What Is Smart on FHIR and How Does It Impact Healthcare?

Posted in Healthcare App Development

For years, healthcare providers have grappled with fragmented data locked away in Electronic Health Records (EHRs) from various vendors. This lack of interoperability between systems hinders collaboration, efficient care delivery, and, ultimately, patient outcomes.

SMART (“Substitutable Medical Applications, Reusable Technologies”) on FHIR is an open, HL7 FHIR standard-based platform that enables developers to create apps that can securely and seamlessly be integrated into all the industry’s significant EHRs. 

SMART on FHIR is a set of open specifications for integrating apps with Electronic Health Records, portals, Health Information Exchanges, and other Health IT systems.

Understanding the Building Blocks: FHIR and SMART

FHIR (Fast Healthcare Interoperability Resources):

Envision a common language for data in healthcare. That is the essence of FHIR. This standardized data interchange format, which is pronounced as “fire,” was created by Health Level Seven International (HL7). 

FHIR establishes a standard set of resources or data kinds (such as prescription drugs, allergy information, and test results) that various healthcare information systems can comprehend and handle. The barrier of complicated, vendor-specific data formats is eliminated by this standardization, allowing for the smooth sharing of medical data.

Benefits of FHIR

• Interoperability:  Dismantles data silos to facilitate effective information sharing and communication amongst healthcare systems.
• Flexibility: FHIR’s modular design accommodates a range of requirements for healthcare data.
• Accessibility:  Makes use of contemporary web technologies (JSON, XML, RESTful APIs) to facilitate user-friendly data interchange.

SMART (Substitutable Medical Applications & Reusable Technology)

SMART adds an application layer to FHIR, the foundation for data interchange. Consider SMART as the healthcare industry’s app store. It enables programmers to design cutting-edge medical applications (SMART on FHIR apps) securely linked to any EHR system that complies. These applications can use the FHIR-defined standardized data to carry out several tasks, including:

• Clinical Decision Support: At the moment of care, give physicians up-to-date, evidence-based suggestions.
• Patient Engagement: Provide patients with the resources they need to manage their medical records, medication compliance, and interactions with healthcare professionals.
• Population Health Management: Make data gathering and analysis easier to spot trends, enhance public health programs, and bolster research.

Advantages of SMART

• Innovation: Promotes a robust ecosystem of healthcare appsted to various requirements.
• Flexibility: Medical professionals can add pertinent apps to their EHR systems to personalize them and improve workflows.
• Security: Secure authentication mechanisms like OAuth 2.0 and OpenID Connect are used to protect patient data privacy.

How SMART on FHIR Works: A Symphony of Standards

The fundamental tenets of integration, interoperability, and security underpin SMART on FHIR. Let’s investigate the enchantment underlying this potent pairing:

FHIR Data Exchange: The foundational data exchange standard, or FHIR, guarantees standardized and ordered communication between apps and EHR systems.

• Scopes and Launch Contexts: This framework provides fine-grained control and data security by specifying what data an application can access and when.
• SMART App Launcher:  This links healthcare providers, EHRs, and SMART on FHIR apps.
• User Authentication (OAuth 2.0) & App Authorization: The user Authentication (OAuth 2.0) and App Authorization protocols protect patient privacy by ensuring that only authorized users may access patient data.
• Open Standards: Using open standards, SMART on FHIR encourages creativity and interoperability across various platforms. By doing this, vendor lock-in is removed, giving healthcare providers more freedom to select

SMART on FHIR builds a dynamic environment where healthcare apps may securely exchange data, connect easily, and give patients and doctors insightful healthcare information by fusing the benefits of FHIR and SMART.

Unlocking the Potential: SMART on FHIR Applications in Action

Numerous healthcare applications benefit from SMART on FHIR’s adaptability, all of which work toward making the healthcare system more patient-centered and effective:

• Clinical Decision Support (CDS) Systems: Imagine a physician getting treatment recommendations in real time based on a patient’s medical history and available data. At the point of care, SMART on FHIR apps can provide these evidence-based insights by integrating with EHRs, which may enhance patient outcomes and clinical decision-making.
• Personalized Medicine: By accessing a patient’s medical record through FHIR, healthcare professionals can adopt a more personalized approach to patient care by utilizing SMART on FHIR apps to customize treatment plans and interventions to each patient’s unique needs.
• Patient Engagement Apps: In the current healthcare environment, patient empowerment is essential. With the help of SMART on FHIR apps, patients can take an active role in their health journey by managing their meds, accessing their health information, keeping an eye on their vital signs, and interacting with physicians more efficiently.

SMART App Launch: Secure Integration for Healthcare Applications

The healthcare industry is undergoing a digital transformation, and a vital component of this shift is the seamless integration of third-party applications with Electronic Health Records (EHRs). This is where SMART on FHIR, specifically SMART App Launch, comes into play.

