SMART Platform (www.smarthealthit.org) is a project that lays the groundwork for a more flexible approach to sourcing health information technology tools. Like Apple and Android’s app stores, SMART creates the means for developers to create and for health systems and providers to easily deploy third-party applications in tandem with their existing electronic health record, data warehouse, or health information exchange platforms.
To deploy SMART-enabled applications, health systems must ensure that their existing health information technology infrastructure supports the SMART on FHIR API. The SMART on FHIR starter set detailed below lists the minimum requirements for supporting the API and SMART-enabled applications. You may wish to augment this list of minimum requirements with suggestions from the Add-On Functionality listed depending on the types of applications your organization wishes to deploy.
This document is intended as a resource for providers and health systems as they draft Request for Proposals (RFPs) and negotiate with their HIS vendors for added functionality. It has multiple authors from across the SMART team and its advisors. Feedback is welcome.
The vendor must support the SMART on FHIR platform, a vendor agnostic API that allows third-party developers to build external apps and services that integrate with the vended product.
At a minimum, the vendor product should include the following components in order to support SMART on FHIR and SMART-enabled applications:
Data Access
- Provide automated, standards-based, read-only access to:
- a well-defined set of real-time discrete data (represented in FHIR, with appropriate profiles and vocabularies)
- automated bulk export of standards-based data
Data Manipulation
- Write structured data from third-party apps back to the organization’s EHR and where relevant, a data warehouse, using the FHIR REST API to communicate data including:
- free-text clinical notes
Standards-Based App Authorization
- Protect data and identity endpoints with standards-based authorization mechanisms (OAuth2)
Identity Management
- Act as as standards-based Identity Provider using OpenID Connect. This ensures that users can authenticate to plug-in apps using single-sign-in via their existing EHR credentials.
- Act as a standards-based relying party to a customer-selected Identity Provider using OpenID Connect. This ensures that users can sign into the EHR using an external, hospital-supplied single-sign-on account.
Workflow
- Support standards-based embedding of external application UI (HTML5). This ensures that app developers can build Web apps, and these apps can run directly inside of the EHR.
- Support the launch of external applications in the clinician’s workflow (this is not limited to the EHR, and should include non-EHR integrated tools such as smart phones and tablets). For example, a clinician that has opted to use a third-party-developed native iPad app to visualize a patient’s BMI over time can seamlessly use the application alongside the EHR via single-sign-on.
- Support notifications to and from running applications. For example, an embedded app can notify the EHR when the user is “done” with it.
Add-On Functionality
The provider organization may also want to consider the following additions to its RFP depending on the types of applications it wishes to develop and run in the future.
Data Access
- Provide automated access to bulk export of vendor-specific data (complete representation of all data).
Data Manipulation
- Write structured data from third-party apps back to the organization’s EHR and where relevant, a data warehouse, using the FHIR REST API to communicate data including:
- medication prescriptions
- lab and diagnostic imaging orders
- Support the dependent transactions necessary to ensure that actions completed by third-party applications using the API are valid in the EHR and data warehouse.
Standards-based App Registration
- Support Auth Dynamic Registration (with access controlled by the customer) so that third party apps can perform automated, standards-based registration.
Context-Specific Service Hooks
- Support the ability to call an external standards-based service in specific workflow steps, such as:
- new prescriptions
- new lab orders
- new imaging studies
Intellectual Property
The IP of any app integrated through the SMART on FHIR API belongs to the author and not the vendor.
Custom SMART on FHIR Extension to a Proprietary API
Should a vendor neglect to provide SMART on FHIR natively, the client has the right to provide a custom extension to the vendor’s API. The ownership of the IP for the custom extension is negotiable between the client and the vendor, but the ownership of the app using the custom extension belongs to its author.