Can I use SMART Apps to add SNOMED CT support in an EHR?
Collection: Technology adoption
Summary: Yes, SMART Apps are an effective way to add SNOMED CT support to an EHR, offering flexible, user-friendly interfaces for data entry and clinical decision support. They leverage FHIR APIs and can integrate with FHIR-based terminology services to fetch SNOMED CT codes dynamically, enabling seamless and standardized data capture without requiring major changes to the EHR's core system.
Technology use case
Adding SNOMED CT support for data capture in existing medical record systems can be challenging, primarily due to limitations such as rigid data models, lack of interoperability features, and inflexible user interfaces imposed by the original system design.
The best practice for implementing SNOMED CT is to use FHIR-based terminology servers, which offer greater flexibility for designing user interfaces that utilize specific, dynamic value sets of SNOMED CT. However, adding support for terminology servers may require significant changes to a clinical application's terminology capabilities. As a result, developers may seek alternative solutions that provide the flexibility needed to create customized user interfaces.
SMART on FHIR (Substitutable Medical Applications, Reusable Technologies) is a standard developed by the SMART Health IT project1. This standard provides an easier way to connect third-party apps to existing electronic health records (EHRs). SMART apps are web or mobile applications that use the SMART on FHIR standard to integrate with EHR systems seamlessly. These apps can be used for various purposes, such as data entry, clinical decision support, or patient engagement. For example, a SMART app could help clinicians easily document allergies by providing an intuitive interface that contains the necessary fields to describe all the allergy details precisely and pulls relevant SNOMED CT codes to enable a quick selection, ensuring accurate and standardized data capture.
Another example of how SMART apps can enhance clinical workflows is summarizing clinical information based on SNOMED CT codes. For instance, a SMART app could analyze a patient's medical records, extract key SNOMED CT-coded data, and present a summary of relevant clinical details, such as current conditions, previous diagnoses, and ongoing treatments. This summary can help clinicians quickly review essential patient information at the point of care, improving efficiency and supporting better decision-making.
SMART on FHIR apps communicate with EHR systems using the FHIR (Fast Healthcare Interoperability Resources) API. When a user interacts with a SMART app to capture SNOMED CT data, the app sends the data back to the EHR through the FHIR interface. This allows the captured information to be securely stored alongside the rest of the patient's medical records. The FHIR API supports various resource types, such as Observations, Conditions, and MedicationStatements, enabling the SMART app to structure and transmit the data in a standardized way. This ensures that data captured via the SMART app is properly integrated and accessible within the patient's overall health record. Using SMART apps, developers can overcome many challenges associated with modifying legacy systems and create customized user interfaces for data entry.
One key advantage of SMART on FHIR is the ability to share and reuse apps across different EHR systems. This reduces development time and simplifies the creation of user interfaces for SNOMED CT data entry, as developers can leverage existing solutions rather than building custom tools from scratch. Reusing SMART apps ensures consistency, improves interoperability, and allows healthcare organizations to benefit from a growing ecosystem of proven applications.
Advice
It is important to differentiate data entry linked to basic building blocks of the clinical information model and data entry intended to collect detailed clinical information about a particular event or situation.
SMART Apps are a great solution for customized data entry interfaces if your system already supports SMART on FHIR.
Basic data entry user interfaces for diagnosis, problems, or procedures are usually better served by a native solution of the EHR system, preferably relying on a FHIR terminology service.
A good example is the previously mentioned Allergy recording SMART App. If a system does not have a dedicated UI for capturing allergy details, deploying the SMART App provides a very simple and fast solution that ensures the use of a validated and standardized model. Some development effort is necessary to integrate the data returned by the SMART App with the EHR information, and this is simplified by the use of standard data structures, like FHIR resources2.
There is a list of EHR providers that already include support for SMART Apps and other SMART standards out of the box3. For compatible EHRs, using SMART Apps can provide significant advantages in integrating SNOMED CT data entry seamlessly.
However, adding SMART on FHIR support to an EHR that currently lacks it can be complex, akin to incorporating native SNOMED terminology services. This process often involves substantial changes to the system's architecture, such as updating APIs, integrating FHIR capabilities, and ensuring compliance with data standards. Organizations considering this approach should carefully evaluate the benefits of improved interoperability and flexibility against the resources required for implementation.
Tips for best results using SNOMED CT with SMART Guidelines and CQL
Leverage SMART on FHIR Apps: SMART on FHIR can provide a practical solution for integrating SNOMED CT. By creating a standalone SMART app that connects to the EHR, you can design a user-friendly, flexible data entry interface without directly modifying the core EHR system. This approach allows you to use SNOMED CT for clinical data capture in a way that is decoupled from the limitations of the original system.
Use FHIR Terminology Services: For optimal use of SNOMED CT, consider combining SMART apps with FHIR-based terminology services. These servers can dynamically provide value sets that align with specific clinical workflows, which means that your SMART app can fetch relevant SNOMED CT codes in real-time. This allows you to enhance data quality and accuracy in a flexible manner dn without the need to modify the native EHR architecture.
Differentiate UI Designs for Specific Use Cases: When implementing SNOMED CT data entry through SMART apps, consider the different types of user interfaces needed for various clinical contexts. For example, generic clinical coding in progress notes or problem lists may benefit from a streamlined interface that allows for rapid data entry, or it may even be better served by a native SNOMED lookup function based on a database search. On the other hand, specialized UIs are often required for areas like allergy documentation, cancer reporting, or other specific clinical domains where tailored data capture is necessary. Designing UIs that fit the unique requirements of these specialized workflows will improve usability and data quality.
Balance Effort with Benefit: While integrating SMART on FHIR apps and terminology services offers substantial flexibility, consider the development effort required. Start with a pilot project to evaluate the integration process, user feedback, and overall impact on data quality. Scaling up can be planned based on these insights.
References
SMART Standards and Specs: https://docs.smarthealthit.org/
Example: Allergy FHIR Resource: https://hl7.org/fhir/r4/allergyintolerance.html
Who is using SMART? https://smarthealthit.org/an-app-platform-for-healthcare/who-is-using-smart/
Learn More
To learn more, please reach out to [email protected].
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