It’s hard to imagine a medical application that operates with electronic health records without SMART on FHIR. Don’t get me wrong, they do exist but they aren’t easy to maintain not to mention how painful and costly it’s to integrate them with some custom EHR systems. Sustainability, interoperability, and security are the three pillars of modern healthcare which explains how important and popular SMART on FHIR is nowadays.
So what is SMART of FHIR? The short answer is that SMART on FHIR is a set of open specifications that regulate the development of healthcare apps integrated with EHR systems. These specifications allow us to use plug-in applications and run them inside any EHR that complies with HIPAA. Continue reading and learn about the limitations, implementation, use cases, and the future of SMART on FHIR.
SMART and FHIR: Brief overview
Unintegrated siloed healthcare apps generate little value compared to those integrated with other digital solutions like clinical support or EHR systems. To make more use of the healthcare data and improve healthcare outcomes, clinics and healthcare service providers really need the EHR to travel freely between medical apps. This is where we first meet Fast Healthcare Interoperability Resources also known as FHIR. To understand the value of SMART on FHIR, we should first learn what is FHIR.
So what is FHIR?
The FHIR standard defines the type and format of health data for digital solutions and apps that want to share this data. FHIR was developed by a non-profit organization called HL7 which specializes in creating standards for healthcare data interoperability. Here’s how FHIR API works:
- An app needs to fetch patient vitals from electronic health records
- It checks what kind of data is available
- Looks which command it should send to request data from EHR
- Figures which responses can the app receive to process them adequately
What is SMART?
SMART stands for Substitutable Medical Applications, Reusable Technologies and is a specification framework developed by data interoperability enthusiasts who recently started collaborating with FHIR/HL7. Before SMART on FHIR was a thing, vendors had to go and ask programmers to develop a new app to access EHR data since APIs they were using were closed.
So to overcome those complications, HL7 developed the first version of SMART. It happened in 2010 when smartphone innovations became a big thing. The creators were looking for ways of exchanging health data swiftly and securely. SMART allowed healthcare service providers to try out new apps programmed by various vendors and move on when the solutions failed to help them run operations well.
How do SMART and FHIR come together?
The birth of SMART on FHIR named a new era in healthcare solutions development. It accelerated the engineering process and simplified integration with EHR and medical software. But what does SMART on FHIR stand for? To be precise, it’s Substitutable Medical Applications, Reusable Technologies on Fast Healthcare Interoperability Resources. SMART relies on the way FHIR standardizes data and, at the same time, provides an additional authorization layer.
As of now, SMART on FHIR is an open and standardized means of exchanging data between EHR systems, data sources, and medical software. On the SMART side, there’s an app gallery and a sandbox for testing.
So why do programmers love SMART on FHIR? First of all, it shares data in a predictable format which generates fewer bugs during data processing. Secondly, programmers work with concrete data objects which accelerates the development process.
Incorporating SMART into the Century Cures Act
SMART was incorporated into the 21st Century Cures Act in 2016. The Act demanded the adoption of a standard API to “allow individuals to securely and easily access structured electronic health information using smartphone applications.”
Later, in 2020 The Office of the National Coordinator for Health Information Technology’s (ONC’s) Final Rule on Interoperability stated that SMART is a universal API.
This means that for ONC-certified health IT SMART API is a requirement. Another detail worth mentioning is that the ONC certification program is not mandatory for private sector businesses. Therefore, SMART isn’t compulsory for companies whose digital products aren’t used in government apps.
The Centers For Medicare and Medicaid Services (CMS) issued similar policies. The policies encourage payers to implement Application Programming Interfaces (APIs) to improve the electronic exchange of health care data.” And CMS, too, lists SMART on FHIR as a mandatory standard for those health systems that accept Medicaid and Medicare.
Why should you use SMART on FHIR?
Tech-wise, SMART on FHIR delivers many benefits such as app reusability, big app gallery, and open standards that’s why SMART on FHIR is widely adopted. Let’s take a closer look at the list of benefits.
- SMART on FHIR has an ever-growing app gallery of providers and patients to choose from.
- Apps that comply with SMART are reusable. For instance, one app can be repurposed with minimal effort.
- SMART on FHIR has a large community of engineers and tech experts to ask for advice.
- Programmers can improve their apps without ruining the way healthcare providers and patients access data. The technology simply disengages the protocols for accessing EHR from an app.
Now that we know that SMART on FHIR is a great tool for ensuring interoperability we can move on to discovering the benefits SMART on FHIR generates for businesses, engineers, providers, patients, designers, and other parties involved.
SMART on FHIR benefits engineers
SMART significantly improves interoperability and saves development cost and duration. How so? The thing is that when a business wants to add another app that will be exchanging health data with the database, they need to request custom software development. Creating proprietary APIs is costly and takes some time. SMART resolves this issue by offering standardized plug-and-play connections.
In simple words, any EHR database that uses SMART works seamlessly with any technology built with SMART. As a result, we receive impeccable interoperability and a wider variety of applications that they can add.
“A bunch of popular EHR platforms such as Epic, Cerner, Allscripts, Meditech, and Intersystems support SMART on FHIR.”
This is partially why many healthcare service providers switch from legacy medical software to popular EHR providers.
The positive role of SMART on FHIR for providers and patients
Better interoperability grants access to a wider variety of applications businesses can add, test out, and adopt. For providers, this means that they won’t be stuck with a solution that doesn’t match their needs.
“SMART on FHIR allows healthcare providers to expand their business offerings without additional fuss.”
They can jump from one app to another until they deliver a perfect user experience.
Unknowingly, users, too, benefit from SMART on FHIR. Thanks to this technology, they can access their health data in a secure way. Moreover, patients of various age groups enjoy interacting with intuitively designed apps.
SMART on FHIR brings security benefits
Solutions built with SMART on FHIR technology allow us to grant and restrict access to data to responsible people. For instance, a patient and a doctor will see only the data they need to see.
The beauty of SMART on FHIR lies in the authorization and authentication layers that simplify granting access to data. On top of that, we have a single sign-in function. It guarantees that you can move freely between a bunch of apps that use PHI without being signed out.
SMART on FHIR improves the user experience
Switching between a couple of EHR platforms can be a challenging job, especially when they have different interfaces. SMART on FHIR allows accessing UI of other applications via their own EHR.
SMART on FHIR vs. FHIR Alone
There’s a significant gap between FHIR alone and SMART on FHIR. For instance, SMART on FHIR has built-in authorization and authentication. The biggest difference, however, is that SMART on FHIR offers EHR UI integration that simplifies navigation between apps by uniting them under one user interface. So, for instance, when clinicians use a couple of integrated apps, they can access them through their EHR.
Issues with building health apps using SMART on FHIR
Despite the growing popularity of SMART on FHIR in healthcare app development, some healthcare app developers restrain from using it. Let’s see why.
1. Insufficient documentation for implementation
SMART on FHIR has somewhat scarce documentation and not that many app developer forums. This leaves engineers only a test-and-try approach to dealing with issues. Additionally, there aren’t many EHR vendors supporting SMART on FHIR. However, those who do (Cerner, Epic, Intersystems, etc.) are quite popular.
2. Not all vendors provide SMART on FHIR support
As of now, there’s a limited number of EHR providers that fully integrate with SMART on FHIR. Thus, it’s not always possible to develop one app and integrate it with any EHR possible. Those EHR vendors who support the technology still have their own requirements for integration.
How to develop a SMART on FHIR application?
1. Decide which type of SMART on FHIR app you want to create
Before you even begin the development process, decide which type of app you need. There are plenty of app types, you can choose from
- Mobile and web apps
- Patient-facing and healthcare provider-facing apps
- An integrated or stand-alone web app
With SMART on FHIR, you can focus on programming the main functionality since there’s no need to write all interoperability functionality. The app development process using SMART on FHIR is quite quick due to its libraries that can be used for Python, Swift, JavaScript, Ruby, and many other programming languages.
There are also cloud services for the server-side that comply with SMART on FHIR. Some cloud technologies like Azure and Google are more standard-ready while others may require more time and effort. For instance, AWS is gradually becoming a better fit for the development of SMART on FHIR apps.
2. Ensure security on all levels
SMART on FHIR has integrated security specifications such as OAuth 2.0 and OpenID. With these technologies, system owners can grant permissions and manage access levels for people in their team and in TPAs alike.
They allow healthcare providers to skip authentification each time they switch between the integrated apps. Providers don’t need to indicate passwords each time they log into third-party applications and EHR systems. What’s more, oAuth OpenID in SMART on FHIR is compliant with the HIPAA standard .
3. Develop the app features with engineers
Now that you know what your solution has to do for you, it’s time to implement it with your engineers. And if you don’t have one, you can collaborate with healthcare software development companies like Binariks. We have profound experience in creating HIPAA-compliant software with the application of SMART on FHIR and FHIR alone depending on our client’s needs.
