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Understanding SMART on FHIR

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Apr 30, 2023

7 min read

Healthcare providers and software providers serving them are facing numerous challenges related to efficient sharing and utilization of health data. One of the most promising solutions to these challenges is the adoption of interoperable healthcare systems, which allow for seamless data exchange across different healthcare platforms. SMART on FHIR is one such technology that is rapidly gaining popularity.

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What is SMART on FHIR?

SMART stands for Substitutable Medical Applications, Reusable Technologies. It is a platform for developing healthcare applications that are interoperable, secure, and scalable. The SMART platform provides a standard way for healthcare organizations to integrate third-party applications into their electronic health record (EHR) system, making it easier to share patient data between different healthcare providers.

The acronym FHIR refers to Fast Healthcare Interoperability Resources, which were developed by the Health Level Seven International (HL7) organization. It is a standard for exchanging healthcare data between different systems. FHIR provides a framework for organizing and exchanging healthcare data in a way that is easy to understand and implement, using modern web-based technologies such as RESTful APIs, XML, and JSON. The goal of FHIR is to make healthcare data more accessible and interoperable, allowing healthcare providers to provide better care to their patients and giving patients better ownership over their own health information.

SMART on FHIR is gaining widespread adoption in the healthcare industry because it combines the strength of the two standards to create a powerful and flexible platform for building and deploying healthcare applications.

Advantages of SMART on FHIR

One of the primary advantages of SMART on FHIR is its ability to facilitate the development of interoperable healthcare applications. SMART applications are designed to be easily integrated with different EHR systems, which allows for seamless data exchange between applications. This interoperability enables healthcare providers to access patient data from multiple sources and create a more comprehensive patient record, helping patients, providers and apps that require healthcare data.

Another advantage of SMART on FHIR is its ability to improve the efficiency of healthcare workflows. By allowing instant access to patient data by software tools within the context of the EHR system, SMART applications can help reduce the time spent on manual data entry, searching for patient information, and many other use cases. This can improve access to—and contextualization of—patient data, which can lead to better care and ultimately better patient outcomes.

SMART on FHIR also provides enhanced security and privacy features that are critical in the healthcare industry. SMART applications use industry standard security protocols such as OAuth 2.0 to ensure that patient data is protected at all times. Additionally, SMART on FHIR provides granular access control features such as role-based access that allow health system administrators to control who has access to patient data and what level of access they have.

In comparison to traditional healthcare, SMART healthcare can better promote patient engagement and empowerment. SMART healthcare apps can provide patients access and more visibility into their medical records, appointment scheduling in a more straightforward way, and medication reminders, among other features. This can help patients take a more active role in their healthcare. All of these features can provide value to the patient while leaving the provider unaffected.

SMART on FHIR and Health Data Interoperability

Interoperability is a key feature of SMART on FHIR and it is a symbiotic relationship. A good example of interoperability in healthcare that is made possible by SMART on FHIR apps would be uncovering a way to allow healthcare providers to easily integrate third-party applications into their EHR system.

At the same time, FHIR provides healthcare interoperability solutions through a framework for organizing and exchanging healthcare data in a way that is easy to understand and implement. A majority of health information exchange and data interoperability is based on documents. Instead of exchanging individual pieces of information across systems, applications may point to the same version of the same data with the creation of accessible and standard URLs with FHIR in healthcare. This data interoperability in healthcare makes it easier for SMART on FHIR apps to access and utilize that data.

What is the difference between HL7 and SMART on FHIR?

HL7 is an organization that develops healthcare interoperability standards, including FHIR. FHIR is a specific standard developed by HL7 that is designed to enable the seamless exchange of healthcare data between different healthcare systems and applications. HL7 also provides HL7v2, an interface, as an alternative, legacy way of requesting healthcare data from EHRs. All hospitals provide HL7 (HL7v2) integrations and it is a typical, legacy event-based connection to the hospital. You need to have a VPN connection to access the internal hospital’s network to then set up the HL7 client in the hospital system. There are specified event queues, the most common being Admittance Discharge Transfer (ADT), i.e., data about the current patients. In HL7v2, you receive the events about all admits and discharges in real-time, about all the patients and would need to manage the current waitlists on your end.

SMART on FHIR, on the other hand, is still less universal, especially within smaller hospital systems. It is a technology that leverages the FHIR standard to enable the development of interoperable healthcare applications. SMART on FHIR is designed to provide healthcare application developers with a set of tools and guidelines that enable them to create secure, user-friendly applications that can be easily integrated with different EHR systems.  If you want to check if the patient is currently admitted, you would simply send a request for the needed resource, i.e., encounters.

SMART on FHIR Authentication

Authentication is a critical component of any healthcare application, and SMART on FHIR is no exception. SMART on FHIR uses the OAuth 2.0 standard for authentication, which provides a secure way for users to authorize third-party applications to access their health data.

OAuth 2.0 works by enabling a data controller to grant access to their data to a specific application. When the application requests access, they are redirected to the authorization server (e.g., the EHR system), which verifies the user’s identity. Once the system has authorized the access, the authorization server issues an access token to the application, which can be used to access the data stored in the EHR.

This process ensures that patient data is only accessed by authorized applications. Additionally, SMART on FHIR provides granular access control features that allow health system administrators to control who has access to patient data and what level of access they have.

Real-Life SMART on FHIR Examples

The use of SMART on FHIR is rapidly growing in the healthcare industry, and there are numerous examples of applications that are already making a difference in patient care. SMART even offers a SMART on FHIR app gallery. Here are a few examples:

  • Cerner HealtheLife: Cerner HealtheLife is a patient engagement platform that provides patients with access to their medical records, test results, appointment scheduling, and other features. The platform is built on the SMART on FHIR technology and is designed to be easily integrated with different EHR systems, making it easier for healthcare providers to provide patients with access to their data.
  • ActivateCare: Activate Care’s tools for community care coordination, social referral management, and cross-sector data exchange help you address SDOH for better community health outcomes.
  • Cardiac Risk: SMART Cardiac Risk app presents relevant patient vitals and lab measurements and the calculated Reynolds Risk Score, which is used to estimate the 10-year cardiovascular risk of an individual., along with a succinct, patient-friendly explanation for each result. The app’s presentation produces a highly attractive document to hand to a patient. Furthermore, the SMART Cardiac Risk app also offers simulation: the clinician (or patient) can make changes to one or more of the patient’s vitals or lab results to see how the patient’s current Reynolds Risk Score could be improved.

Going Deeper into SMART on FHIR

US healthcare is complex, and often so are the software systems that support it. Expert teams like HTD Health can help businesses gain a deeper understanding of things like SMART on FHIR and use that knowledge to design systems that are highly configurable and scalable. HTD Health is a medical software development company committed to partnering with digital health solutions that are willing to look ahead and build new functionality required for the future, without wasting time reinventing the wheel. Ready to chat through planning, designing, and developing healthcare software that empowers people? Get in touch today.

HTD is a boutique consultancy focused on virtual care and enabling digital transformation in healthcare through thoughtful design and deployment of digital technology.

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