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Enhance the Quality of Care with
EHR and PGHD Integrations

By: John Bailey


Fitness trackers and step counters were the start of what has become a growing trend in the healthcare industry. Wearables have gained popularity and now include devices that measure heart rate, blood pressure, blood glucose levels, blood oxygen saturation, and more.

patient-generated health data generated by wearable devices and integrated with healthcare devices

These systems generate large amounts of healthcare data that, if leveraged, can improve the delivery and quality of care. The information gathered from these sensors can be critical in early detection, diagnoses, and treatment. Until recently, however, integrating the data from wearable devices

FHIR Standards and Patient-Generated Health Data (PGHD)

There has been an industry-wide push to decentralize medical data and transition to a patient-centric, value-based care system. Wearable technology solutions can play an integral role in this effort. Data from sensor technology has proven helpful in preventing falls in elderly people, improving mother-and-child communication, and detecting excessive stress in children. They show incredible promise, but only if there is communication between these devices and EHRs to extract actionable insights.

In an attempt to decentralize care and facilitate interoperability, a number of standards were created for the transference of clinical and administrative data between disparate systems. This group of standards was created by the Health Level Seven International, a nonprofit organization dedicated to developing standards and solutions that standardize and support the global exchange of healthcare data.

This organization is responsible for creating some of the most innovative and transformative protocols in the industry, such as FHIR and SMART on FHIR. They have been widely accepted by industry professionals and software developers.

Understanding SMART and FHIR Resources

SMART, standing for Substitutable Medical Applications and Reusable Technologies, was an initiative started by the Office of the National Coordinator for Health Information Technology (ONC). It provides a standard on how applications would integrate with and launch within an EHR, and provides an open source library for developers to reference. Though the problem with building interoperable solutions remained. This opportunity led to the development of SMART on FHIR, an open source API, and a set of standardized models used for structuring and accessing personal health data. With this API, developers are able to build an app once and have it run anywhere within the healthcare continuum.

open source APIs and solutions makes interoperability and the transferring of health data possible

SMART on FHIR focuses on formalizing the process for interacting with FHIR interfaces. It defines how apps launch inside an EHR, how to determine which EHR user is interacting with the app, and what data is being shared. SMART on FHIR has been adopted by major EHR producers, including EPIC and Cerner, and software developers, such as Microsoft, Google, and Apple.

In other words, FHIR and SMART are guidelines and standards. SMART on FHIR enables those guidelines and standards to become a possibility. It uses a standard, internet-based approach to connecting different elements of the healthcare information network.

Connecting Wearable Health Technology to EHR Databases

SMART on FHIR has defined a way for health applications to connect to EHRs while maintaining compliance, high levels of security, and intuitive user interfaces (UX/UI).

programming languages such as Java and HTML, are used to build interoperable applications to capture and integrate PGHD

According to the HL7, SMART on FHIR technology must use FHIR standards that meet these four definitions:

  1. A SMART on FHIR system has implemented the SMART on FHIR specification, including profiled versions of FHIR, OAuth2, and OpenID Connect. Such a system can run SMART apps..

  2. A SMART on FHIR application runs against a SMART on FHIR system, extending its functionality through the use of clinical and contextual data.

  3. OAuth2 is a web standard for authorization. Its key function is to enable an end user (patient or clinician) to approve a third-party app to access a specific set of data from a service provider.

  4. OpenID Connect is a web standard for authentication. It defines an OAuth2-based protocol allowing end users to sign into apps using external identity providers.

Following these protocols, software developers can create advanced solutions that are inherently interoperable, having the ability to easily communicate with other wearable devices and with major EHR systems.

Smart Markers and Wearable Technology Solutions

SMART Markers is a framework used to identify and capture patient-generated health data (PGHD) to then integrate into EHR databases. With SMART Markers, you can build custom, patient, or client facing healthcare apps that would be programmed with the ability to receive and transmit PGHD.

According to SMART, it uses a “Request & Report” model encapsulated with the functionality necessary for practitioners to be able to send PGHD requests to their patients; and for patients to respond to the requests with data generated through their ubiquitous personal devices.

Get HAPI: FHIR’s Open-Source Java Platform

HAPI-FHIR is an open source, Java software library that uses the JPA 2.0 API to store and collect data. Leveraging this library shortens the time it would take to create a FHIR compliant server due to the built-in Derby database, allowing it to run without the need for an external, database, it is also configurable to run with other systems.

HAPI leverages the FHIR standard to support the transfer of data throughout the healthcare system. This server acts as a central repository to store information from EHRs and other databases. It includes search features and data management modules that can map to FHIR resources, establishing a standard way of representing complex clinical models like diagnoses and medications.

Explore the Potential of SMART Solutions

Solutions that seamlessly communicate by way of APIs and advanced technologies are providing relief in healthcare interoperability. While FHIR defines the structure of where data should live how it should look, SMART defines how apps will launch inside the EHR or EMR. It uses standard codes and languages to secure third-party protocols and allow the free exchange of information between EHR providers.

Software that incorporates FHIR resources can revolutionize healthcare technology. With new standards and guidelines from SMART on FHIR, building healthcare API is fast and simple. Creating custom apps facilitates the flow of healthcare information from wearable devices to streamline workflows, lower costs and improve patient outcomes.


Chetu, Inc. does not affect the opinion of this article. Any mention of specific names for software, companies or individuals does not constitute an endorsement from either party unless otherwise specified. All case studies and blogs are written with the full cooperation, knowledge and participation of the individuals mentioned. This blog should not be construed as legal advice.

Chetu was incorporated in 2000 and is headquartered in Florida. We deliver World-Class Software Development Solutions serving entrepreneurs to Fortune 500 clients. Our services include process and systems design, package implementation, custom development, business intelligence and reporting, systems integration, as well as testing, maintenance and support. Chetu's expertise spans across the entire IT spectrum.

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