How SMART on FHIR Improving the Healthcare World


One of the most probable questions comes in mind of the reader after learning about what is FHIR and what is SMART on FHIR?

In this article, we will learn about SMART on FHIR in detail.

SMART stands “Substitutable Medical Applications, Reusable Technologies”.

SMART on FHIR is developed by Boston Children’s Hospital in 2010 and Harvard Medical School Department of Biomedical informatics and is immensely supported by the healthcare industry.

The foremost purpose of SMART is to build in interchangeable healthcare applications, which will help any developer to create a healthcare application that can work at any healthcare organization. A great focus is placed on the “substitutable” aspect of SMART, which will provide ease to healthcare experts to try new applications, which will help them in selecting the best solution for them.

FHIR and SMART on FHIR only provide guidelines on the implementation of certain technology, while HL7 creates the specification and how they want to implement it depends totally on EHR vendors.

SMART Focuses on Three Key Areas

  1. It guides the client to have a review of them and to negotiate the access of data in the EHR. This leverages the OAuth2 standard.
  2. It provides the guidelines as to how the information will be exchanged, and how a person can access it. This can be done with the help of FHIR REST API as the query mechanism an FHIR Resources for the content.
  3. Providing a medium to launch an external app through EMR.

Read Also: Best Electronic Medical Record (EMR) Software In 2019

Future Growth of SMART


SMART (like FHIR) is an evolving standard, and so is likely to change and extend as it is implemented internationally. The areas where we are likely to see evolution are:

Becoming the ‘de facto’ security standard for FHIR interfaces. FHIR itself doesn’t prescribe a security mechanism, leaving that to the implementer. Given SMARTs use of widely accepted standards, it is likely that it will become the ‘normal’ security mechanism

Supporting different profiles. As described in this paper, SMART is already moving in the direction of allowing the client to describe the profiles it supports.

CDS Hooks – an exciting new development that seeks to standardize how an EHR can invoke Decision Support capability in the course of its usual operation. This standard – if it becomes widely adopted – could make it easier for a provider of Decision Support services to be utilized by different EMR/EHR systems – another important aspect of exposing advice generated as part of the Precision Medicine initiative.


SMART renders hands to all manner of healthcare tasks. Following it is discussed about how SMART provides support to various healthcare tasks:

  • Healthcare Application Development: It supports the app development team by laying down them free open-source resources and tools for effortless generation of applications. It helps in the smooth alliance of EHR and FHIR at least cost.
  • Healthcare Professionals and Patients: SMART assists in the development of apps that favors the uninterrupted and quick flow of communication between healthcare professionals and patients. This ultimately improves the patient’s satisfaction.
  • Healthcare systems: SMART offers healthcare institutions to have an edge over its competitors through innovative app development and helps them in improving and expanding their existing systems. This comforts for a better return on investment.

Read Also: Know the Difference Between EHR And EMR?

  • Public Health: It supports the development of an application that is related to public health which reaches the audience at large. Distinct directives can be propagated based on derived decisions without changing the EHR, especially during any outbreak incidents or in announcing guideline changes.

Top SMART on FHIR Apps

Below is the best SMART on FHIR apps:

  1. EnrG | Rheum
  2. Growth Chart
  3. Duke PillBox
  4. Cardiac Risk
  5. BP Centiles

Developing SMART on FHIR Apps


An application that uses SMART on FHIR in its development holds a lot of advantages. But to avail such advantages you need to overcome certain challenges.

First, this technology is still in its development phase, it has not emerged fully. You won’t find much data on the internet regarding this. There will be times when you will stick into something and it will take a lot more searching to find someone with the same problem as you. If you ever find that someone often you will be left to figure it out on your own.

Although FHIR pinpoints on consistency, it doesn’t give guarantees about what information will be presented. Most values you receive from FHIR will be optional because some patients won’t have a value provided for them.

The world of medical data is vast, and it’s not FHIR’s fault that we try to standardize the medical data. At times you may find its development perplexing and the development of code chaotic.

Launching an app

SMART describes a couple of ways of launching an app – from within an app (the EHR launch) and an externally launched app (Standalone launch). The standalone launch is really just an external app requesting access via the external API as described above.

Read Also: What is FHIR? Know About Smart On FHIR

The ‘EHR launch’ describes how the EHR can start a SMART aware app, preserving the current EHR context – the current user and patient (if selected). In brief:

The user invokes a function to launch a previously registered app (eg clicks on a link in the User Interface).

The EHR stores the context information somewhere, creating a token (the launch token) that refers to it. Alternatively the EHR could include the context within the token encrypting and signing it.

The app then authenticates in the same way as described above.

After authentication, the app includes the launch token with each call to the Resource Server. The Resource Server uses the token to retrieve the context of the call – either by using the token as a key to some internal store or by decrypting it – depending on how it was initially created.

Note that like the other aspects of SMART, most of the server side implementation details can vary between implementations. As long as the interface between client and server is preserved it doesn’t matter to the client.

Word of Advice for Developers:


Here are few tips if you’re initiating with SMART on FHIR development:

  • Your developed application will be launched inside another application. It will be advisable for you to not open external links because they may not behave the way you expect them to.
  • The record you may have created one day may disappear the next day because the records in the SMART Sandbox are reset within a night.
  • You can have control over the timing of resetting data by installing self- hosted sandbox. This tool can prove to be highly useful.
  • SMART context gives access to a lot of information. So make sure that you limit your requests so that you can ask for more at necessary times.


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