SMART on FHIR: How Standardized is Electronic Medical Record Access for Third Party Applications?

Presentation Time: 01:45 PM - 02:00 PM

Abstract Keywords: Informatics Implementation, Data Standards, Data Sharing, Interoperability and Health Information Exchange
Primary Track: Applications
Programmatic Theme: Clinical Informatics

The Office of the National Coordinator strongly promotes interoperability and exchange of healthcare data. The 21st Century Cures Act includes a rule to prevent "information blocking" and promote open-source, standards-based application program interfaces (APIs), such as SMART on FHIR, that enable third party access to electronic medical record (EMR) data. Yet, adequate vendor support for practical applications of SMART on FHIR third-party access is still lacking. We describe our experience connecting a SMART family health risk assessment application to the Epic® electronic medical record in four different health systems, which identified several key limitations in the EMR's deployment of the SMART authentication process and FHIR APIs. These challenges illuminate the barriers to real-world interoperability, support for data access by third party applications, and meaningful reuse of medical data. In addition, the implementations demonstrated that electronic medical record process and configuration changes implemented without health system engagement have widespread ramifications. Closer collaboration between vendors, application developers, and users is necessary to avoid unexpected system failures and to more effectively “unblock” electronic health information.

Speaker(s):
Lori Orlando, MD, MHS, MMCI
Duke

Author(s):
Josh Peterson, MD, MPH - Vanderbilt University Medical Center; Harris Bland, MPH, MBA - Vanderbilt University Medical Center; S. Trent Rosenbloom, MD, MPH, FACMI, FAMIA - Vanderbilt University Medical Center Dept of Biomedical Informatics; Luke Rasmussen, MS - Northwestern University; Robert Freimuth, PhD - Mayo Clinic; Jeritt Thayer - The Children's Hospital of Philadelphia; Joseph Kannry, MD - Mount Sinai Health System; Kathleen Mittendorf, PhD; Georgia Wiesner, MD MS - Vanderbilt;