SMART Health IT

SMART Health IT
Name	SMART Health IT
Abbreviation	SMART
Established	2010
Purpose	Interoperability platform for health data
Parent organization	Boston Children’s Hospital; Harvard Medical School

SMART Health IT

SMART Health IT is an open platform for healthcare interoperability and application development centered on a standardized application programming interface (API) and data models. It provides a modular framework for clinical apps, device integration, and research tools that connects electronic health records and health information systems across institutions. The initiative emphasizes reusable software components, standardized terminologies, and vendor-neutral deployment to accelerate innovation in digital health.

Overview

SMART Health IT defines a set of specifications, developer tools, and reference implementations that enable third-party applications to read and write clinical data using standardized interfaces. The project links clinical systems such as Epic Systems Corporation, Cerner Corporation, Allscripts, McKesson Corporation, GE Healthcare, and InterSystems to research platforms like i2b2, OpenMRS, VistA, and OMOP-based repositories. It leverages terminology services from organizations including SNOMED International, LOINC, and the RxNorm program, and integrates identity and authorization frameworks established by OAuth and OpenID Connect. The platform is widely used by academic centers such as Harvard Medical School, Boston Children’s Hospital, Stanford University School of Medicine, and Massachusetts General Hospital.

History and Development

SMART originated from research programs at Children's Hospital Boston and Harvard Medical School with funding and collaboration involving agencies like the Office of the National Coordinator for Health Information Technology and grant partners such as the National Institutes of Health and the Robert Wood Johnson Foundation. Early prototypes built on standards from HL7 International and projects by IHE (Integrating the Healthcare Enterprise) led to adoption by developer communities around initiatives such as Blue Button, Sync for Science, and pilots with vendors including Athenahealth and Practice Fusion. Major milestones include demonstration projects at events hosted by Health Datapalooza, integrations with federal systems like Department of Veterans Affairs platforms, and contributions to the development of SMART on FHIR extensions and profiles.

Architecture and Standards

The architecture centers on a RESTful API model implemented atop clinical data standards such as FHIR (Fast Healthcare Interoperability Resources), terminology bindings to SNOMED CT, LOINC, and RxNorm, and security protocols based on OAuth 2.0 and OpenID Connect. Data models align with research frameworks like OMOP Common Data Model and clinical data warehouses exemplified by i2b2. Reference implementations rely on middleware technologies from FHIR servers provided by vendors such as HAPI FHIR and Microsoft Azure-hosted services, and use identity management solutions influenced by SAML and OAuth deployments in large organizations like Kaiser Permanente and NHS Digital. SMART promotes app launch standards that enable context-aware applications to run inside EHRs from Epic Systems Corporation and Cerner Corporation via embedded app frameworks.

Implementations and Use Cases

SMART-enabled apps support decision support, population health, patient engagement, and clinical research. Notable deployments include clinical decision tools used at Massachusetts General Hospital, genomic and precision medicine integrations at Stanford Health Care, mobile patient-facing apps tied to portals like MyChart from Epic Systems Corporation, and research cohort discoveries in networks such as All of Us Research Program and PCORnet. Implementations span ambulatory systems from Athenahealth to community health setups using OpenMRS in global health programs by Partners In Health and Médecins Sans Frontières. Apps leveraging SMART interfaces have been showcased at conferences including AMIA Annual Symposium and HIMSS Global Health Conference & Exhibition.

Governance and Security

Governance of the specifications and ecosystem involves collaborations among academic institutions, standards bodies, and vendor consortia such as HL7 International and stakeholder groups including CommonWell Health Alliance and Carequality. Security practices incorporate role-based access, consent management influenced by frameworks from Office for Civil Rights (OCR), and privacy protections aligned with laws like HIPAA and directives in jurisdictions such as European Union regulations. Risk assessments and penetration testing draw on methodologies from organizations like NIST and standards committees within ISO to ensure secure app-to-EHR interactions.

Impact and Adoption

SMART has catalyzed an ecosystem of hundreds of applications, contributed to the maturation of FHIR profiles, and influenced procurement and interoperability strategies at large health systems including Kaiser Permanente, Veterans Health Administration, and national programs such as NHS England. The platform has fostered startups and vendors in digital therapeutics, clinical decision support, and data analytics, with academic publications appearing in journals like Journal of the American Medical Informatics Association and presentations at Science Translational Medicine forums. Metrics of adoption include increased developer participation in hackathons sponsored by CTSA (Clinical and Translational Science Awards) hubs and integration activities reported in industry analyses by Accenture and Gartner.

Future Directions

Future work focuses on expanded support for genomic and imaging standards, tighter integration with health information exchanges like eHealth Exchange, enhanced patient-mediated data sharing in programs such as Blue Button 2.0, and broader adoption of federated analytics approaches exemplified by GA4GH and OHDSI. Ongoing collaboration with standards organizations—HL7 International, DICOM Standards Committee, and ISO technical committees—aims to refine profiles for social determinants of health, precision medicine, and device-generated data from vendors including Apple Inc., Google LLC, and Microsoft Corporation. Continued alignment with regulatory initiatives from Centers for Medicare & Medicaid Services and policy bodies such as the Office of the National Coordinator for Health Information Technology will shape clinical, research, and consumer-facing innovations.

Category:Health information technology