SMART on FHIR architecture

[Chandan Datta]

Hi,

Is there any talk/documentation online explaining the SMART on FHIR architecture? Specifically I am looking for the sequence diagram and component diagrams for the new SMART on FHIR implementation to understand the structure. I guess the current open source FHIR server doesn't have a reference EMR in the backend (https://github.com/jmandel/smart-on-fhir)?

I watched Josh's HIMSS lightning talk and the Devcon talk for SMART on FHIR for Cerner Millennium. I would be quite interested to download and play with any such actual reference implementation of the SMART on FHIR stack with a sequence of interaction as in the diagram attached - illustrate establishing patient and provider context and clinical data extraction in that context.

Is there any plan for trying out the interface on the openmrs-fhir module that is in the ideation phase?

Is the Millennium product available for example for trying out the SMART on FHIR stack?

[Josh Mandel]

Hi Chandan,

The SMART on FHIR reference implementation source repositories are available at:

https://github.com/smart-on-fhir

These repositories include our API server, sample apps, and an installer that you can use to configure a complete local environment. In short, these are the same reference components we use to host our public sandbox.

As far as documentation, the docs site we host includes definitions of the SMART API, as well as sequence diagrams for the authorization workflow. 

The work Cerner has done to-date to prototype SMART on FHIR has been limited to a couple of demonstration environments. I'll email them to see whether they'd be willing to open any aspects of these prototypes more broadly, but  the best advice for the time being is to use our public sandbox (reference server) for testing.

We're still talking with the OpenMRS team about support for SMART on FHIR, but I'm pretty excited about the possibilities there.

Best,

  Josh

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[Chandan Datta]

Thanks Josh.

Which components have changed to access the FHIR data model from the classic platform? Is there a higher level component diagram to tell the transition? For example, what is the equivalent of the SMART reference container from the classic platform to the FHIR server for the SMART on FHIR platform. This would be helpful higher level info for those architects who had understanding of the SMART classic platform integration and then the transition to new SMART FHIR platform. I would be keen to participate in the openmrs-fhir module for the new integration, specially for their FHIR server, which I am guess has not been developed yet. 

Thanks for writing up the tutorial: http://docs.smartplatforms.org/tutorials/server-quick-start/

It would be helpful to see the SMART server with  a real world reference EMR as the backend such as Cerner.

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Regards,
Chandan

[Josh Mandel]

Hi Chandan,

The rough equivalences are:

	SMART on FHIR	SMART "Classic"
Authorization	OAuth2	OAuth 1.0a
Authentication	OpenID Connect	N/A (limited "user context")
Data Models	FHIR + SMART profiles (~50 resources)	SMART Clinical Statement ontology (~15 clinical statements)
Data Access	FHIR REST API	SMART REST API
Data Format	FHIR JSON or XML	SMART RDF/XML
Live sandbox	https://fhir.smartplatforms.org/	http://sandbox.smartplatforms.org/
Code for sandbox	https://github.com/smart-on-fhir	https://github.com/smart-platforms/smart_server

Hope this helps!

  -J

[Chandan Datta]

Thanks Josh. That helps

[Chandan Datta]

Hi Josh,

Just as a thought. Referring to my earlier question regarding a vendor implementation guide for SMART adoption ( https://groups.google.com/forum/#!topic/smart-app-developers/CnQw7zI-3-Q), I think there should be a strategy to write a guide for a EMR/EHR vendor .That kind of is beginning with your tutorial: http://docs.smartplatforms.org/tutorials/server-quick-start/

I think the architects at Cerner and such who represent the vendor community and have an early adopter and future commercial interest with SMART ( as the starting point of an open programmable ecosystem) should help in sharing their experience to help the rather reluctant vendors in thinking about it. Eventually it might be a preferable thing for the vendors depending on the market forces and certification maturity requirements. Nevertheless, at this stage it's a good thing to do. What is your opinion and any conceivable roadmap thoughts for such?

I have a non-competitive interest in the EMR side of things as I come from robotics, hence if it means helping with that with openmrs as a reference EMR backend, I would be keen to contribute.

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Regards,
Chandan

[Josh Mandel]

Hi Chandan,

Thanks for these suggestions! We're definitely keen on supporting vendor implementation of SMART. The quick-start guide is the first step in this direction. The overall challenge, of course, is that vendor systems have diverse architectures; so providing generalizable guidance is hard. We've focused on detailed specifications -- but as we gain more experience, detailed case studies will become possible, too.

For example, David Hay has a write-up of his experience following our quick-start guide, in two parts.

If you're interested in OpenMRS specifically, I would definitely recommend getting involved in their FHIR implementation. I believe they're actively scoping out this project, and it may make sense to join their calls, etc. (Details here.)

Best,

  Josh

[Chandan Datta]

Thanks Josh.

 

It's quite true about the diverse architecture vendors have. I think that the vendor led community should participate in sharing experiences with case studies.

I haven't played with installing the FHIR server locally, but is it possible to include new concepts and make changes to the reference data container? For example, add or modify fields for a patient's long term medications.

[Josh Mandel]

Hi Chandan,

Sure thing, if you host your own server, you can load in whatever resource instances you like (as long as they are valid FHIR resources). You can simply HTTP POST, or you can use our sample-patients generator (modifying the built-in data sets).

Best,

Josh