Demystifying Smart on FHIR: Building Smart on FHIR App
Before understanding Smart on FHIR, let's understand what is FHIR?
Table of Contents
Key Takeaways
- FHIR provides standardized healthcare data models and APIs
- SMART on FHIR adds authentication, authorization, and UI integration
- OAuth 2.0 and OpenID Connect ensure secure access to healthcare data
- EHR UI integration simplifies clinician workflows
- Industry adoption is growing but still requires improvement
FHIR (Fast Healthcare Interoperability Resources), developed by HL7, plays a pivotal role in addressing the critical issue of data interoperability in healthcare systems. The need for FHIR arises from the inherent challenges faced when organizations with different EHR systems or departments utilizing diverse software solutions attempt to communicate and share patient information.
🏥 Healthcare Interoperability Challenge
Within a healthcare institution like a hospital, different departments often employ separate computer systems to manage various aspects of patient data, such as appointments, medical records, and billing. When patients transition between these departments, the details are often manually re-entered into the new system, leading to potential data loss and inconsistencies.
How does FHIR ensure interoperability?
FHIR provides a set of data models and APIs for structuring and accessing medical data, enabling different software applications, systems, and devices to communicate healthcare information in a standardized way.
Data Models
FHIR data models, termed as resources, structure healthcare data with defined attributes, relationships, and meanings for various data types like patient personal information, observations, medications, and conditions.
The FHIR Resource list published by HL7 FHIR R5 comprises 157 Resources categorized into different groups encompassing administrative, clinical, financial, infrastructure, and other workflow aspects.
Resource Structure
Each resource captures specific attributes, relationships, and metadata related to that piece of information. For instance, the Patient resource captures:
- • Patient Identifier
- • Patient Name
- • Gender
- • Contact Information
- • Active Status
What is Smart on FHIR?
SMART or Substitutable Medical Applications, Reusable Technologies was developed in 2010 with the purpose of building a standard framework that allows the development of "interchangeable healthcare applications". It works in conjunction with and on top of FHIR hence referred to as SMART on FHIR.
Key Focus Areas
- Substitutable Aspect: Enabling any developer to create a healthcare application that would work across any healthcare organization, regardless of the type or version of EHR/other healthcare systems
- Authentication and Authorization: The other pillar for SMART, functioning as a security barrier positioned over FHIR
- OAuth2 and OpenID Connect: Providing third-party applications with the necessary authorization to access data from any healthcare system that adheres to the SMART on FHIR standards
OAuth 2.0 and OpenID Connect Implementation
OAuth 2.0 operates by issuing access tokens to third-party applications. These access tokens serve as temporary keys, allowing applications to access specific healthcare resources on behalf of the user.
OAuth 2.0 Features
- •Issues access tokens to third-party applications
- •Defines permissions known as "scopes"
- •Specifies what data or actions applications can access
- •Ensures secure and controlled access to healthcare data
- •Safeguards user privacy through controlled access
OpenID Connect Benefits
- •Enhances OAuth 2.0 with identity management capabilities
- •Provides secure access and identity verification
- •Requests additional user information for enhanced UX
- •Enables Single Sign-On (SSO) reducing multiple logins
- •Critical role in SMART on FHIR identity management
How SMART builds on top of FHIR
The table below summarizes how SMART builds on top of FHIR:
| Component | SMART on FHIR | FHIR |
|---|---|---|
| Authorization | OAuth2 | None |
| Authentication | OpenID Connect | None |
| Data Models | From FHIR | FHIR Resources |
| Profiles | SMART profiles | None |
| Data Access | From FHIR | FHIR REST API |
| Data Format | From FHIR | FHIR JSON or XML |
| EHR UI Integration | SMART Launch Specification | None |
Key Enhancements SMART Provides
EHR UI Integration
Perhaps one of the most crucial features of SMART is enabling integration with the user interface of EHRs, thus simplifying the process of navigating between applications by bringing them together in one interface.
With SMART, clinicians can access all integrated applications directly within their EHR, enter information, view data and make informed decisions without needing to leave the EHR environment.
Enhanced Security
In SMART on FHIR, OAuth Authorization is employed to provide secure access to healthcare data, allowing only authorized apps to retrieve patient information, while OpenID Connect is used to securely confirm the identity of users accessing healthcare data.
The focus of FHIR is on organizing and exchanging healthcare data and it does not directly incorporate OAuth Authorization or OpenID Connect for security purposes.
Industry Adoption and Compliance
According to the Journal of the American Medical Informatics Association (JAMIA), while the number of unique healthcare applications rose from 600 to 734 in 2023, only 22% of the applications conformed to the FHIR standard. To improve compliance to FHIR, the Lantern tool, developed by the ONC (The Office of the National Coordinator) was set up to help ONC monitor and share insights on the presence and uniformity of FHIR compliant applications. Click here to view the Lantern dashboard
Source: Journal of the American Medical Informatics Association (JAMIA) - FHIR application usage across different healthcare categories
As federal regulations come into play and FHIR gains more traction, the number of applications conforming to SMART on FHIR is expected to increase significantly across all healthcare categories.
Future Outlook
As federal regulations come into play and FHIR gains more traction, the number of applications conforming to SMART on FHIR is expected to increase significantly across all healthcare categories.
How Finarb Analytics Implemented SMART in a Web-Based Application
Finarb Analytics collaborated with a leading public hospital in Texas in developing a web-based application for early sepsis detection and prevention. This case study demonstrates practical SMART on FHIR implementation.
Application Features
- •Seamless integration with multiple data sources
- •User-friendly dashboard with real-time patient data
- •Historical data analysis for trend identification
- •Real-time alert system for abnormal values
- •Risk score calculation and monitoring
Technical Implementation
- •EHR platform selection supporting SMART on FHIR
- •API compatibility verification
- •FHIR standards adherence
- •SMART App Launch framework utilization
- •Authentication and authorization handling
Development Process and Considerations
EHR Interoperability
SMART on FHIR is designed to be interoperable with various Electronic Health Record (EHR) systems. An EHR platform needs to be selected that supports the SMART on the FHIR standard. The process involves researching different EHR vendors, their compatibility with SMART on FHIR, and their reputation in the healthcare industry.
Application Development
The development involves using the FHIR resources and SMART App Launch framework to create a web-based application. There is a demand for developers who are familiar with FHIR standards and web application development. The SMART on FHIR framework provides libraries and tools that simplify this process and ensures proper authentication, authorization, and data exchange.
🏆 Key Success Factors
- • Choosing technology firms that understand business needs and HL7/SMART guidelines
- • Ensuring compliance with HIPAA regulations
- • Implementing robust authentication and authorization mechanisms
- • Designing user-friendly interfaces that integrate seamlessly with existing workflows
- • Thorough testing and validation of FHIR compliance
SMART on FHIR represents a significant advancement in healthcare interoperability, enabling the development of applications that can work across different healthcare systems while maintaining security and data integrity. As the healthcare industry continues to embrace digital transformation, SMART on FHIR will play an increasingly important role in enabling innovation and improving patient care.