4. Run app testing with sandboxes
Why is it so important to test your medical solution? Firstly, because there are many data formats and you need to make sure they are adequately sent and received. The good news is that SMART offers its own sandboxes for testing app features.
Sandboxes have their own synthetic patient datasets for testing and emulating interaction between SMART on FHIR app and EHR interfaces. You can also test in EHR vendors’ sandboxes. For example, Epic allows you to test your own app features with its sandbox.
5. Deploy your app
Now that the app development phase is finalized, you can deploy it and allow your employees, clients, and partners to download it from an app store. Since you’ve created a SMART on FHIR app, you can upload it to a specialized gallery with the rest of the healthcare providers.
A few samples of SMART on FHIR apps
There are around 58 SMART on FHIR apps in the store. Not much but the number is growing. Each app serves a particular goal and can be repurposed to fill another gap. There are apps for practitioners, patients, healthcare service providers, and literally every party engaged in providing healthcare services. Let’s take a closer look at the latest and most innovative SMART on FHIR apps.
BP Centiles
Boston Children’s Hospital created an app that interprets childrens’ blood pressure readings for physicians. The thing is that physicians must take into consideration continually changing body sizes which may sometimes be quite a challenging task. On top of that, doing all of the required data entry takes a long time.
This app saves physicians time by computing both systolic and diastolic blood pressure percentiles and normalizing them by age, sex, and height. When the computing is done, BP Centiles employs visual clues so that doctors may quickly determine whether the readings are normal (represented by green), prehypertensive (represented by yellow), hypertensive (shown by red), or hypotensive (blue).
Duke PillBox
The latest DukeHealth app seeks to make it simpler for patients to manage complicated prescription regimens. About 50% of all treatments aren’t properly followed which costs the industry approximately $100 billion per year. Patients may drag and drop their medications and recommended amounts into the proper time slots using the interactive learning tool known as PillBox (i.e morning, afternoon, or evening). The fact that every pill has a picture and there is a “hint” option available for those who are having trouble remembering their dosing regimen makes the app user-friendly.
Cardiac Risk
Boston Children’s Hospital created the Cardiac Risk app that reads patient information to predict the 10-year cardiovascular risk of a person. It analyzes family history of heart attacks, systolic blood pressure, and whether or not the patient smokes. The patient may change any of these metrics or vitals and see how it affects their risk score, which is one of the app’s best features. A patient who smokes, for instance, might see how much their Reynolds Risk Score would decrease if they gave up.
How Binariks Can Help you build a SMART on FHIR app
To create a HIPAA-compliant medical app with a convenient UX and a high security level, you’ll need a company that has hands-on expertise, certifications, and expertise. Binariks has it all. We help healthcare providers leverage technology and comply with all necessary standards by offering professional architecture and business analysis consulting, software development, and quality assurance expertise.
Recently, we helped a healthcare provider that has a cloud platform for doctor referrals create a platform architecture that would enable better interoperability. Our team of solution architects and business analysts tested Athenahealth, Epic, and Allscripts to conduct test integrations. As a result, they decided that it was best to implement an EHR system that supports SMART on FHIR:
Due to its support for SMART on FHIR, Epic was selected as the best EHR provider out of all of them. This choice healed the platform to smoothly interact with the features offered by numerous EHR providers.
In order to guarantee the security of patient health data transmitted over APIs, our client has embraced HL7 FHIR version 4.0.1 as the fundamental data interchange standard suggested by both the ONC and the Centers for Medicare & Medicaid Services (CMS).
Final thoughts
SMART on FHIR and healthcare go together like a hand in a glove. Considering the advantages and the fact that it is included in the Cures Act, developing SMART on FHIR apps is virtually required for every healthcare system. Major EHR providers including Epic, Cerner, and Allscripts already use SMART for this purpose.
However, at the time this article was written, there were only 98 apps available in the SMART app gallery, indicating that not many businesses have yet used the standard in their products. Therefore, SMART adoption might provide some tech businesses with a sales advantage.
Aside from requirements, early SMART acceptance might aid healthcare tech businesses in ensuring that their programs are eventually more generally used. Binariks will help you bring into life SMART on FHIR applications that serve your purpose.
Share your requirements with us and we will assemble a team of tech specialists who will cater to your needs.
Originally published at https://binariks.com.
