{"id":7733,"date":"2018-12-13T23:05:34","date_gmt":"2018-12-13T23:05:34","guid":{"rendered":"http:\/\/orionhealth.weareiceberg.co\/?p=646"},"modified":"2024-06-11T01:39:08","modified_gmt":"2024-06-11T01:39:08","slug":"what-is-smart-about-smart-on-fhir","status":"publish","type":"post","link":"https:\/\/orionhealth.com\/global\/blog\/what-is-smart-about-smart-on-fhir\/","title":{"rendered":"What is smart about SMART on FHIR?"},"content":{"rendered":"\n<p class=\"wp-block-paragraph\">Application Programming Interfaces (APIs), particularly those that expose Personal Health Information (PHI) have security issues to consider. Substitutable Medical Applications and Reusable Technologies (SMART) is a healthcare standard, that adds a layer of security in front of FHIR interfaces to support safe access to data held within an Electronic Health Record (EHR) \u2013 or any other repository.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Recently I gave a webinar in SMART for HL7\u00ae&nbsp;and one of the comments I received was there was not enough detail to allow a developer to implement it. This was not the main focus of the event, but it did make me realise that there a lot of interest about SMART from developers and how could this need be met. In the next year, we\u2019re planning on ramping up FHIR implementations in New Zealand, and we need to start with security up front \u2013 rather than something that gets thought about once an app or an API has been developed.<\/p>\n\n\n\n<h5 class=\"wp-block-heading\"><strong>The SMART specification&nbsp;<\/strong><\/h5>\n\n\n\n<p class=\"wp-block-paragraph\"><a href=\"http:\/\/hl7.org\/fhir\/smart-app-launch\/\" target=\"_blank\" rel=\"noreferrer noopener nofollow\">The SMART specification<\/a>\u00a0is very readable \u2013 but this is a complicated topic, and having different descriptions and perspectives is always helpful.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">To help developers out, I\u2019m developing both a SMART client and server and I will use these in a series of posts to call out the key parts of the \u2018OAuth handshake\u2019 that occurs when a client authenticates to a server in sufficient detail for a developer. The focus will be on how SMART is used to protect APIs, where the API is a source of data that can be provided in a secure, controlled fashion to an external party.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">If you\u2019ve heard of SMART, it\u2019s likely in the context of supporting \u2018app launches\u2019 \u2013 the ability to have separate \u2018mini-apps\u2019 that can be launched from an Electronic Health Record (EHR) to perform a specialised function. This is then able to identify itself to the EHR and access data from its database via FHIR APIs. There are 2 \u2018launch types\u2019 defined:<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>The \u2018EHR launch\u2019 where an EHR user launches the app in the context of a patient or an encounter. In this scenario, the app is effectively extending the functionality of the EHR. Note that the term Electronic Medical Record (EMR) is often used as well.<\/li>\n\n\n\n<li>The \u2018standalone\u2019 launch where the app is started externally to the EHR but is able to securely connect to the EHR and access this data.<\/li>\n<\/ul>\n\n\n\n<p class=\"wp-block-paragraph\">It\u2019s the standalone pattern that I\u2019m going to be focusing on, as \u2013 really \u2013 this is just an application accessing data through an external API.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">In describing SMART in the past, I\u2019ve generally described how the authentication process works starting with the app being launched, connecting to the API and the subsequent workflow steps that occur. However, an alternative way of thinking about this is to view it from the perspective of the API.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Suppose you\u2019re an EHR or shared repository exposing data you have through an API. One of the key things you\u2019re going to be interested in is who is making the call \u2013 and are they allowed to access the data you\u2019re providing. You\u2019ve got a couple of ways of managing this. You could do it all yourself \u2013 establishing a way to identify the caller and figure out what data they are allowed to access and what operations they are allowed to do \u2013 read, write, update, delete.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Or, you could offload that task to someone else and focus on the \u2018business\u2019 side of providing access to data. You\u2019d want some way for each caller to be able to prove that they have been validated by the other service. They would have to provide a \u2018token\u2019 of some sort that you could check before allowing them access to the data \u2013 in a similar way to a passport that proves to a customs agent that you are who you say you are.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">This is how OAuth2 (and therefore SMART) works \u2013 as SMART is a way of using OAuth2. The system providing the API is called the \u2018Resource Server\u2019, and the system checking the caller is called the \u2018Authorisation Server\u2019. Note that they don\u2019t have to be completely separate systems, they can just be specialised modules within the same application. Also, the exact way that the 2 systems interact is not defined in the specification \u2013 that\u2019s up to the individual implementation. For example, when the Resource Server receives a request for data, there will be a token of some sort that was supplied by the Authorisation Server. This token could itself contain the identification of the user and their permissions in some encrypted fashion that the Resource Server can examine directly. Or it could simply be a unique \u2018key\u2019, and the Resource Server uses it to check with the Authorisation Server on each request.