smart on fhir and cds hooks implementation considerations · 2018-10-24 · •technological leaps...
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SMART on FHIR and CDS Hooks Implementation Considerations
Nikolai Schwertner
March 2017
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Technology Overview – SMART on FHIR
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Open framework for substitutable medical applications integration
with EHR systems building on top of FHIR
Features
• Launch context acquisition
• Authentication via OAuth
• Authorization based on scopes
• Public vs confidential applications
• Embedded and standalone applications
• Clients available for JavaScript, Python, iOS
• Argonaut profiles
• App Gallery
• Developer communityBenefits
• Standards based approach to development of
portable medical applications
• Multiple launch workflows
• OAuth security framework
• Predictable data profiles
• Maturity of technology
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Technology Overview – CDS Hooks
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Lightweight event-driven framework for integration of Clinical
Decision Support Services into the EHR workflow
Features
• Subscription model
• Events-driven invocation
• Relevance determination
• Context prefetch
• Types of cards: Information, Warning, Full
Stop Suggestion, App Launch
• Card presentation left to EHR
• FHIR-based messaging
• Rapidly evolving
• Supported by Argonaut and major EHR
vendors
Benefits
• Separation of concerns between EHR and
CDS vendors
• Substitutability of CDS services
• No end user training requirements
• Standardization of CDS integration
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Risk Calculators
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Blood Pressure Percentiles
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Growth Charts
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Duke PillBox
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ClinDat (Rheumatology)
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Pre-procedure Antibiotics
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Procedure Consent Form
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SMART Apps Gallery
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CDS Hooks – Pharmacogenomics CDS Service
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• Technological leaps
• Alignment of vendors, health systems, government, and end user
• Community support
• Early marketplace for medical applications
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Success stories:
An Application Vendor’s Perspective
• Level of expertise and effort required to be effective
• Data uniformity
• Uncertainty and lack of well defined business models
• Extreme risk averseness in health care organizations
Challenges: