenges by focusing on reducing these barriers and accelerating the innovation, adoption, and use of digital health technologies. CardinalKit provides a mobile template application and web dashboard to enable an interoperable foundation for developing digital health applications. We demonstrate the applicability of CardinalKit to a wide variety of digital health applications across 18 innovative digital health prototypes.

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An overview of clinical decision support systems: benefits, risks, and strategies for success

Reed Sutton, David Pincock, Daniel Baumgart … (2020)

Computerized clinical decision support systems, or CDSS, represent a paradigm shift in healthcare today. CDSS are used to augment clinicians in their complex decision-making processes. Since their first use in the 1980s, CDSS have seen a rapid evolution. They are now commonly administered through electronic medical records and other computerized clinical workflows, which has been facilitated by increasing global adoption of electronic medical records with advanced capabilities. Despite these advances, there remain unknowns regarding the effect CDSS have on the providers who use them, patient outcomes, and costs. There have been numerous published examples in the past decade(s) of CDSS success stories, but notable setbacks have also shown us that CDSS are not without risks. In this paper, we provide a state-of-the-art overview on the use of clinical decision support systems in medicine, including the different types, current use cases with proven efficacy, common pitfalls, and potential harms. We conclude with evidence-based recommendations for minimizing risk in CDSS design, implementation, evaluation, and maintenance.

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SMART on FHIR: a standards-based, interoperable apps platform for electronic health records

Joshua C Mandel, David Kreda, Kenneth Mandl … (2016)

Objective In early 2010, Harvard Medical School and Boston Children’s Hospital began an interoperability project with the distinctive goal of developing a platform to enable medical applications to be written once and run unmodified across different healthcare IT systems. The project was called Substitutable Medical Applications and Reusable Technologies (SMART). Methods We adopted contemporary web standards for application programming interface transport, authorization, and user interface, and standard medical terminologies for coded data. In our initial design, we created our own openly licensed clinical data models to enforce consistency and simplicity. During the second half of 2013, we updated SMART to take advantage of the clinical data models and the application-programming interface described in a new, openly licensed Health Level Seven draft standard called Fast Health Interoperability Resources (FHIR). Signaling our adoption of the emerging FHIR standard, we called the new platform SMART on FHIR. Results We introduced the SMART on FHIR platform with a demonstration that included several commercial healthcare IT vendors and app developers showcasing prototypes at the Health Information Management Systems Society conference in February 2014. This established the feasibility of SMART on FHIR, while highlighting the need for commonly accepted pragmatic constraints on the base FHIR specification. Conclusion In this paper, we describe the creation of SMART on FHIR, relate the experience of the vendors and developers who built SMART on FHIR prototypes, and discuss some challenges in going from early industry prototyping to industry-wide production use.

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Digital Health Interventions for Cardiac Rehabilitation: Systematic Literature Review

Shannon Wongvibulsin, Evagelia E Habeos, Pauline P. Huynh … (2021)

Background Cardiovascular disease (CVD) is the leading cause of death worldwide. Despite strong evidence supporting the benefits of cardiac rehabilitation (CR), over 80% of eligible patients do not participate in CR. Digital health technologies (ie, the delivery of care using the internet, wearable devices, and mobile apps) have the potential to address the challenges associated with traditional facility-based CR programs, but little is known about the comprehensiveness of these interventions to serve as digital approaches to CR. Overall, there is a lack of a systematic evaluation of the current literature on digital interventions for CR. Objective The objective of this systematic literature review is to provide an in-depth analysis of the potential of digital health technologies to address the challenges associated with traditional CR. Through this review, we aim to summarize the current literature on digital interventions for CR, identify the key components of CR that have been successfully addressed through digital interventions, and describe the gaps in research that need to be addressed for sustainable and scalable digital CR interventions. Methods Our strategy for identifying the primary literature pertaining to CR with digital solutions (defined as technology employed to deliver remote care beyond the use of the telephone) included a consultation with an expert in the field of digital CR and searches of the PubMed (MEDLINE), Embase, CINAHL, and Cochrane databases for original studies published from January 1990 to October 2018. Results Our search returned 31 eligible studies, of which 22 were randomized controlled trials. The reviewed CR interventions primarily targeted physical activity counseling (31/31, 100%), baseline assessment (30/31, 97%), and exercise training (27/31, 87%). The most commonly used modalities were smartphones or mobile devices (20/31, 65%), web-based portals (18/31, 58%), and email-SMS (11/31, 35%). Approximately one-third of the studies addressed the CR core components of nutrition counseling, psychological management, and weight management. In contrast, less than a third of the studies addressed other CR core components, including the management of lipids, diabetes, smoking cessation, and blood pressure. Conclusions Digital technologies have the potential to increase access and participation in CR by mitigating the challenges associated with traditional, facility-based CR. However, previously evaluated interventions primarily focused on physical activity counseling and exercise training. Thus, further research is required with more comprehensive CR interventions and long-term follow-up to understand the clinical impact of digital interventions.

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Author and article information

Contributors

Oliver Aalami

Mike Hittle

Vishnu Ravi

Ashley Griffin:

ORCID: https://orcid.org/0000-0002-1535-0797

Paul Schmiedmayer:

ORCID: https://orcid.org/0000-0002-8607-9148

Varun Shenoy

Santiago Gutierrez

Ross Venook

Journal

Journal ID (nlm-ta): JAMIA Open

Journal ID (iso-abbrev): JAMIA Open

Journal ID (publisher-id): jamiaoa

Title: JAMIA Open

Publisher: Oxford University Press

ISSN (Electronic): 2574-2531

Publication date Collection: October 2023

Publication date (Electronic): 19 July 2023

Publication date PMC-release: 19 July 2023

Volume: 6

Issue: 3

Electronic Location Identifier: ooad044

Affiliations

Stanford Byers Center for Biodesign, Stanford University School of Medicine , Palo Alto, California, USA

Department of Epidemiology, Stanford University School of Medicine , Palo Alto, California, USA

Stanford Byers Center for Biodesign, Stanford University School of Medicine , Palo Alto, California, USA

Department of Health Policy, Stanford University School of Medicine; VA Palo Alto Health Care System , Palo Alto, California, USA

Stanford Byers Center for Biodesign, Stanford University School of Medicine , Palo Alto, California, USA

Author notes

Corresponding Author: Oliver Aalami, MD, Stanford Byers Center for Biodesign, Stanford University School of Medicine, 780 Welch Rd. CJ350, Palo Alto, CA 94304, USA; aalami@ 123456stanford.edu

Author information

Ashley Griffin https://orcid.org/0000-0002-1535-0797

Paul Schmiedmayer https://orcid.org/0000-0002-8607-9148

Article

Publisher ID: ooad044

DOI: 10.1093/jamiaopen/ooad044

PMC ID: 10356573

SO-VID: 8a73d15e-f57c-4141-9955-568940903050

License:

This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( https://creativecommons.org/licenses/by/4.0/), which permits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited.

History

Date received : 28 June 2022

Date revision received : 20 December 2022

Date: 13 June 2023

Date accepted : 19 June 2023

Page count

Pages: 7

Funding

Funded by: Stanford Coulter Grant & Stanford Biodesign;

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CardinalKit: open-source standards-based, interoperable mobile development platform to help translate the promise of digital health

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Most cited references 11

An overview of clinical decision support systems: benefits, risks, and strategies for success

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Digital Health Interventions for Cardiac Rehabilitation: Systematic Literature Review

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