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">We\u2019ll talk more about this in later posts.<\/p>\n\n\n\n<h5 class=\"wp-block-heading\"><strong>Other actors<\/strong><\/h5>\n\n\n\n<p class=\"wp-block-paragraph\">There are 2 other actors in this picture to think about, and they are on the caller side.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">There is the actual application that is making the call, and also the user of that application. For example, suppose I am the developer of a Consumer Portal and I want to access data from the consumers EHR (maybe their Primary Care system) or from a repository of other data like laboratory results.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">From the perspective of the EHR providing the API, they are quite different things, and it would want to be able to identify both of them when deciding whether or not to allow a specific call to proceed.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Incidentally, the user of the app making the call is called the \u2019Resource Owner\u2019 in OAuth2 \u2013 reflecting the common use of AOuth2 to allow a person to use a separate app to access data that they provided to the resource server \u2013 think of a mobile app accessing Twitter or Facebook data for example.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">So, we have a total of 4 different actors to think about:<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>A user (person) who is using an app that needs to access data from somewhere else.<\/li>\n\n\n\n<li>An application that the user is using to do so.<\/li>\n\n\n\n<li>The system that has the data being exposed through the API \u2013 the Resource Server.<\/li>\n\n\n\n<li>The system that is responsible for checking the app and the user of that application \u2013 the Authorisation Server.<\/li>\n<\/ul>\n\n\n\n<p class=\"wp-block-paragraph\">And the overall flow of the interaction is something like this:<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>The user invokes a function in the app that requires it to get data from the API.<\/li>\n\n\n\n<li>The app connects to the Authorisation Server and validates both itself and the user. (This is important \u2013 both are checked). The Authorisation Server returns a token (called an Access Token) that the app can include in a subsequent call to the Resource Server as proof that it is allowed to call the API.<\/li>\n\n\n\n<li>The app makes the API call, including the access token. The Resource Server checks that the access token is valid, and that the app\/user is allowed to access the data they are requesting, and if so, will process the API call.<\/li>\n<\/ul>\n\n\n\n<p class=\"wp-block-paragraph\">The link to the\u00a0<a href=\"https:\/\/smartclient.com\/\" target=\"_blank\" rel=\"noreferrer noopener nofollow\">app is here<\/a>.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Of course, the details are a bit more complex than that \u2013 but fundamentally this is how it works.\u00a0To understand SMART in detail,\u00a0<a href=\"https:\/\/fhirblog.com\/2018\/12\/10\/delving-into-smart\/\" target=\"_blank\" rel=\"noreferrer noopener nofollow\">learn more here<\/a>.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">We\u2019ll dive into those details in later posts.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">To learn more about why SMART on FHIR is smart, read my white paper which reviews SMART, and considers how an organisation can support and benefit from this healthcare standard.<\/p>\n\n\n\n<div class=\"wp-block-button\"><a class=\"wp-block-button__link wp-element-button\" href=\"https:\/\/orionhealth.com\/white-papers\/how-to-maximize-security-by-adding-smarts-to-your-fhir-apis\/\">Go to White Paper<\/a><\/div>\n","protected":false},"excerpt":{"rendered":"<p>Application Programming Interfaces (APIs), particularly those that expose Personal Health Information (PHI) have security issues to consider. Substitutable Medical Applications and Reusable Technologies (SMART) is a healthcare standard, that adds a layer of security in front of FHIR interfaces to support safe access to data held within an Electronic Health Record (EHR) \u2013 or any [&hellip;]<\/p>\n","protected":false},"author":6,"featured_media":15611,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"content-type":"","footnotes":""},"categories":[1],"tags":[],"region":[23],"class_list":["post-7733","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-blog","region-global"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.6 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>What is smart about SMART on FHIR? - Orion Health<\/title>\n<meta name=\"description\" content=\"Learn more about Substitutable Medical Applications and Reusable Technologies (SMART) as it relates to FHIR in this blog post.\" \/>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/orionhealth.com\/global\/blog\/what-is-smart-about-smart-on-fhir\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"What is smart about SMART on FHIR? 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