What Is SMART?

SMART—An App Platform for Healthcare

SMART Health IT is an open, standards based technology platform that enables innovators to create apps that seamlessly and securely run across the healthcare system. Using an electronic health record (EHR) system or data warehouse that supports the SMART standard, patients, doctors, and healthcare practitioners can draw on this library of apps to improve clinical care, research, and public health.

The SMART platform is composed of open standards, open source tools for developers building apps and a publicly accessible app gallery. To date, dozens of clinical applications have been built on this platform, and SMART applications are being used to provide clinical care at healthcare institutions, including Boston Children’s Hospital and Duke Medicine.

The project is run out of the not-for-profit institutions, Boston Children’s Hospital Computational Health Informatics Program and the Harvard Medical School Department for Biomedical Informatics.

Open Standards

Open standards enable developers to build apps that can connect to health data systems such as EHRs and data warehouses without requiring specialized knowledge about each system. For clinicians, patients, and researchers, standards facilitate an ecosystem of third party apps that can offer EHR modules tailored to their needs, as well as extend systems with new capabilities such as integrated precision medicine.

The SMART project defines a health data layer that builds on the emerging FHIR (Fast Healthcare Interoperability Resource) API and resource definitions. FHIR provides a detailed set of “core” data models, but in order to support diverse requirements across varied regions and use cases, many fields optional and vocabularies are under-constrained. To enable substitutable health apps as well as third-party application services, SMART applies a set of “profiles” that provide developers with expectations about the vocabularies that used to express medications, problems, labs, and other clinical data.

Additionally, SMART standards outline a robust authorization model for apps based on the OAuth standard, providing a key component that enables innovation while keeping patients and providers in control of their data. Finally, through the SMART Genomics and SMART CDS Hooks efforts, the SMART project is taking the lead on defining the next generation of FHIR based standards for the clinical use of genomic data and the integration of  clinical decision support into provider workflows.

Tools and Infrastructure

To make it easy for developers to get started building apps based on the SMART standards, the SMART Health IT project created, maintains and supports a set of open source libraries that simplify and streamline the use of these standards in real world apps. Currently, libraries are available for HTML5/Javascript, iOS and Python.

The SMART team also offers free API “sandbox” servers on the web for developers to test their apps (along with with a locally installable version that users can run on their own systems). Additional tools, such as a web-based FHIR resource editor to help developers structure sample data for their apps (FRED) and a software library that integrates the SMART platform with Apple ResearchKit framework (C3-PRO) are under development.

App Gallery

The SMART App Gallery provides a central place to connect apps and app users, offering developers a free and open way to share their apps and healthcare providers an easy way to find and try SMART compatible apps.

Unlike many app stores, the App Gallery is not restricted to a single EHR platform or technology and hosts commercial and open source apps. Integration with SMART infrastructure enables developers to offer app trials without needing to run their own SMART server, and provides app users the ability to safely try out apps with a single click.

SMART Health IT Project

The SMART Health IT Project is run out of the not-for-profit institutions, Boston Children’s Hospital Computational Health Informatics Program and the Harvard Medical School Department for Biomedical Informatics.

The U.S. government funded the creation and initial development of SMART with a four year $15M contract, resulting in standards, open source technology and a robust community of app developers. To sustain the project going forward, an extraordinary group of organizations committed to the transformation of healthcare have joined the SMART Advisory Committee and are supporting SMART through philanthropy, strategic guidance, and deployments.

Additionally, through a project called Argonaut, the five largest EHR vendors have joined forces with the SMART team and the HL7 organization to build SMART into the releases of their products, and to standardize the SMART API in HL7 specifications.

The term SMART was originally coined as an acronym for “Substitutable Medical Apps, Reusable Technology”, features which remain a core part of the project’s mission.