Healthcare Data Exchange with SMART on FHIR

SMART on FHIR is a comprehensive, secure, and standardised approach to improving healthcare interoperability – it seamlessly integrates health applications with electronic health records (EHRs) to improve patient outcomes.

In this article, we unpack the significance of SMART on FHIR and look at the distinctive features that make it a considerable utility in digital health technology and interoperability.

An introduction to FHIR

Fast Healthcare Interoperability Resources (FHIR), pronounced ‘fire’, is a modern open standard-based framework created by Health Level Seven International (HL7). FHIR aims to address the global challenge of healthcare data fragmentation through improving health data interoperability. This is achieved through a set of standardised ‘resources’ or data types that can seamlessly operate in different contexts, enabling disparate systems to process the same information cohesively.

What sets FHIR apart is its adaptability and versatility, leveraging modern web technologies like RESTful APIs and JSON for streamlined data exchange and integration. In a field where data exchange poses challenges, FHIR is semantic and introduces simplicity and consistency.

Compared to previous HL7 standards, FHIR supports a wider array of information formats, seamlessly integrates with different technology solutions, and interfaces more efficiently with remote technology, wearables, and medical devices. FHIR’s capabilities extend to enabling data exchange across diverse systems, including patient administration, practice management, laboratory information, dietary, pharmaceutical, payment systems, and electronic records, providing a comprehensive interoperability solution.

FHIR also supports the Clinical Document Architecture (CDA), an XML-based standard for encoding clinical documents, and Arden Syntax, a language promoting the exchange of medical knowledge, enabling informed treatment decisions.

An introduction to SMART

Substitutable Medical Applications Reusable Technologies (SMART) enhances FHIR’s capabilities. While FHIR establishes a robust data exchange framework, SMART introduces an application layer that enables health applications to seamlessly run across different healthcare systems.

SMART’s primary objective is to create an ecosystem of innovative healthcare applications that can effortlessly plug into any compliant EHR, similar to how apps are installed on a smartphone. SMART empowers healthcare professionals to tailor their EHR systems according to their unique needs and workflows using a variety of applications, promoting flexibility and efficiency in healthcare settings.

The SMART on FHIR protocol has several key principles for software engineers:

  • Define the format for information exchange through the SMART API
  • Utilise CDS Hooks for third-party applications to request data from the healthcare system.
  • Implement data profiles that dictate the type of patient information accessible through FHIR and its format.
  • Leverage the FHIR Bulk Data API for transitioning from individual records to vast quantities of data.
  • Implement the SMART App Launcher interface to synchronise applications with EHRs and healthcare providers.
  • Employ SMART Backend Services dedicated to managing formats, standards, and setting the logic for data exchange.

How SMART on FHIR Functions

SMART on FHIR operates on the core principles of integration, interoperability, and security, significantly enhancing the functionality of healthcare IT systems. Let’s delve into the essence of this groundbreaking system.

In essence, SMART on FHIR combines the robust FHIR standard, which standardises electronic healthcare information exchange, with SMART, adding a versatile layer of user-focused apps to healthcare systems. This fusion aims to create a healthcare ecosystem where apps seamlessly integrate, swap, and get reused across various healthcare systems, thus enhancing interoperability.

SMART on FHIR establishes a system of ‘scopes and launch contexts’ to orchestrate information exchange between apps and healthcare systems, specifying what data an app can access and when. The SMART App Launcher plays a crucial role in this process, syncing apps with Electronic Health Records (EHRs) and healthcare providers. Once authorised, a SMART on FHIR app can access relevant patient data from an EHR system for functions such as data analysis, decision support, or patient education.

A key aspect of the SMART on FHIR system is its embrace of the OAuth 2.0 open authorization framework for secure data access and OpenID Connect for user authentication. These ensure that only approved apps can access patient data, and users are verified before accessing these apps, preserving data security and patient confidentiality.

