Healthcare Interoperability

What is SMART on FHIR?

Over the past couple of weeks, I’ve been immersing myself in a technology that shows promise for developing app stores within Electronic Medical Records and Health Information Exchange environments.

In 2009 Harvard Medical School started a research project on “Substitutable Medical Apps and Reusable Technology” (SMART) that was funded by ONC as part of a larger initiative called the SHARP project (Strategic Health Information Technology Advanced Research Projects). A fifteen million dollar grant was provided to conduct this research.

The goal of the project was to “develop a platform to enable medical applications to be written once and run unmodified across different healthcare IT systems”. Over time the platform’s goal has evolved into being “a growing selection of high-quality tools built to solve small and big problems”.

The first version of SMART, dubbed SMART classic, was revolutionary for its approach of using open standards such as HTML, RDF (Resource Description Framework), JavaScript, Oauth2, and OpenID; thus breaking away from the old, but unfortunately pervasive, approach of proprietary standards in HealthCare.

When subsequently coupled with FHIR (Fast Healthcare Interoperability Resources) SMART really began to become well known within the health care community.

SMART on FHIR has been adopted by industry heavyweights such as Cerner, Epic, and AllScripts whom all provide sandboxes for development. Open source client libraries are available that take away some of the complexities of writing code to implement a SMART on FHIR app.

The platform has some great examples of web applications such as the Boston Children’s Growth Chart (Boston’s Children’s), and the Bilirubin Chart (Intermountain Healthcare). iOS, Android and desktop operating system applications are also supported.

It’s still early days for SMART on FHIR.  Not all vendors have rolled the technology out into full production use, but there is hope that in the not too distant future the dream of building web apps and deploying them into a hospital near you may become a reality.