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SMART on FHIR as the Key to Healthcare Data Interoperability

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Statista points out that 71% of all physicians in the U.S., like many of their counterparts globally, feel that the sheer volume of patient data is overwhelming. Also, half of all hospitals see data management as the most formidable obstacle to improving interoperability in healthcare. As a result,  SMART on FHIR continues to emerge as a crucial player — delivering the promise to improve data interoperability in the medical landscape. 

SMART on FHIR in healthcare

This piece outlines the ins and outs of the protocol, its unique benefits, and the critical attributes of applications designed around it. Additionally, we provide insights into our journey and expertise in developing applications based on this technology. Whether you are a healthcare professional seeking efficient data management solutions or a tech enthusiast exploring healthcare data interoperability, this blog is sure to be an enlightening guide.

By leveraging state-of-the-art technologies, we can access, scrutinize, and apply an extraordinary amount of health data across various points of patient care. At SPsoft, we’re innovating using FHIR standards to unlock and harness the enormous potential of interconnected healthcare data systems.

Romaniya Mykyta
Head of Product Management, SPsoft

Our strategic adoption of FHIR standards is pioneering a new era in the healthcare sector. This approach leads to a more sophisticated and effective interaction with information systems, catalyzing digital transformation. Integrating these standards contributes to significant productivity gains and provides a robust solution for meeting overarching healthcare objectives and realizing operational cost efficiencies.
Mike Lazor
CEO, SPsoft

What Is SMART on FHIR All About?

SMART on FHIR is a collection of interoperable protocols and guidelines that provide  IT specialists in the healthcare sector a better way to develop and smoothly incorporate health-related applications. The protocol combines two robust health IT standards. So, what does SMART on FHIR stand for? Substitutable Medical Apps, Reusable Technologies (SMART), and Fast Healthcare Interoperability Resources (FHIR).

What Are SMART and FHIR?

Both counterparts work in tandem or separately. Yet, each one of them has a particular objective to complete. 


SMART is a protocol, or a set of rules, that specifies how applications can be created to run across various healthcare systems. It fosters an ecosystem of safe, effective, and interoperable healthcare apps.


FHIR is a standard for healthcare data exchange published by HL7. It outlines how to represent various healthcare data types and how they can be exchanged between systems.

How Does SMART on FHIR Work?

SMART on FHIR operates through a sequence of well-defined steps:

Steps in SMART on FHIR functionality. The basic 4-step process
Figure 1. Steps in SMART on FHIR functionality. The basic 4-step process
  1. Authorization. The SMART app requests authorization from the FHIR server, outlining the required data.
  2. Granting Access. If the user permits, the FHIR server sends an authorization code to the SMART app.
  3. Exchange of Codes. The SMART app then exchanges this authorization code for an access token.
  4. Data Access. The SMART app can access the FHIR resources using this access token.

In simple terms, FHIR standardizes data while SMART standardizes how this data can be accessed.

Ready to enhance your healthcare knowledge? Take advantage of the comprehensive deep dive into FHIR resources – your guide to the future of healthcare interoperability! Discover it here!

Advantages of Building SMART on FHIR

Gartner states that interoperability transforms administrative and clinical data exchange among healthcare payers, patients, and providers. SMART on FHIR adoption can take things even further by adding these unique benefits:

  • Interoperability. It provides a standardized way for health applications to access structured clinical data across diverse healthcare systems.
  • Information Access. It offers rich and flexible access to health data, enabling developers to build various innovative healthcare apps.
  • Security. It ensures secure and authorized access to patient data, with patient consent being an essential requirement.
  • Usability. It encourages the development of apps that can be integrated directly into existing workflows, enhancing provider efficiency and patient engagement.
  • Scalability. It allows for creating substitutable apps that can run universally on any system that supports the SMART on FHIR specifications. This broadens the potential user base for these apps and enhances their scalability.
  • Efficiency in Development. The technology decreases the resources needed for new app creation and integration, enabling developers to focus more on functional applications than complex implementations.
  • EHR Integration. The technology simplifies transferring and sharing healthcare data by addressing common issues related to EHR integrations.
  • Substitutability. With the protocol, outdated applications within EHR systems can be replaced without risking data loss, enhancing overall system performance.
  • Standardization and Choice. Standardizing app implementation under SMART on FHIR technology provides clinicians with a broader range of applications that support their workflows, improving patient care and data accessibility.

These are among the key advantages of the protocol. Yet, the list can be much longer with further adoption and development. 