What is SMART App Launch?

SMART App Launch is an official implementation guide by HL7 (http://www.hl7.org/fhir/smart-app-launch/) that defines a secure and standardized approach for user-facing healthcare applications to connect with FHIR-based data systems.

How Does SMART App Launch Work?

Imagine a doctor using a cutting-edge app to analyze a patient’s medical history directly within their EHR system. SMART App Launch facilitates this by establishing a communication channel between the app and the EHR. Here’s a breakdown of the critical aspects:

• Discovery: The app first discovers the authorization endpoint URLs and features the EHR server supports using a well-defined discovery document located at .well-known/smart-configuration.
• Authorization: The user initiates the app launch within the EHR, allowing the app to access relevant patient data based on the user’s permissions and context (e.g., currently selected patient). This authorization leverages OAuth 2.0, a secure protocol for delegating access.
• Launch Context: SMART App Launch can share “launch context” with the app. This context might include details about the current patient, such as their demographics or specific medical conditions, allowing the app to tailor its functionality accordingly.
• Scopes: To ensure granular control over data access, SMART App Launch utilizes “scopes.” These scopes define the specific permissions granted to the app, specifying which FHIR resources (e.g., medications, allergies) and operations (e.g., read, write) the app can perform.

Benefits of SMART App Launch

• Improved Interoperability: SMART App Launch promotes seamless integration between EHRs and various healthcare applications, fostering a more connected healthcare ecosystem.
• Enhanced Security: By leveraging OAuth 2.0 and scopes, SMART App Launch upholds robust security measures, ensuring patient data privacy.
• Streamlined Workflows: Launched apps can improve clinical workflows and decision-making by allowing direct access to relevant patient information within the EHR system.
• Patient Engagement: User-facing apps empowered by SMART App Launch can promote patient engagement by providing tools for managing health information and communication with providers.

Beyond the Overview: A Deeper Dive

The provided excerpt from the official SMART App Launch Implementation Guide delves into the technical details of the protocol. It outlines:

• Client Authorization: Two patterns for authorizing client applications (the apps):
  • SMART App Launch (user-facing apps)
  • SMART Backend Services (headless or automated apps)
• Client Authentication: Two methods for client authentication (when required):
  • Asymmetric (“private key JWT”) authentication (preferred)
  • Symmetric (“client secret”) authentication
• Scopes for Limiting Access: The concept of scopes and how they define granular access permissions for apps.
• Token Introspection: An API allowing servers to understand the context associated with access tokens.
• FHIR Publication Details: Intellectual property statements, cross-version analysis, and package dependencies.

Understanding these technical aspects is valuable for developers creating SMART on FHIR apps. However, the core concept of SMART App Launch – enabling secure and context-aware integration of healthcare applications – truly revolutionizes how healthcare data is accessed and utilized.

Software Libraries

• JavaScript or TypeScript: Client-side and server-side library with support for SMART App Launch
• Node.js from Vermonster: An alternative Node.js implementation
• Python: Server-side Python library with support for SMART App Launch
• R
• Ruby
• Swift (iOS)
• Java
• .NET: FHIR client library 

Test Environments

• SMART App Launcher: Developer tool for SMART apps
  • Docker Container: For local installation or experiments
  • R4 open endpoint (see also R2, R3)
• SMART Bulk Data Server: Developer tool for Bulk Data clients
  • Source Code
• Logica Health Sandbox: Manage your sandbox server and users over time

Vendor Sandboxes

• Allscripts
• Athena health – athenaOne
• Cerner – Provider and Patient Facing Apps
• Epic Provider Facing Apps
• Epic Patient-Facing Apps
• InterSystems
• Meditech

Integrations for Connected Care with Folio3 Digital Health

Folio3 Digital Health is your healthcare software development partner, we connect healthcare providers and systems through seamless integrations for connectivity and information exchange.

Imagine your medical records being effortlessly transferred between your doctor’s office, the hospital, and even your phone. This is what we do with HL7 and FHIR integration. We’re not only about technology; we want to make your healthcare journey easier. With our HL7 and FHIR expertise, we’re connecting the dots in healthcare, allowing you to focus on what’s most important: your health.

Let’s team up to create a future where your health data works for you. Choose Folio3 Digital Health and let’s collaborate for a healthy tomorrow.

Conclusion

To put it simply, SMART on FHIR is a disruptive force in healthcare, breaking down silos and encouraging innovation through the seamless integration of software with Electronic Health Records. SMART on FHIR empowers both healthcare practitioners and patients by adapting open standards like FHIR and robust security mechanisms like OAuth 2.0, thereby boosting interoperability, streamlining processes, and, ultimately, patient outcomes. With its adaptable and secure structure, SMART on FHIR sets the way for a patient-centered healthcare ecosystem in which data flows freely, allowing for informed decision-making and individualized care delivery.

 

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