Developed by Harvard Medical School and Boston Children’s Hospital, SMART preceded Argonaut, which is using the combined approach known as SMART on FHIR. Members of the SMART collaborative developed the FHIR profiles that Argonaut is now testing and implementing, Mandel says. So, while SMART is not the only user interface that could be melded with the FHIR-based API, it is the one available out of the box.
From the viewpoint of SMART app developers, FHIR is a building block for clinical data. “When a SMART app connects with a SMART on FHIR-enabled server, it asks for data, and that’s how it gets data back. It’s using a FHIR REST API,” Mandel says.
A number of SMART on FHIR apps are displayed on SMART’s website. Some of them are already being used in large healthcare organizations that have built their own FHIR-enabled servers. For example, Duke Medicine in Durham, N.C., and Intermountain Healthcare in Salt Lake City are using a growth chart app with their Epic and Cerner EHRs, respectively, notes Mandel. The Danville, Pa.-based Geisinger Health System, which also has an Epic EHR, has introduced a rheumatology app.
Among the other provider organizations now experimenting with SMART on FHIR, Tripathi adds, are Boston Children’s Hospital, Beth Israel Deaconess Medical Center, and Partners Healthcare, all in Boston, and Hackensack Medical Center in Hackensack, N.J.
Provider- and consumer-facing apps
The majority of the 33 apps in SMART’s app gallery are designed to help clinicians in their daily work. Some deal with specific situations such as helping doctors treat excessive bilirubin in newborns, calculate a child’s blood pressure percentile, estimate a patient’s 10-year risk of heart attack or stroke, or predict a patient’s likelihood of adhering to prescribed medications. These functions are not normally available in an EHR.
Cerner has created an app that launches a web portal for a health information exchange network within its EHR. Instead of having to leave the EHR, go to the HIE portal, and sign in to find patient information from other providers, a physician can get that data with a single click and without leaving the electronic chart he or she is working in.
Another app from Crimson Care Management, a division of the Advisory Board Co. consulting firm, expands EHR capabilities for care management. Mandel says a lot of care coordination software vendors are interested in using SMART on FHIR.
Specialists might also use the plug-in technology to customize general-medicine EHRs to their fields without having to use specialty EHRs that lack the advanced features offered by the leading products, Tripathi points out.
Other apps in the SMART gallery suggest the multiplicity of directions for consumer-facing apps. For example, the Duke pillbox app educates patients about the correct dosage and frequency of prescribed medications. Mandel cites another app that helps patients shop for drugs in local pharmacies. A “metabolic meter” app helps patients understand their risk of diabetes, heart attack and stroke.
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