Academy of Pediatrics News Article Highlights Potential of EMR FHIR App Stores

Iltifat Husain, MD

New EMR integrated apps highlighted in Academy of Pediatrics article

Recently there was a great article published by Dr. Kevin Dufendach in the American Academy of Pediatrics News on SMART on FHIR. Dr. Dufendach, MD, MS, is an assistant professor in the divisions of Neonatology and Pulmonary Biology and Biomedical Informatics at Cincinnati Children’s Hospital.

SMART on FHIR has existed for years, and people have claimed how it will “revolutionize” EMRs. The reality is it’s taken some time, but we’re almost there. But first, what is SMART on FHIR?

Dr. Dufendach’s article is one of the best I’ve read on defining what SMART (Substitutable Medical Applications, reusable technologies) on FHIR (Fast Healthcare Interoperability Resources) is and the opportunities it holds. He starts the article by laying out exactly how “SMART” works with “FHIR”.

He gives an example of how the “SMART” portion works similar to to the technology you see when you try to login to apps via your Facebook or Google account. Using your existing login information, you can login to an entirely new app. In this case, if you’re a physician, your existing credential would be your EMR login, enabling you to login to a SMART on FHIR app.

The “FHIR” portion is where there is a “common language” between the EMRs and also the apps you create for the EMRs. FHIR enables a standardized mechanism for bi-directional transfer of information and data. It’s critical to have this standardization as it enables you to create apps that will function on various EMRs with minimal variation from the developer standpoint. For example, this “common language” is what enables the app you create for the EMR to pull specific patient demographic information and write back to the patient’s medical record. I encourage everyone to read read Dr. Dufendach’s article in detail to get a more nuanced understanding of SMART on FHIR.

My favorite part of Dr. Dufendach’s article was the section on “substitutability”.

Another key to SMART is the concept of substitutability. A SMART app is intended to give users options, much like you have when choosing a web browser. Most EHRs include a growth chart application. But what other options do you have, besides asking your understaffed information services team to create a custom design for you? SMART apps seek to give users options through substitutability, whereby a user or institution could choose an alternate application or feature through an EHR app store or repository.

This is where I think there is the biggest potential for hospitals and clinicians. SMART FHIR apps enable hospital systems to reduce the workload for their informatics departments and enable them to focus on tasks such as security, EMR version changes, optimizing features, and more. At the same time, these SMART FHIR apps enable clinicians and hospitals to quickly implement game changing apps in EMR app stores, such as those by EPIC, Cerner and Allscripts. These apps have the ability to improve patient outcomes, change physician behavior, and optimize workflows.

An example of an EMR-integrated app is our HEART Pathway plug-in. A clinically validated chest pain clinical decision support (CDS) app that standardizes how patients with chest pain are managed. At Wake Forest Baptist Medical Center, our CDS algorithm saved more than $2m a year in unnecessary healthcare costs, while improving patient outcomes.

Now, we are taking the successful HEART Pathway CDS app to other hospital systems via SMART on FHIR. Currently we are finishing a build for the Cambridge Health Alliance hospital system, while concurrently discussing partnerships with other hospitals across the country that use Cerner, EPIC and other EMRs. Our company is also developing other pathways into CDS apps for a variety of clinical indications.

The future is now, and it is SMART on FHIR. I encourage everyone to read Dr. Dufendach’s article in detail at the following link: