Since Apple released its first iPhone in 2007, the smartphone has become a ubiquitous, indispensable technology. Part of the rapid success of iOS and Android has been the way the two platforms facilitate innovative development and delivery of integrated apps.
On the front end, users can choose specific applications to meet their needs. On the back end, each application is granted only limited access to data and system resources, which helps ensure device security. SMART on FHIR seeks to bring similar technology to health care, allowing innovators to create apps that run seamlessly and securely in a variety of electronic health record environments.
SMART on FHIR is an amalgamation of two primary technologies. SMART stands for substitutable medical applications, reusable technologies, and FHIR stands for fast health care interoperability resources.
SMART focuses on authorization and authentication. To achieve this, SMART uses the OAuth standard, which is the same technology behind a “Login with Facebook” or “Login with Google” button on a website. A SMART application authenticates using existing credentials, such as a patient’s online portal login or a provider’s active EHR session, to allow access to authorized EHR data.
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However, obtaining access to the data is only half the problem, as individual EHR systems speak a variety of internal languages. This is where FHIR becomes useful, as it represents an open, common language that allows computers to exchange information. FHIR specifies exactly where and how data should be communicated, and then SMART defines a set of “profiles” to ensure apps know exactly what data elements should be included to ensure the data are useful. This combination is what allows SMART on FHIR to provide an application programming interface (API) for an EHR. For example, a developer can use the API to create a growth chart app that retrieves a specific patient’s name, birthday, sex and all weight measurements and displays them to the patient.
Another key to SMART is the concept of substitutability. A SMART app is intended to give users options, much like you have when choosing a web browser. Most EHRs include a growth chart application. But what other options do you have, besides asking your understaffed information services team to create a custom design for you? SMART apps seek to give users options through substitutability, whereby a user or institution could choose an alternate application or feature through an EHR app store or repository.
Patients also have options when it comes to accessing their data through SMART on FHIR apps. A patient or caregiver may want an app for viewing age-specific health and safety recommendations, managing chronic disease, keeping track of medications or accessing inpatient acute care data. In this case, the patient connects the app to the EHR and uses his or her own existing credentials to log in. As long as the appropriate APIs and authorization protocols are in place, the EHR doesn’t need to know anything specific about the app that will be accessing the data. It just needs to share the secret SMART on FHIR handshake.
Currently, SMART on FHIR is generating a large amount of excitement. Several EHR vendors are supporting the API to varying degrees, and health care systems and commercial companies are creating applications. A recent proof of concept demonstration at the AMIA 2016 Annual Symposium displayed how the technology could be used to access external clinical decision support recommendations and display them natively in two separate vended EHR systems.
SMART Health IT hosts an App Gallery that includes live examples, such as the pediatric-focused growth and bilirubin chart apps
Still, the technology is considered early or experimental. Providers as well as vendors continue to work on some of the more complicated nuances of the system, including how to incorporate write access through the SMART on FHIR platform, how to distribute apps to various end users, and how to govern which apps are safe and appropriate to include in a medical record. To this point, only a few medical centers have implemented the necessary infrastructure and incorporated apps into clinical care.
SMART on FHIR continues to gain momentum in the world of health information technology. It has the potential to bring innovation, competition and collaboration into the health care field for both patients and providers. As more medical systems implement the necessary infrastructure, we likely will find ourselves interacting with an increasing number of connected apps as we care for children.
Date:May 03, 2017