Nov 25 2020

Time to get SMART on FHIR

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“There’s an app for that” is something we never heard before the iPhone was introduced in 2007. Today, we hear it all the time because innovators built small, purpose-built, apps that solve specific problems. Because not all users have the same problems, apps exist for different solutions. We don’t replace our phones every time we want to do something new, we just add an app, and our phones get new functionality – that’s the “App Store” innovation model.

Nurses, pharmacists, physicians, and other clinicians routinely spend time in multiple applications for different purposes – sometimes in a billing app, sometimes in an electronic health record (EHR) system, sometimes in a pharmacy system, and so on. Those are called “systems of record” and every app developer believes you should just buy another app every time you need more functionality.

In today’s connected age, advanced IT systems allow for a single sign-on (SSO) identification system that allows users to access multiple applications and websites with one set of login credentials. SSO helps make overall password management easier and improves security as employees access applications that are on-premises as well as in the cloud.

The best way for the layman to understand it is…what if you could access the apps you use every day by just logging into your EHR? Think of the efficiencies for your entire organization.   Quite the dream, right?

The challenge in the healthcare industry has been the lack of a standard protocol that allows applications to easily connect to each other.   The FHIR standard and its extension, SMART on FHIR solve for this interoperability issue, allowing the dream to come true, dramatically increasing convenience, security, and efficiencies for all types of healthcare organizations.



Fast Healthcare Interoperability Resources (FHIR) is a standard that was developed by the world’s pre-eminent healthcare standards body called Health Level Seven International (HL7). FHIR creates a foundation for sharing patient health information among professionals using different applications. These various applications are where the exchange of data becomes difficult.

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The best analogy for how FHIR addresses this challenge is the Google search bar. As we know from our everyday lives, when you type a specific website URL into the Google search bar, it directs you to the correct page. Using standard URLs means that no matter what operating system or device you use, you can always find the right page because there is a system and device agnostic common language built into the search protocols.

The U.S. Government, led by CMS, has embraced FHIR as the foundational standard to support data exchange via secure application programming interfaces (APIs). This means that healthcare providers and the health IT companies that support them need to migrate to the FHIR standard. For more on the CMS mandate included in the Interoperability and Patient Access final rule, click here.



Substitutable Medical Applications and Reusable Technology (SMART) is a set of open specifications to integrate 3rd party applications into health IT systems. There is of course a lot of technology behind it but essentially SMART on FHIR enables business process interoperability. It allows apps that your EHR does not know about or control to seamlessly sit inside other systems and allows the SSO dream – accessing your day-to-day apps from your EHR - to come true.



Many innovative Health IT companies support FHIR. At Citus Health we like to say that we were born on FHIR. From our initial development stage, we adopted the FHIR standard which makes it easy for our solution to integrate with EHRs that support the FHIR standard. And now with the Citus Health “App Center” capability we are SMART on FHIR compliant, which means teams can access our features and functionality as well as custom-built applications, directly from their EHR, with the same login credentials.

Our technology enables teams to work “SMARTer” so to speak, and more efficiently. Think of it as a version of the “App-Store” for the modern clinician’s workflow – now, if a nurse or physician spends time in an EHR and that EHR supports the SMART on FHIR standard, the IT department can install a Citus Health App and enable immediate access without leaving the EHR.

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Using the new App Center, Citus Health can seem like it is built into any of the many EHRs that support the standard, which means clinicians can more conveniently use our advanced functionality. Our comprehensive virtual patient care platform can be accessed on desktops, phones, and now in your favorite EHR.

Just like we download apps to enhance our phones, now you can enhance your EHR with Citus Health’s functionality and get the best of both worlds: familiarity of your EHR workflow and the advanced functionality of our patient engagement tools.


Additional resources:


For IT leaders that want to get smarter on SMART on FHIR, here is a webinar we recommend:


Here is the HL7 website for those Interested in implementing FHIR


And here is the CMS Interoperability and Patient Access final rule:


App store analogy image source:  Medullan Inc.


Author Info

Citus Health

Citus Health

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