Proposal for an App Store approach for incorporating Class III software in future systems

VA has thousands of Class III software packages out there, which can be seen as 1) a wonderful example of peer-to-peer and crowdsourcing of collective intelligence, or 2) a royal pain in the neck, with all these weird ideas and activities popping up.

One of the original goals of the original VistA developers was the notion of "programmerless programming" - giving non-technical people the ability to use a set of tools to generate their own reports, databases, templates, bulletins, etc.  These could be created by individuals - not unlike people developing macros for spreadsheets or documents.

I look back at the proliferation of Class III software as a sign of the robustness and vitality of VistA.  (Option #1 above.)  It is part of a fabric of interaction between computer geeks, users, administrators, and the VHA's organization itself that have co-evolved over the years.  This fabric is not understandable by looking only at a thread at a time...

This is a proposal to support an "App Store" in the next generation software, which can also serve as a container for some, if not all, of today's Class III software.

The App Store model could be based on the Smart Platform technology.  Apps could be passed through various levels of approval and vetting, a reputation (thumbs up/thumbs down) system, reviews, suggestions for improvement, etc.

Ideally, the system would have migration tools for converting the templates, Fileman report writers, etc. into a new format.  It would also be able to provide cross-platform access for the app, from web, smart phone,  embedded devices, "quantified self" equipment, smart gowns, smart band-aids or whatever other else pops up in the future.  (See Eric Topol's The Creative Destruction of Medicine, how the Digital Revolution will create better health care  for an optimistic perspective on this.)  The Enterprise Web Development framework has some interesting potential to support multi-tier access to existing systems.

With today's "mash up" capabilities and open source support, apps will become much more capable than before.  Folks will be able to link clinical, genomic, population health, geographic, demographic and and many other sources of information with relative ease.  A high school student with a little Javascript knowledge could pull together information that a few years ago would have been a multimillion dollar research project.  Clinicians will be able to run "what if" questions and simulations that would have been inconceivable a decade ago, even in research labs.

More sophisticated tools, such as Informatics for Integrating Biology and the Bedside, could provide tools for doing large scale research.  Here is a video interview I did with Isaac Kohane, leader of this project as well as the SMART platform above. 

One of the chief lessons learned in the VistA experience is the immense depth of skill and enthusiasm within the VHA for using computers and communications to improve health care.  Docs come out of med school with computer skills and expectations far beyond what could have been dreamed about 10 years ago.  For any given medical skill or technology, VA has (or is one link away from) a world-class expert in the field. 

Creating a App Store could be a way of re-engaging the rank-and-file VA staff, and build a world class ecosystem of clinical innovation.