SMART (Substitutable Medical Apps, Reusable Technology) is a platform that seeks to integrate apps across different healthcare IT systems. This computational health informatics program was developed to open Application Programing Interface (API) specifications for Electronic Health Records (EHR) data access. The EHR system refers to any system that can control and keep individually identifiable health information. Such a system should be able to authorize access to Fast Healthcare Interoperability Resources (FHIR) and mediate app requests. With this platform, an app written once can integrate and communicate freely with portals, Electronic Health Records, Health Information Exchanges and other different healthcare IT systems without any hindrances. The SMART platform facilitates this integration by adding EHR UI integration patterns to FHIR, adding a standard set of data profiles that improve FHIR and provides secure and reliable authorization technologies (OAuth 2.0 and OpenID Connect).
With this, innovators and app developers can develop apps that can securely and seamlessly integrate into the healthcare system. Doctors, patients, and other players in healthcare can make use of the library of apps supported by the SMART standard to improve clinical care, public health and research and development domain. To further support this initiative, the five largest electronic health record vendors, the HL7 organization (Health Level Seven International) and the SMART team launched the Argonaut Project. The Argonaut project seeks to standardize the SMART API in HL7 specifications as well as integrating SMART into the releases of EHR products. The Argonaut project seeks to further enhance the sharing of electronic health information by developing a Core Data Services specification; an FHIR based API as well as a Security Implementation Guide. With this, providers and other interested vendors can design and apply a complete FHIR API specification and the necessary security implementation.
Kenneth D Mandl and Isaac S Kohane were some of the first people to propose for a departure from the then inflexible EHR architectures to platforms that could not support third-party apps. Establishment of a common interoperable data specification was necessary for the current mobile app space, for EHR systems to support such apps without expensive custom integration. As opposed to the then inflexible EHR architectures and other interoperability and data exchange efforts, SMART was different in the sense that it centered on creating tangible vendor-independent apps that were immediately interoperable. The project of developing the platform began in 2010; it was started by Harvard Medical School Department of Biomedical Informatics and the Boston Children’s Hospital with funds from the U.S. government to the tune of $15M on a four-year contract. Since then, many clinical applications have been developed.