Beyond EHRs: The SMART Revolution in Healthcare IT

By: Amos (Kippi) Bordowitz

Published: 15/02/2024

The healthcare industry has struggled with fragmented, disconnected data trapped in disparate health IT systems. But an exciting new framework called SMART on FHIR aims to change that by connecting systems through an interoperable app ecosystem.

What is SMART?

SMART stands for “Substitutable Medical Applications and Reusable Technologies.” It is an open standards framework that enables secure integration of web-based apps with EHRs and other health IT systems.

The core design principles of SMART are:

Substitutability - Apps can be swapped in and out of EHRs easily without disrupting workflows.

Reusability - Apps are designed for reuse across multiple systems, avoiding vendor lock-in.

Modularity - Apps are modular components that can be configured in flexible ways.

Security - SMART integrates OAuth 2.0 authorization for robust access controls.

Together, these principles facilitate seamless interoperability and accelerated innovation. By facilitating integrations between apps and health IT systems, SMART aims to drive interoperability and spur faster innovation.


Building on the SMART standard, SMART on FHIR integrates these principles with the FHIR specification for data exchange. This allows apps to connect to EHRs and other health IT systems using modern web APIs to securely access, retrieve, and update patient data.

SMART on FHIR helps to pave the way for the healthcare ecosystem of the future, where data flows seamlessly across connected systems to drive holistic care. By embracing this app revolution, healthcare can be transformed.

A key goal of SMART on FHIR is to enable developers to create innovative healthcare apps that can run anywhere, regardless of the underlying health IT system. SMART supports an "app store for health" model where apps are readily substitutable - they can be swapped in and out as needs change without major disruption.

This substitutability drives competition and quality up while costs go down. It also accelerates innovation by making it easy to deploy new apps when needs arise, or as better solutions become available.

To achieve seamless substitutability, SMART provides specifications including standardized clinical data models based on FHIR resources. This semantic interoperability ensures apps work predictably across diverse systems.

Benefits of the SMART Healthcare App Revolution

While some challenges remain around interoperability, data governance and security, the possibilities are too transformative to ignore. As SMART on FHIR gains traction, we can expect a revolution in healthcare apps that break down data silos and truly transform care through connectivity.

A major innovation in SMART is the use of FHIR’s structured APIs and normalized data models. This provides a consistent, well-defined interface for developers, avoiding the need for apps to re-map and interpret fragmented data schemas. For instance, medications are reliably coded in RxNorm across systems, while procedures employ SNOMED-CT codes. 

Such data standardization and clearly defined expectations enable developers to focus on building robust app capabilities rather than wasting efforts ‘making sense’ of inconsistent interfaces and data.

This substitutable app approach built on FHIR is already being adopted in major EHRs and health platforms like Apple Health and Microsoft Azure.

By opening up EHRs and data, SMART on FHIR supports an ecosystem of intelligent apps that integrate with clinical workflows, providing enhanced capabilities like:

  • Improved interoperability
  • Holistic view of patient data
  • Clinical decision support
  • Patient engagement
  • Accelerated research
  • Overcoming Adoption Challenges


The SMART and FHIR frameworks aim to transform healthcare by connecting disparate systems into an interoperable app ecosystem. This standards-based approach breaks down data silos, enabling seamless health information exchange and powering an “app store” model where innovative solutions can be readily deployed and substituted. While adoption challenges remain, SMART’s substitutable modular architecture and standardized data models promise to accelerate care innovations, foster competition on quality and costs, and facilitate continuous improvement. By embracing interoperability with SMART’s open specifications, healthcare organizations can finally connect fragmented systems to drive holistic, high-value care. Though the road ahead still requires work, the building blocks for an integrated digital health ecosystem are emerging.

SMART on FHIR implementation guide:
Here you will find all the information for launching a SMART on FHIR app, including client and server authentication and working examples.

List of available apps (As of February 2024):



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