The healthcare industry is an ever-evolving field. The increase in demand for better initiatives has sparked the growth of a fast-growing market that fulfills the need for interoperable and secure methods to access and exchange healthcare data.
Smart on FHIR
SMART on FHIR is an innovative solution that helps developers design highly secured healthcare applications linked to sensitive patient databases
If you are new to the concept of SMART or FHIR, or for that matter, if the title of this post has intrigued you, let’s start with the basics. However, if you belong to the “I have an idea” spectrum, I would ask you to skip to the good part. (Section: Designing and Developing SMART on FHIR apps)

Introduction to SMART and FHIR

SMART is the acronym for Substitutable Medical Applications and Reusable Technologies. In 2010, SMART was proposed to create a framework for interchangeable healthcare applications.

Back then, the major obstacle to creating interchangeable applications was the inability to access and share sensitive patient information securely. Thus, the goal of introducing SMART was to eliminate data fragmentation challenges, creating a seamless omnichannel user experience.

SMART is an open-source, standards-based API (Application Programming Interface) that provides secure access to healthcare data, i.e., EHRs (Electronic Healthcare Records).

FHIR stands for Fast Healthcare Interoperability Resources. It is an open, standards-based data format that allows the transmission or exchange of information between healthcare ecosystems.

FHIR is the brainchild of HL7 (Health Level Seven International), which sets global standards for organizing and accessing medical data.

Thus, FHIR and SMART are meant to maintain the industry benchmarks of data access and data.

What is SMART on FHIR?

As stated earlier, SMART on FHIR is a framework that enables the development of secure and interoperable healthcare apps. This is a platform-agnostic standard, i.e., it runs on any combination of operating systems and underlying processor architecture.

SMART ON FHIR offers a set of APIs, standards, and specifications that make developing and deploying healthcare apps easier and effortless.
Healthcare apps built on the SMART on FHIR framework make patient health data accessible and usable for healthcare providers. This, in turn, improves patient care and reduces healthcare costs.

Designing and developing SMART on FHIR apps

The first step to designing and developing interoperable healthcare software solutions is understanding the hows and whats of working with the framework in collaboration with the data format standard (FHIR).

Authentication and Security

SMART is built on the OAuth 2.0 standard (authorization protocol implemented by the organization AUTH0) for authenticating and approving users and apps. Thereby, implementing the protocol onto the applications necessitates that it seeks approval before accessing a user’s medical data.

Besides authentication standards, the framework supports encrypted communication over HTTPS, ensuring data is transmitted securely. This helps maintain users’ trust and transparency regarding using relevant data.

Curious about authentication OAUTH? Learn about the proper method to authenticate and authorize using the platform AUTH0.

SMART also provides a set of “Launch Contexts.” These contexts control an app’s launch, such as whether it opens in a new window or within an existing EHR window.

EHR Integration

The applications built on the SMART on FHIR framework get access to APIs to integrate the application with EHR (Electronic Health Record) systems.

EHRs are the databases that hold sensitive PHI (Protected Health Information). These are provided by parties dealing extensively with securing, managing, and accessing highly confidential data.

For instance, developers can use the APIs to authenticate and authorize users, retrieve patient data, and update EHR records.

Intrigued about how you can integrate EHR systems into a healthcare application?
Learn more with: EHR integration

Use of FHIR resources

FHIR is a collection of data models and resources that describe various medical data, such as patients, observations, lab results, and medications

FHIR’s data elements help maintain a consistent flow of healthcare data within the framed healthcare ecosystem. While FHIR resources such as predefined operations, viz., read, write, and search, help the app access and manipulate a user’s medical data once it gets approval from the concerned parties.

Advantages of using SMART on FHIR

  • SMART being an open standard, is effortlessly integrated into current EHR systems. Thus, making it a lucrative option to be explored by EHR vendors. 
  • SMART is a platform-agnostic standard that can be utilized with many systems. 
  • The framework also provides user interface (UI) components that help developers create app UI elements.
  • OAuth 2.0 enables safe, user-authorized access to patient data, which is critical for patient privacy and security.
  • SMART on FHIR aid in addressing the problem of data silos. SMART simplifies communicating data between EHR systems by offering a standard set of data models and operations. This enhances patient care and saves healthcare costs. For example, a medication management app might receive data from different EHR systems, allowing the app to deliver more comprehensive and accurate information to the patient and the healthcare professional.
HL7 vs. SMART on FHIR. Which is better?

Best practices for implementing SMART on FHIR

When integrating SMART on FHIR apps, developers should adhere to recommended certain practices for a successful solution development and deployment:
  • Creating intuitive and simple-to-use apps.
  • Ensuring app security and compliance with HIPAA and other healthcare privacy laws.
  • Thoroughly testing apps before deploying.
  • Providing proper documentation and user support.
  • Frequent updating to guarantee that the apps remain compatible with the changing demands.

SMART PopHealth: Successful Implementation of SMART on FHIR

Let’s dive into an example that demonstrates the effectiveness of the SMART on FHIR framework in improving healthcare delivery – SMART PopHealth.

The SMART Health IT project team developed and launched (in December 2020) a SMART on FHIR application known as SMART PopHealth, in collaboration with its original partner, Boston Children’s Hospital. It had received a grant of $1 mn from Leading Edge Acceleration Projects (LEAP) in Health Information Technology.

The app serves as a population health analytics dashboard designed for clinicians. In detail, it provides payers and providers with a view of the live data and metrics of the health outcomes for the populations they cover.

Data is sourced from various organizations and sources and displayed for a two-year window (the current year and the previous) on a single page in the form of charts. This app also features a detailed reporting page on quality measure descriptions and a data grid to preview the cohort.

According to the Office of the National Coordinator for Health Information (ONC), apps like SMART PopHealth that provide shared insights into a common dataset are robust solutions to transform healthcare systems, i.e., software solutions as such have the proficiency to change how value-based care is viewed and delivered.

A Robust Solution to Value-Based Care

SMART on FHIR is a potent tool for developing healthcare applications to improve patient care while lowering healthcare expenses. Developers can easily design using any programming language and integrate the applications with existing EHR systems. All this is done by providing a platform-agnostic framework for accessing and modifying medical data and using open standards such as OAuth 2.0.

It’s worth noting that, for now, most commercial EHRs and health systems do not support SMART on FHIR. Thus, getting it to function on your EHR system may take time and effort. However, because it is an open-source standard, many open-source EHRs/Health systems and organizations use it.

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