SMART on FHIR Implementation Guide: Interoperability for Digital Healthcare

Details

SMART on FHIR serves as the standardized mechanism for integrating external applications into FHIR-based Electronic Health Records (EHRs). The framework utilizes three primary launch modes. First is 'Patient standalone,' where a patient launches an app from a portal or mobile application, requiring scope requests and user consent—ideal for patient-facing apps. Second is 'EHR patient launch,' used by clinicians at the point of care, launching the app within the EHR context with specific patient information. Third is 'Backend services,' which facilitates system-to-system integration via JWT assertion and client credentials, suitable for server-to-server communication. Technically, scopes are categorized into three types: patient-context (`patient/{Resource}`), user-context (`user/{Resource}`), and system-scope (`system/{Resource}`). Implementation best practices highlight several common pitfalls, including missing v2 scope support, managing short TTL tokens for backend services, configuring CORS correctly, and ensuring proper JWT claim validation. Major vendors like Epic, Cerner, Athenaclinicals, Aidbox, and Medplum all support this pattern, establishing it as a universal standard across US EHRs.