SMART on FHIR: Inter-app-ability

Recent research by peer60 shows that more than half of community hospitals are dissatisfied with their EHRs due to poor usability and a lack of functionality. Dissatisfaction is also high among physicians, as evident in a recent survey by Rand.

Results from the peer60 Community EHR Report:

Peer60 EHR

peer60 Community Hospital EHR Report | 2015


A big problem is that once clinical data is captured, it is usually presented in an “unimaginative and substantially unhelpful way.” However, health IT is finally catching up to other industries as it is poised to adopt RESTful-based APIs (See HL7 FHIR) that will allow mobile developers a pathway into EHRs across the country. SMART is a complimentary solution that enables apps to run on top of EHRs, so that physicians, patients, and others can more easily visualize and interact with health data.

Technically, SMART is an API—an application programming interface that leverages the emerging FHIR standards to define health data resources: REST web services to transmit the data, and oAUTH for authentication.

Plug-and-Play Capabilities

According to Josh Mandel, the Chief Architect for SMART, “The big message about a platform like this is that if you’ve got someone who has a bright idea for a better way to interact with the data in an EHR system, you don’t need to wait for an EHR vendor to adopt that idea, you can go and build it yourself.”

SMART Platforms is the interface between healthcare data and innovation. The goal of SMART is audacious and can be expressed concisely: an innovative app developer can write an app once and expect that it will run anywhere in the healthcare system. Further, that app should be readily substitutable for another.

Visual, User-Centered Design

An example of visual, design thinking is the award-winning pediatric “Growth Chart” app, co-created by SMART, MedAppTech software development, Fjord service design consultancy, and clinicians. Personal growth charts can be overlapped with several different growth chart standards, including charts from WHO, the Centers for Disease Control and Prevention, and for children with Down’s syndrome. Clinicians get a clear view of the data offered, and vital information is available in an intelligible way, without neglecting the complexities of pediatrics. There is also a “parental view” that presents data with simple visuals in an engaging way.

SMART Pediatric Growth Chart App

“Data visualizations should tell human stories. With our re-design of the pediatric growth chart each story is communicated for both the expert and the family,” explains Charlie Gower of Fjord, “There is a huge opportunity for user-centered design to revolutionize patient care.”

SMART is open source, and you can find the code for the Growth Chart app on GitHub, and a tutorial provided by SMART on FHIR.

FHIR Makes App Platforms More Adaptable for EHRs

Mandel says FHIR is really important to facilitate an app platform such as SMART and to make it more easily adaptable to the various EHRs.

FHIR provides two key building blocks: a set of clinical data models for things such as medications, lab tests, allergies, problems, or demographics (“Resources”), and a REST API that lets you easily query for the specific data elements you’re interested in.

Anyone can go to, create an account, and play in our sandbox.

According to Rob Brull, product manager for Corepoint Health, FHIR “is a big opportunity to create something that will be widely adopted.” View the gallery of SMART on FHIR apps here.


Alistair Erskine, MD, Chief Clinical Information Officer for Geisinger Health System, explains “inter-app-ability”.

Inter-app-ability is the idea that we want to rely on the investments that have been made in healthcare technology with these systems, these vendors that have been able to provide us Electronic Health Records, but also augment them with apps that are created right at the edges of innovation at the point of care, so that we can do things that are more specialized, or sometimes even compete – that are better – than what our EHR vendors offer us.

Interoperable APIs for Health Information Technology Innovation

In the “Annals of Emergency Medicine,” Levin Brown and Dr. Adam Landman believe interoperable APIs are key to driving health information technology innovation forward,

The extraordinary browser-based Web applications we use every day exist largely because the Internet has open standards by design, and developers have permissionless access to build for a market of potential users. The Internet, Web browsers, and operating system application programming interfaces are essentially families of interoperability standards that are the sine qua non of their success as platforms.

To realize a similarly thriving application market in health care, there must be definition, adoption, and enforcement of standards for application programming interface-style interoperability.

In Cell Systems, Josh Mandel et al, conclude, “These apps will give new life to data entered into EHRs and other health IT platforms by providing the ability to visualize risks, trends, and trajectories; mash up clinical records with external data sources; and deliver decision support to clinicians and patients during and between encounters. Apps will also create new flows of data from sensors, devices, and patient reports into EHRs. This tectonic shift toward 21st century IT, which mirrors changes sweeping across other industries, will change the experience of physicians and patients, dramatically increasing return on EHR investments.”

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HealthIsCool is a writer and trends analyst. She writes about health innovation, wearable tech, the Internet of Things (IoT), new health technologies, and future trends. Her latest trends research includes: The Rise of Wearable Technology and Google’s Ambitions in Healthcare. Follow on Twitter at @HealthIsCool.

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