How to Build Interoperable Health Apps: What is SMART on FHIR?

Modern medicine is transforming, acquiring digital functions and standards. According to Grand View Research, the global market for electronic medicine reached $110 billion in 2021 and is predicted to grow to $296 billion by 2028 with a CAGR of 15.1%.

The development of IT solutions for digital medicine has always been associated with some difficulties. The main one was interoperability, or rather its absence. Health Level Seven International managed to partially solve it by releasing SMART on FHIR, the modern information exchange protocol. At the beginning of 2020, HHS approved the final list of specifications and protocol requirements.

Today GloriumTech will talk about the peculiarities of creating virtual tools for digital medicine using SMART on FHIR. In this article, you will learn about the nuances of telemedicine solutions and all the necessary certifications.

What is SMART on FHIR?

SMART is an API for healthcare. It is used to develop standardized apps. This technology allows you to create interoperable solutions that can be synchronized with any digital medical system, regardless of their types and formats. The only condition for integration is SMART support by the EHR provider.

FHIR is an extended version of the HL7. This standard ensures secure data exchange between healthcare institutions and provides access to healthcare systems with a RESTful or HTTP service.

Unlike its predecessor, FHIR has greater support for information formats, is easier to integrate into mobile SaaS solutions, and interacts with wearable and medical devices more efficiently.

The protocol has support for:

• Exchange of requests. Data exchange is provided between digital patient administration systems (PAS), electronic practice management systems (EPM), laboratory information systems (LIS), dietary, pharmaceutical, and payment systems, as well as electronic medical records (EMR) or electronic health records (EHR).
• Clinical Document Architecture (CDA). It is an XML-based standard, which defines the encoding, structure, and semantics of clinical documents included in medical records. Documents consist of text for display and structure for organizing data in an app.
• Arden Syntax is a language that facilitates the exchange of medical knowledge. The standard helps make prescribing decisions and sends medical personnel warnings, interpretations, and messages. Its capabilities allow for sending reports if the patient’s tests raise concerns. Arden Syntax helps you make informed treatment decisions.

What Does SMART on FHIR Stand for?

It is the way the FHIR protocol interacts with the SMART API, OAuth2, and OpenID Connect. The main purpose of this solution is to provide a secure, interoperable principle of information synchronization between the IT solution, EHR, and healthcare providers.

The principle of the SMART on FHIR protocol is based on:

• Defining the format for exchanging information with the SMART API.
• CDS Hooks, which help third-party apps request info from the healthcare system.
• Data profiles that determine what kind of information and in what form can be obtained about the patient by FHIR.
• HIR Bulk Data API, which changes the format from a single record to large amounts of data.
• SMART App Launcher, an interface for synchronizing apps with EHRs and healthcare providers.
• SMART Backend Services, a system for processing formats and standards and setting data exchange logic.

Interoperability Definition in Healthcare

Interoperability means the opportunity to exchange patient and prescription information between specialized, authorized systems and devices by sharing information. Ensuring the universalization of formats and standards is one of the areas where interoperability opens up the possibilities of IT solutions for the healthcare industry.

There are 4 types of interoperability:

• Basic: establishing a relationship between two specific systems.
• Structural: providing exchange considering the format, syntax, and other features.
• Semantic: defining basic models and the qualification of relationships. Using standard definitions understandable to users.
• Organizational: a senior type of compatibility when a policy of full or partial trust and access to data exchange is applied.

SMART on FHIR App Development

Healthcare app development is a bit different from simple multi-platform solutions. In addition to the standard functionality, they must support modern security standards and medical certificates.

It also requires support for EHR and EMR systems, format universalization, and a reliable information exchange channel between the IT solution and healthcare providers.

Implementing all of the above was problematic without SMART on FHIR. It required manually creating dependencies and synchronization between the app and the EHR of a specific health care provider.

There was no talk of any interoperability. The HL7 organization partially solved this problem by releasing the first version of the protocol.

1. App Type Selection

An interoperable healthcare app must be multi-platform. It may be implemented as a stand-alone or integrated system. For example, you can create a mobile solution for ordinary users and a web platform for doctors with access to EHR, EMR, and patient accounts.

SMART on FHIR is implemented as an API with support for RESTful and HTTP services as well as JSON or XML data formats so that it can be embedded into any app. It is preferable to use JAVA-oriented frameworks like Angular, React, or Node due to better protocol compatibility.

2. Safety and Certification Standards

SMART on FHIR is a protocol for communicating between clients and clinical systems. But do not forget that certificates and standards like GDPR, HIPAA, ICD-10, XDS, XDS-I, and EVV are essential for healthcare.

For the app to work with healthcare providers, you should not refuse to implement these standards in your IT product. Consider it when ordering development and preparing technical specifications for the contractor.

3. Integration with Vendors

When connecting your app to EHR and EMR systems, consider SMART on FHIR support. For example, Epic, Allscripts, Cerner, and Orion Health support this protocol. It is also supported by ONC in the US, NHI in the UK, HINZ in New Zealand, and NEHTA in Australia.

4. Testing

The SMART APP Launcher platform allows you to test the performance of your IT product before deployment. Some healthcare providers offer their test environments based on this API. They emulate their EHR data or even provide factual information. Thus, the application logic and interface elements, the relevance of the output data, and the operation of notification systems are checked.

5. Deployment

You can publish your IT solution with SMART on FHIR support on specialized platforms like Google Market or AppStore if you have a native app. To host a web product, you can use cloud platforms. SMART on FHIR is supported by Google, Amazon, Verily, Azure, and other providers. You can also visit Cerner, a profile website with different SMART on FHIR apps. By the way, this platform allows you to deploy IT products for testing or just publishing.

Let’s Summarize

Interoperable apps for healthcare and medical services based on SMART on FHIR are a trend for the next decade. With the help of the GloriumTech team, you will launch your app to the market as quickly as possible. Our experts will consider all specifications, certificates, and protocols to release a quality IT product synchronized with the EHR of the healthcare provider you need. For advice and ordering the service, please contact our manager.

FAQ