SMART with and without FHIR 

The distinction between FHIR and SMART on FHIR becomes more apparent when you delve into the following specific features:

  • Authorization. While FHIR provides the necessary groundwork for exchanging healthcare information, it does not inherently address authorization protocols. In contrast, SMART on FHIR protocol integrates the OAuth2 standard for authorization and allows secure delegated access to data.
  • Profiles. FHIR utilizes profiles to provide more context to the standard healthcare data models, aiding data interoperability. SMART on FHIR solution employs these profiles and adds  a layer of app functionality and security.
  • Authentication. SMART on FHIR supplements FHIR with built-in authentication mechanisms, ensuring secure data transactions between systems. This feature is a significant selling point for SMART on FHIR tech and does not come within FHIR alone.
  • EHR UI Integration. This is where the SMART on FHIR approach proves its worth. This feature enhances user experience by simplifying navigation between various integrated apps. Such integration is not available for FHIR alone.
  • Data Models. FHIR establishes a set of “resources” or data models for representing healthcare concepts. But SMART on FHIR protocol takes this a step further by ensuring these models can be utilized in app development in a standardized and secure way.
  • Data Access. While FHIR provides the structures and API for data exchange, SMART on FHIR solution offers a standardized way of accessing this data across different healthcare applications to improve data interoperability.
  • Data Format. FHIR proposes a universal data format for healthcare information, promoting data consistency across systems. When used with SMART, this information can be securely accessed and manipulated within various healthcare applications to enhance  its usefulness and application.

While FHIR lays the groundwork for the standardized healthcare data exchange, SMART on FHIR takes it further by ensuring secure and standardized app development and data access across systems.

Get in touch for even more details on the difference between the standards above and much more applicable to healthcare interoperability.

SMART on FHIR Apps’ Features

When working with a SMART on FHIR solution, it must have particular features to deliver its key advantages. The following are the features you want to see in a good SMART on the FHIR app:

9 key SMART on FHIR app features
Figure 2. 9 key SMART on FHIR app features


SMART on FHIR applications leverage RESTful APIs, which allow them to exchange information with disparate systems. Standard HTTP protocols and FHIR resources enable seamless data transmission across diverse healthcare IT infrastructures.

Standardized Data Access

These applications use FHIR’s consistent data models based on standardized definitions and terminologies. That allows the apps to handle healthcare data in a unified way, irrespective of the source of the information.

Authentication and Authorization

SMART on FHIR apps use OAuth 2.0 and OpenID Connect protocols for secure data access. OAuth 2.0 provides a robust authorization framework, facilitating limited data access on behalf of the resource owner. OpenID Connect extends OAuth 2.0 for authentication, verifying end-user identity based on the authentication performed by an authorization server.


The user interface of these apps is integrated directly within EHR systems using SMART launch protocols. The result is a unified user experience that maintains the context of patient records across multiple applications.

Data Driven

SMART on FHIR apps can leverage the granular data available in FHIR resources. That includes complex structured data types such as genomic, imaging, and detailed medication instructions.


Thanks to the SMART App Launch Framework, these apps can be swapped in and out of an EHR system without causing disruptions. The launch framework defines how apps get authorized and launched from within platforms like EHRs to enable plug-and-play functionality.

Platform Independence

Built on web standards, SMART on FHIR apps is platform-agnostic. They can run on any system that supports modern web technologies, enhancing their reach and accessibility.


The FHIR standard allows developers to create custom resources or profiles to suit specific healthcare use cases. This adaptability means that SMART on FHIR applications can cater to a broad range of clinical and administrative needs.

Collaborative Care

These apps support FHIR’s CarePlan resource, which facilitates sharing a patient’s care plan among healthcare providers. That ensures well-coordinated, patient-centered care, which is especially beneficial for managing chronic or complex care needs.

Remember that only some of the features on the list might be created and adopted. It all depends on your budget and the development team’s expertise. The rule of thumb is that the more features you get, the costlier it will be. However, it would also mean more advantages of SMART on FHIR you can deliver. 

Looking for a comprehensive overview of FHIR API? Discover essential facts, fascinating insights, and all you need to know in this meticulously crafted fact sheet.

How to Develop SMART on FHIR Solution?

Building SMART on FHIR app entails going through a series of successive steps. These ensure the solution is high-quality, secure, and provides the intended services. Start by following these steps: 

Step 1. Understand the Standards

First and foremost, familiarize yourself with the FHIR data model, SMART authorization sequence, and the OAuth 2.0 and OpenID Connect protocols for secure access. Knowledge of RESTful API concepts is also critical. A good starting point is the official FHIR and SMART on FHIR documentation.

Step 2. Define the App Type

Before development, determine the kind of app you need. It could be a mobile or web app, patient-facing or provider-facing, integrated or stand-alone. Leveraging SMART on FHIR technology allows you to concentrate on core functionality as interoperability aspects are catered for. Libraries are available for several languages like Python, Swift, JavaScript, and Ruby to expedite the process.

Step 3. Select Cloud Services

Next, choose a cloud service that aligns with SMART on FHIR solution for server-side operations. Options like Azure and Google Cloud offer better compatibility, while AWS is progressing toward SMART on FHIR compliance.

Step 4. Implement Robust Security

SMART on FHIR incorporates OAuth 2.0 and OpenID, facilitating permissions management and access control. These technologies eliminate the need for repeated authentication when switching between apps, enhancing user experience and adhering to HIPAA requirements.

Step 5. Design

This step involves two substeps. First, there is data design. Determine which FHIR resources you need for your use case. FHIR resources are modular components representing different healthcare data elements (like Patient, Practitioner, Medication, etc.). Second, there is UX/UI design. Plan the user interface and experience. If the app is embedded in an EHR, consider how it will fit into the workflow.

Step 6. Development

Collaborate with your engineering team or healthcare software development firms to develop features specific to your app type. Whether the app is oriented toward population or individual patient data will guide this process. While doing so, focus on these aspects:

  • Backend Development. Set up your server to interact with the FHIR API, handle OAuth 2.0 authentication, and process incoming and outgoing FHIR data.
  • Frontend Development. Implement the user interface, adhering to the SMART App Launch Framework for launching within EHR systems.

Step 7. Testing

Testing ensures data formats are handled correctly. SMART provides sandboxes with synthetic patient datasets for feature testing and interaction emulation between your app and EHR interfaces. You may also use EHR vendors’ sandboxes, such as Epic.

Start your journey with Epic FHIR and explore how it’s revolutionizing the health industry. Take the first step towards a future of advanced, seamless, and secure health data sharing.

Step 8. Deployment

Once tested, the app is ready for deployment. As a SMART on FHIR app, you can list it on the SMART App Gallery. This public platform promotes standardized applications, fosters development, and encourages stakeholder communication. With that said, your work continues even after deployment. . Regular maintenance, updates, and improvements based on user feedback are critical for the app’s longevity and relevance.

Best SMART on FHIR Examples

Best examples of apps using SMART on FHIR

Let’s explore several apps that use the technology effectively to see what a final-end product or a good SMART on FHIR example might look like. The following examples are SMART on FHIR apps that took most of the benefits we discussed earlier and adopted them extensively.

  1. Apple Health. Introduced in 2014, the Apple Health app became a significant proponent of SMART on FHIR standards when it incorporated them in 2018. That played a role in healthcare legislation, urging medical institutions to adopt these standards. Now, Apple Health Records employs SMART on FHIR to provide up-to-date records from over 700 providers. In 2021, a feature enabling users to share health data was introduced, further cementing Apple’s position as a pioneer in SMART on FHIR data sharing.
  2. Geisinger Health System. Known for its innovative healthcare technology, Geisinger Health Systems was an early adopter of SMART on FHIR apps. Their Family Caregiver App facilitated bi-directional communication between patients and clinicians. The MedTrue app, a collaborative effort with Merck, aids patient and provider medication adherence.
  3. CommonSpirit Health Respiratory Care. CommonSpirit Health’s SMART on FHIR app, Propeller, has helped reduce asthma and COPD hospitalizations by 54%. The app captures live data from sensors attached to patients’ inhalers, enabling doctors to predict potential respiratory events and empowering patients to manage their respiratory health.

The SMART on FHIR examples above show that the technology is out there, and there is a good chance you can reap its advantages. The fundamental understanding was that even if you know how to develop a SMART on the FHIR app, you must be aware of the challenges you might face when adopting the technology. 

