Catalyze Innovation that Advances Health

SMART on FHIR (Ignite) Implementation

Christine Laccay and Kevin Maloy, MD, of MI2 Informatics



The team led the launch of an open platform to enable easier integration of innovative apps within MedStar's EHR.


MI2 Informatics, with the MedStar FHIR Clinical Steering Committee


Interoperability” is more than a buzzword at MedStar Health. The ability for different information technology solutions to effectively work together to further improve outcomes is central to our approach to caring for people and enhancing the experience of patients, families, and providers

In January 2017, MedStar launched Cerner’s Ignite solution at MedStar. Cerner is MedStar’s electronic health record (EHR) vendor, and Ignite is one of Cerner’s open platforms that enables organizations to share information through and integrate applications (apps) with its EHR system to enhance workflows and address other needs.

Ignite is Cerner’s implementation of SMART (Substitutable Medical Applications, Reusable Technologies) on FHIR (Fast Healthcare Interoperability Resources; pronounced “fire”). Essentially, SMART allows users to sign into any app built for the open platform, while FHIR is the framework those apps use to identify, organize, and utilize relevant data. The Ignite platform, and related SMART on FHIR offerings from other EHR vendors, allow developers to build a single app that can integrate with any EHR system deployed at any healthcare organization. The SMART on FHIR platform allows healthcare providers to more quickly and seamlessly test and implement apps chosen from an extensive gallery of options.


To catalyze SMART on FHIR usage at MedStar Health, the MedStar Institute for Innovation (MI2) Informatics team was asked to lead the MedStar FHIR Clinical Steering Committee, which focuses on: 

  • Acting as a hub and source of expertise for SMART on FHIR within the MedStar system

  • Providing vetting, development, or implementation guidance to MedStar associates interested in using an app in the Cerner App Gallery or building their own

  • Vetting and providing test environments and feedback for app developers associated with external organizations


The MedStar FHIR Clinical Steering Committee has made it possible for MedStar associates to enable an app from the Cerner App Gallery in an average of eight hours instead of 100+ hours. This has led to a significant increase in adoption and utilization of SMART on FHIR within the MedStar system. Increased adoption and utilization touches the following diverse stakeholders in a variety of ways, and these are just some of the examples of the current impact and future possibilities:

  • MedStar Patients: MedStar’s SMART on FHIR-supported connection to Apple Health Records allows MedStar patients to access their medical records on their iPhones. MedStar patients and developers can also read more here about accessing medical data through external apps via an Application Programming Interface (API), which essentially enables apps to communicate with something other than themselves (such as a database) in a standard, agreed-upon way.

  • MedStar Clinicians: SMART on FHIR also allows clinicians to implement apps to support decision-making, documentation, and more—all within the EHR. MedStar anesthesiologists, for instance, are better able to manage perioperative documentation with a SMART on FHIR-enabled app from external partner, ePreop.

  • Startup Partners: Implementing SMART on FHIR also makes it possible to partner with a broader range of startups. For example, our work with healthfinch provides automated support for routine clinical practice tasks (e.g., prescription refills).

  • Additional Collaborators: SMART on FHIR external collaborations include a wide range of organizations and areas of expertise. In particular, our collaboration with Booz Allen Hamilton on Dictation Lens, a “smart EHR viewer” that leverages machine learning algorithms to strengthen decision support for emergency clinicians, earned recognition in the Cerner Code App Challenge for its innovative approach and potential.