SMART on FHIR (Ignite) Implementation

SMART on FHIR (Ignite) Implementation

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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 Health launched Cerner’s Ignite solution at MedStar Health. Cerner is MedStar Health’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 Health system
  • Providing vetting, development, or implementation guidance to MedStar Health 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 Health associates to enable an app from the Cerner App Gallery with more ease and speed than previously possible.

This has led to a significant increase in adoption and utilization of SMART on FHIR within the MedStar Health 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 Health Patients: Patients and developers can also access 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 Health Clinicians: SMART on FHIR also allows clinicians to implement apps and connect different electronic health systems together to support decision-making, documentation, and more—all within the EHR.

  • MedStar Health anesthesiologists, for instance, are better able to manage perioperative documentation with a SMART on FHIR-enabled app from external partner ePreop.

  • MedStar Health primary care and specialist providers can launch a scheduled outpatient video visit directly from within a patient’s chart via a SMART on FHIR integration with telehealth technology partner Bluestream Health, pulling details such as the name, chief complaint, and more directly from the record to help streamline this experience.

  • MedStar Southern Maryland Hospital Center emergency medicine and hospitalist clinicians use EvidenceCare’s SMART on FHIR-enabled clinical decision support tool to help determine the availability of inpatient beds during the hospital admission workflow.

  • MedStar Health Radiology uses FHIR to pull clinical information (such as laboratory results and clinical notes) from Cerner’s EHR into PACS (their picture archiving and communication system) for an integrated environment for interpretation of radiology images.

MedStar Health Researchers: As experts within our system tackle complex healthcare challenges, SMART on FHIR-based tools fuel innovative approaches to compiling and leveraging data.

  • MedStar Health researchers and supporting startup CareJourney used SMART on FHIR to identify individuals who would benefit the most from cardiac risk management through a project funded by the Office of the National Coordinator for Health Information Technology (ONC).

  • Additionally, through a separate project funded by the ONC, MedStar Health researchers and their partners at HealthLab are developing the innovative and novel FHIR Factory Platform, which will ultimately support biomedical and healthcare delivery researchers in processing and utilizing available data for research.

  • Another FHIR-related project of critical importance addresses the opioid crisis and is funded by the Agency for Healthcare Research and Quality. The MedStar Health research team is leveraging interoperable, publicly sharable clinical decision support to help both clinicians and patients in chronic pain management and build upon past work on the CDS resource sharing tool CDS Connect.

Startup Partners: Implementing SMART on FHIR also makes it possible to partner with a broader range of startups. For example, our work with telehealth technology partner Bluestream Health has powered MedStar Health Video Visits and other telehealth services—and we have collaboratively and continuously improved them.

July 2021 Update

As the number of MedStar Health associates using apps powered by SMART on FHIR continues to grow, the MI2 Informatics team—in partnership with the MedStar FHIR Clinical Steering Committee—continues to provide expertise in vetting, developing, and implementing apps from the Cerner App Gallery and those built by associates themselves. See the updated infographic and “Impact” section above for additional information. Related apps play a key role in providing high-quality care to the communities we serve and in responding to urgent needs—such as the COVID-19 pandemic and the opioid crisis. 



For questions or requests related to using SMART on FHIR or the Cerner App Gallery at MedStar Health, please contact MedStar Institute for Innovation and we will direct your inquiry to the appropriate party.

Page last updated: 07/01/21 


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


MI2 Informatics, with the MedStar FHIR Clinical Steering Committee