Obstacles to Adopting SMART on FHIR

SMART on FHIR adoption might be futile without you keeping these obstacles in mind:

8 obstacles to adopting SMART on FHIR.
Figure 3. 8 obstacles to adopting SMART on FHIR
  • Complexity. While the standards simplify healthcare app development and integration, their complexity can still hinder adoption for some.
  • Lack of Knowledge. There can be a need for more understanding or knowledge about implementing SMART on FHIR, which can deter its use.
  • Limited Support. Not all EHR vendors or healthcare systems support SMART on FHIR protocol, which limits its usefulness for some organizations.
  • Inadequate Resources. Developing, integrating, and maintaining applications that use SMART on FHIR technology can require significant resources, including time, money, and expertise that some organizations may need more of.
  • Data Privacy Concerns. Despite the security protocols built into SMART on FHIR, some organizations may have concerns about the potential risks to patient data privacy.
  • Reluctance to Change. Like any new technology, there can be resistance to change, especially in an industry like healthcare where there are severe consequences for mistakes or missteps.
  • Technical Hurdles. While SMART on FHIR is designed to improve interoperability, technical issues can still happen when integrating different systems and applications.
  • Interoperability Limitations. While SMART on FHIR technology can improve data exchange, it only resolves some interoperability issues in healthcare. Some systems may still need to be compatible despite using the standards.

If you are struggling to overcome the challenges above, vendors are always ready to help. Choosing the best is crucial, paying particular attention to experience and expertise in dealing with some critical aspects of the technology. 

SPsoft’s Experience With the SMART on FHIR

With its extensive experience and expertise in healthcare software development, SPsoft plays a crucial role in managing and effectively addressing the challenges associated with FHIR and healthcare interoperability. Here is how our team excels in this domain:

  • Expertise in FHIR Standards. SPsoft’s team understands SMART and FHIR standards to ensure robust and efficient implementation of interoperability solutions. That includes the ability to exchange data securely and entails a deep understanding of the nuances of these standards, which is critical in developing applications that can effectively communicate with each other.
  • Commitment to Security. Recognizing the crucial role of data privacy in the healthcare sector, SPsoft insists on incorporating rigorous security features into its health IT solutions. The company is devoted to designing software that protects patient data and complies with all applicable regulatory and industry norms.
  • Exemplary Software Development and Verification. Our expert teams are renowned for consistently delivering excellently crafted and meticulously verified software. It guarantees that the software is equipped to handle the intensive requirements of the healthcare sector by offering a dependable platform for safely transferring medical data.
  • Support and Maintenance. SPsoft’s commitment to its clients continues after software delivery. They offer critical ongoing support and maintenance, ensuring the software’s performance is continuously monitored and any potential issues promptly addressed. That ensures optimal software performance and reliability.
  • Customized Solutions. Understanding that each healthcare organization has unique requirements, we provide customized solutions tailored to meet each client’s needs. This cost-effective approach ensures clients receive a solution that meets their requirements without compromising quality.

In a nutshell, SPsoft excels in delivering secure and efficient healthcare interoperability solutions and aiding in the seamless exchange of health information and contributing to the overall improvement of healthcare service delivery.

Final Remarks

The advent of SMART on FHIR marks a significant stride toward achieving data interoperability in healthcare. By defining what SMART on FHIR is, delving into the compelling reasons for its utilization, and delineating the unique features of apps built on this platform, we have highlighted its pivotal role in the health tech landscape. 

SPsoft’s SMART on FHIR app development expertise positions us to leverage this innovative technology and offer tailored solutions that meet diverse healthcare needs while promoting data fluidity and security. 

Contact us right away to get a SMART on FHIR solution on your hands as soon as possible.


What is SMART on FHIR?

SMART on FHIR is a protocol for exchanging health-related information electronically. It is a set of open specifications to integrate apps with Electronic Health Records (EHRs), portals, Health Information Exchanges (HIEs), and other Health IT systems. SMART on FHIR leverages FHIR, a standard describing data formats and APIs for exchanging electronic health records. 

What are the benefits of SMART on FHIR?

There are several benefits of using SMART on FHIR:
– Interoperability. It enhances interoperability between various healthcare systems, making it easier to share data.
– Efficiency. By standardizing how health data is stored and retrieved, SMART on FHIR makes systems more efficient.
– Innovation. It allows developers to create new applications across different health record systems.
– Patient Care. It gives healthcare providers a more holistic view of patient data, thus improving patient care.

What is the difference between SMART and FHIR?

SMART is a protocol or a compendium of guidelines for harnessing this standard to architect applications seamlessly integrating with EHRs and various health IT systems. FHIR is a health-related data exchange criterion released by HL7. It lays out the blueprint for representing and reciprocal transferring diverse healthcare data types across various health systems. 

Thus, FHIR sets the data standard while SMART establishes a strategic approach to employ this standard in health app development. Therefore, “SMART on FHIR” refers to applications developed following the SMART methodology, leveraging FHIR as the data exchange norm.

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