SMART on FHIR

What is SMART on FHIR^®?

SMART on FHIR^®, an abbreviation for Substitutable Medical Applications and Reusable Technologies (SMART) on Fast Healthcare Interoperability Resources (FHIR), is an open, standards-based technology that enables innovators to create apps that seamlessly and securely integrate with Electronic Health Records (EHRs).

It combines the Fast Healthcare Interoperability Resources (FHIR) standard with an authorization protocol based on OAuth 2.0 to provide access to data in a standardized format with granular access controls.

Note: HL7^®, and FHIR^® are the registered trademarks of Health Level Seven International and the use of these trademarks does not constitute an endorsement by HL7. CDS Hooks™, the CDS Hooks logos, SMART™ and the SMART logos are trademarks of The Children’s Medical Center Corporation.

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SMART on FHIR has revolutionized the way Electronic Health Records (EHRs) are accessed and utilized in the healthcare industry. This innovation is the product of the collaboration between technology and healthcare, aiming to improve the interoperability and delivery of healthcare services. It has the potential to unlock health data and drive innovation across the healthcare ecosystem.

By leveraging the SMART on FHIR specification, healthcare innovators can develop apps that query, update, and analyze a patient’s EHR data without custom integration or interference to EHR system operations. Apps can offer clinical decision support, customized patient education, interoperability bridges, Population Health Management, and more.

Who Uses SMART on FHIR?

SMART on FHIR is used by major companies like Epic, Cerner, Allscripts, Meditech, athenahealth, Microsoft Azure, and Apple, showcasing its widespread adoption and importance in the healthcare sector. Epic and Cerner, which account for over half the U.S. EHR market, both integrated SMART capabilities into their systems in 2018. The SMART on FHIR specifications allow organizations to use plug-in applications and run them inside any EHR that complies with HIPAA.

In the United States, SMART™ support is specifically referenced in the 21^st Century Cures Act of 2016. The 21^st Century Cures Act requires a universal API for health information technology, providing access to all elements of a patient’s record accessible across the SMART API, with no special effort.

SMART on FHIR is widely adopted because it delivers many benefits. Here are just a few:

• Open standards.
• Apps that comply with SMART are reusable and can be repurposed with minimal effort.
• Programmers can build and modify their apps without ruining the way healthcare providers and patients access data by easily disengaging the protocols for accessing EHR from the app.
• SMART on FHIR has an ever-growing app gallery of providers and patients to choose from.
• SMART on FHIR has a large community of engineers and tech experts to ask for advice.

What is SMART on FHIR used for?

SMART on FHIR apps, both publicly available and custom-created, are demonstrating major healthcare benefits in care coordination, clinical decision support, clinical research, data visualization, disease management, genomics, medication, patient engagement and education, Population Health Management, risk calculation, telehealth, interoperability bridges, and many more areas.

For example, an app called CORSI helps emergency physicians safely prescribe opioids by analyzing FHIR resources against state PDMPs (Prescription Drug Monitoring Program) data. Another app identifies EHR data inconsistencies in under one second compared to traditional manual review methods that take weeks. SMART and SMART on FHIR apps are creating an ecosystem of medical apps that are reducing costs and improving health on a major scale.

A well-recognized and significant usage of SMART on FHIR is for Clinical Decision Support.

The SMART on FHIR Standard

In 2009, in a New England Journal of Medicine article, the Computational Health Informatics Program, Boston Children’s Hospital, introduced the idea of an API to promote an apps-based health information economy. The SMART team focused on leveraging web standards, presenting predictable data payloads, and abstracting away many details of enterprise health information technology systems while marshaling data sources and presenting data simply, reliably, and consistently to apps. Since 2013, through co-development and close collaboration, SMART and FHIR have evolved together. SMART enables FHIR to work as an apps platform today referred to as “SMART on FHIR.” The SMART authorization layer complements the FHIR specification by allowing patients to authorize trusted third-party apps to securely access select FHIR resources relevant to the apps.

Here are the HL/7 Standards and Specifications related to SMART:

• Foundational
  • FHIR: Fast Healthcare Interoperability Resources. Web standard for health interop
  • CDS Hooks: Clinical Decision Support Hooks. Web standard for CDS in the EHR workflow
• Data access
  • US Core Data Profiles: FHIR data profiles for health data in the US (“core data for interoperability”)
  • FHIR Bulk Data API Implementation Guide: FHIR export API for large-scale data access
• UI and Security Integration
  • SMART App Launch: User-facing apps that connect to EHRs and health portals
  • SMART Backend Services: Server-to-server FHIR connections

Trisotech and SMART on FHIR

Access is provided to FHIR®, CDS Hooks™, and SMART™ on FHIR, as well as AI and Machine Learning (ML) capabilities. The Healthcare Feature set makes understanding and using the latest interoperability standards in healthcare technology available in a modern, easy-to-use way that is compatible with existing software systems in any healthcare setting.

Autogenerated SMART on FHIR webapps

How to develop SMART on FHIR apps? With the Healthcare Feature Set, SMART on FHIR web applications can be created from decision, workflow, and case models using one-click deployment. Links to those SMART on FHIR applications are automatically generated and are suitable for inclusion on CDS Hooks “App Link Card” or in any SMART compatible environments.

FHIR Support

Trisotech’s Healthcare Feature Set allows for data storage, retrieval, and patient data exchange using the FHIR (HL-7®) interoperability standard. Re-useable FHIR data types and drag and drop FHIR resources are available for all FHIR Resource structures including Foundation, Base, Clinical, Financial, and Specialized resource structures.

Predefined FHIR Data types

Trisotech provides out-of-the box FHIR data types that can be assigned with one click to elements in Decision models (DMN), Workflow models (BPMN), and Case models (CMMN).

CDS Hooks Support

CDS Hooks is one of the most common ways to embed Clinical Decision Support (CDS) automation functionality in a clinician’s workflow. When an EHR system notifies external services that a specific activity occurred within an EHR user session, a CDS service can gather needed data elements through FHIR services and return information to the clinician in the form of a “card.” As part of the Healthcare Feature Set, Trisotech provides a CDS Hooks server to accept decision support requests and generate customizable CDS Cards in return. Where CDS Services require specific FHIR Resources to compute the decisions the CDS Client requests, CDS Hooks support will provide the interface to acquire those resources.

Connection to a FHIR Terminology Server

The Healthcare Feature Set allows concepts used in Workflow, Decision and Case models to be healthcare coded using healthcare coding systems (SNOMED CT, LOINC, RxNorm, ICD, etc.) and ValueSets through a connection to a terminology server of choice that adheres to the FHIR Terminology Sever specification.