SMART on FHIR simplifies application development by providing clear guidelines and ensures that these applications can securely interact with a range of EHR systems. The result is a move towards a more connected, streamlined, and patient-centric healthcare system.

Key Features of SMART

SMART enhances the functionality and user experience of healthcare applications. It creates an environment where apps can seamlessly integrate into any compatible healthcare system, enabling efficiency, security, and customisation in healthcare delivery.

Standardised Interface: At its core, SMART features a standardised interface that allows healthcare applications to be substitutable, meaning they can be added or removed without causing disruptions across the system. This plug-and-play approach drives healthcare innovation by empowering professionals to tailor their systems to various applications.

EHR Integration: One of SMART’s strengths lies in its seamless integration with Electronic Health Records (EHRs), enabling healthcare providers to directly use specialised tools within their existing workflows. This enhances efficiency and reduces the need to switch between systems.

FHIR Compatibility: SMART’s compatibility with Fast Healthcare Interoperability Resources (FHIR) ensures access to standardised clinical data, extending interoperability and facilitating smooth operation across diverse healthcare environments.

User Authentication: SMART provides a secure framework for user authentication, endorsing various authentication mechanisms, including the industry-standard OAuth 2.0 protocol. This ensures well-managed and secure access to health data.

App Authorisation: SMART ensures appropriate app authorisation, meaning an app can only access the data it needs and is permitted to view. This offers granular control over data access, ensuring data security and compliance with privacy and data protection laws.

Open Standards: SMART is built on open standards, promoting innovation and compatibility across different platforms while minimising vendor lock-in. This ensures that healthcare providers can freely choose the most suitable applications for their needs.

By combining FHIR’s interoperability capabilities with SMART’s app ecosystem, SMART on FHIR has become a valuable tool in the healthcare IT revolution, offering safer, more efficient care through enhanced data accessibility and usage.

Practical Applications of SMART on FHIR

SMART on FHIR has opened up health IT, aprticular in secondary care settings, leading to innovative solutions that streamline healthcare processes and enhance patient care. The versatility of SMART on FHIR is evident in various practical applications:

Clinical Decision Support (CDS) Systems: Imagine a scenario where a clinician needs to make a critical decision at the point of care. By integrating CDS tools with SMART on FHIR, these systems can access real-time patient data from EHRs, providing evidence-based treatment recommendations. This immediate access to vital information facilitates informed, timely decisions, ultimately improving patient outcomes.

Personalised Medicine: Each patient presents a unique health scenario that requires personalised treatment plans. SMART on FHIR facilitates access to a patient’s complete medical history, enabling clinicians to better understand the patient’s health profile and devise personalized therapeutic interventions.

Patient Engagement Applications: SMART on FHIR enables the creation of interactive apps, empowering patients to access health records, monitor metrics, manage medications, and connect with healthcare providers. This fosters active patient involvement in their health journey.

Population Health Management and Research: SMART on FHIR streamlines health data exchange, fuelling population health management and research. It assists researchers and public health officials in compiling and analysing health data from various sources, identifying health trends, patterns, and disparities across different populations.

Telemedicine: With the increasing demand for remote care, telemedicine has become the new normal. SMART on FHIR enhances telemedicine apps by providing real-time, comprehensive patient data to clinicians during virtual consultations. This ensures data-driven decisions, even from a distance.

Interoperability in Healthcare Systems: The key strength of SMART on FHIR lies in its ability to enable interoperability in healthcare systems. Allowing diverse healthcare applications and systems to communicate in the same language and exchange information seamlessly eliminates data silos and promotes coordinated, comprehensive care.

Let’s Recap

SMART on FHIR is a revolutionary leap in healthcare interoperability, combining FHIR’s robust data exchange potential with SMART’s adaptable application layer. This synergy propels significant advancements in health IT, streamlining EHR integration, ensuring secure user authentication and app authorization, and enabling diverse applications, including clinical decision support systems, patient-centric apps, and research initiatives.

Contact us if you need an experienced strategic technical partner to maximise the benefits of SMART on FHIR.

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