SMART on FHIR for the Future of Healthcare

Key Takeaways

• SMART on FHIR, is a healthcare standard through which apps can access medical data seamlessly. It adds a security layer based on standards such as OAuth2 and OpenID Connect, to enable EHR integration.
• SMART and FHIR are not platforms. They are a set of standards that explain how to incorporate technology and offer smooth data transfers.
• Any healthcare technology built with SMART can work with any EHR database that uses SMART. As a result, healthcare technology becomes interchangeable and allows patients and providers to access data on apps that best suit them.

Healthcare systems such as EHR are designed to improve patient engagement, quality of care, and seamless data transfers. However, as per a study published on the NCBI site, some of the potential challenges of using EHR are changes in workflow, a decline in revenue, and temporary loss of productivity. This later builds gaps in the healthcare system such as fragmented data exchange between providers and patients. To address this issue, SMART on FHIR solution was created.

What is SMART on FHIR?

In healthcare, workflows span around varied healthcare systems and EHR software. They may not be connected. If a physician has to acquire a complete picture of a patient, then he/she has to log in to different servers to assemble all the data. Since physicians’ duties are time bound, they’ve to appoint another person to do this task for them. This can be time-consuming and have an internal cost as well.

To explain with an example, a cardiovascular disease patient checks in for a telehealth visit and goes to a local lab for a test. Since the patient has a chronic disease, there’s a need for regular check-ups, which results in continuous medical data generation. With SMART on FHIR, this data can be assembled in a way that healthcare providers no longer have to switch through numerous applications to compile patients’ medical data.

In other words, SMART on FHIR is a healthcare standard through which apps can access medical data seamlessly. It adds a security layer based on standards such as OAuth2 and OpenID Connect, to enable EHR integration. Additionally, SMART wanted it to be easy for care providers to try new applications, so they could pick the solutions that worked for them.

Overall, SMART on FHIR includes three aspects:

• Access to Data: SMART utilizes FHIR standards for updating and reading data. This is secured by using the identity and access management section.
• Identity and Access Management: SMART utilizes the OpenID Connect management protocol that allows access to clinical data. This is read-only access to a few records or reads/write access to the entire EHR system (any of the two).
• Launch: For web applications, SMART explains a consistent URL for EHR, portals, etc. which is used for launching web applications with a context. This context consists of information on selected patients and more.

An Overview of FHIR

HL7 FHIR (Fast Healthcare Interoperability Resources) standard determines how healthcare information can be exchanged between various computer systems, regardless of how it is stored. It allows access to clinical and administrative data to those who need it and to those who have the authorization to access the data for giving care. Benefits offered by FHIR to software developers include:

• Free to use without restrictions.
• Fast and easy implementations, and simple interfaces.
• Support from big vendors such as Microsoft, Apple, Epic, Google, and more.
• A robust foundation in web standards such as JSON, XML, OAuth, and HTTP.
• Several free and downloadable tools such as implementation libraries and reference servers.

An Overview of SMART

SMART (Substitutable Medical Applications and Reusable Technologies) is an interoperable app platform for EHRs. It was developed by the Harvard Medical School and Boston Children’s Hospital in 2010.

Developing SMART aims to enable a medical application that is written once and runs across different healthcare IT systems. It encompasses open standards, open-source tools for software developers, and a publicly accessible app gallery. SMART helps to build applications that provide quality clinical care at healthcare facilities.

SMART and FHIR are not platforms. They are a set of standards that explain how to incorporate technology and offer smooth data transfers. In a nutshell, SMART standardizes data access and FHIR standardizes the data itself.

The 21st Century Cures Act was passed in 2016. It was created to enhance medical product development and bring innovations to patients. In 2020, the 21st Century Cures Act and Final Rule from the ONC made SMART requirements for Health IT Modules. This is the next step towards healthcare interoperability.

SMART Improves Interoperability

Healthcare interoperability ensures that all data is shared, used, and interpreted cohesively. Inability to access patient data securely when in need results in an incomplete understanding of patients’ medical conditions. It can negatively impact patient outcomes. An interoperable healthcare system prevents these issues.

EHR databases are built on proprietary APIs. So, healthcare development companies have to create a custom connection with each database to access health data. This is an expensive process and hinders providers and patients from accessing data via the technology they use. To prevent these problems, SMART is utilized as it provides a standard API for accessing EHR.

Any healthcare technology built with SMART can work with any EHR database that uses SMART. As a result, healthcare technology becomes interchangeable, allowing patients and providers to access data on apps that best suit them, rather than those that work with the EHR system they use.

Arkenea offers interoperable EHR/EMR software for your healthcare organizations. It is created with a focus to work seamlessly with practice management solutions that your facility uses. To know more, get in touch with Arkenea.