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SMART on FHIR

SMART on FHIR ("Substitutable Medical Applications and Reusable Technologies on FHIR") is the auth + data-exchange profile that lets third-party clinical apps and patient-facing apps integrate with FHIR-compliant systems through a standardised launch flow, OAuth2-based authorisation, and FHIR-resource scopes.

First wiki canonicalisation 2026-05-27 in the Databricks + Health Samurai co-marketing post on building a FHIR-native health data platform on Lakebase.

Definition

SMART on FHIR layers three things on top of the FHIR REST API:

  • OAuth2 authorisation — the app obtains an access token from an authorisation server before calling the FHIR API.
  • FHIR-resource-scoped permissions — scopes are encoded in FHIR-resource terms (e.g. patient/Observation.read, user/Patient.read) rather than in opaque API keys.
  • Standardised launch flows — EHR launch (the EHR launches the app with patient + encounter context preselected) and standalone launch (the user launches the app and authenticates against the EHR).

The 2026-05-27 source positions SMART on FHIR as one of three standards-based access surfaces in the dual-access pattern from one FHIR dataset (alongside the raw FHIR API and SQL on FHIR ViewDefinitions).

Architectural role

In the FHIR-server-on-lakehouse-substrate pattern (Aidbox-on-Lakebase + Moonlink + Unity Catalog), SMART on FHIR enables two specific use shapes named in the 2026-05-27 source:

  • EHR-embedded clinical decision support — verbatim: "Clinical and administrative decision support powered by Databricks AI connects back to EHR and billing workflows through SMART on FHIR and CDS Hooks. This enables: HEDIS/STARS scoring and quality measurement, Risk adjustment and HCC capture optimization, Contract analytics and shared savings tracking, Agentic AI that closes care gaps proactively — not retrospectively."
  • Patient-facing apps + portals — verbatim: "Patient portals with FHIR API as the backbone — standards-compliant by design" and "Patient Access API included as a natural property of the architecture" (CMS-0057 Patient Access Rule).

CDS Hooks

CDS Hooks is a complementary HL7 standard that lets clinical-decision-support services hook into specific moments in the EHR workflow (patient-view, medication-prescribe, etc.) and return cards (information / suggestion / app launch). SMART on FHIR + CDS Hooks together close the loop between an analytical/AI-derived insight (computed against the FHIR substrate) and a clinician's point-of-care UI inside their existing EHR.

Seen in

Caveats

  • Capability altitude only. No specific scope set disclosed, no launch-flow walkthrough, no token-exchange mechanism, no relation to UC's on-behalf-of authorisation discussed in the 2026-05-20 Governing AI agents at scale source.
  • Single-source ingest. Tier-3 vendor co-marketing post; no second-source confirmation of specific SMART on FHIR deployments at production scale on the Aidbox-on-Lakebase substrate.
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