SMART on FHIR applications are standards-based tools integrated with electronic health record (EHR) systems and intended for dissemination across EHR platforms. A key challenge for disseminating many apps is that EHR vendors provide different levels of support for FHIR. Thus, app developers must balance functionality versus portability. In this case study, a feature-rich app for neonatal bilirubin management was developed prioritizing physician-requested functionality, with custom FHIR interfaces implemented within the EHR as needed. Following wide intra-institutional use, several approaches are being pursued for adapting the app for cross-institutional dissemination: user surveys and interviews to identify least-valued app features which could potentially be omitted; enabling the application to provide differential features depending on available EHR FHIR capabilities; replacing custom FHIR interfaces with native EHR FHIR interfaces as they became available; and using a canonical logical data model known as QUICK that can be mapped to different FHIR versions and profiles.

Learning Objective: After participating in this session, the learner should be better able to:
- Understand the barriers to dissemination of SMART on FHIR applications which use functionality beyond that supported by the US Core FHIR profiles.
- Formulate an approach to balance functionality versus portability for SMART on FHIR applications using qualitative and technical methods.
- Learn about the University of Utah experience with preparing the SMART on FHIR Bilirubin Management Application for cross-institutional dissemination.


Polina Kukhareva (Presenter)
University of Utah

Phillip Warner, University of Utah
Salvador Rodriguez-Loya, University of Utah
Heidi Kramer, University of Utah
Charlene Weir, University of Utah
Claude Nanjo, University of Utah
David Shields, University of Utah
Kensaku Kawamoto, University of Utah

Presentation Materials: