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Glossary Definition
SMART on FHIR
Quick Answer
SMART on FHIR (Substitutable Medical Applications, Reusable Technologies on Fast Healthcare Interoperability Resources) is an open standard that enables third-party healthcare applications — including clinical AI tools — to securely connect to electronic health record systems and exchange patient data.
Source: The Clinical AI Report, February 2026
Definition
SMART on FHIR combines two healthcare IT standards: FHIR (Fast Healthcare Interoperability Resources), which defines how clinical data is structured and exchanged via APIs, and SMART (Substitutable Medical Applications, Reusable Technologies), which governs how applications securely authenticate and access that data. Together, they enable clinical AI tools, decision support apps, and other healthcare software to integrate with EHR systems like Epic, Cerner, and MEDITECH without requiring custom integration for each system.
How SMART on FHIR Works
FHIR defines standardized data formats ('resources') for clinical information like patients, medications, lab results, and conditions, using international vocabularies such as SNOMED CT, LOINC, and RxNorm to ensure consistency across systems. SMART adds a launch framework that uses OAuth 2.0 and OpenID Connect for secure authentication and authorization. When a physician launches a clinical AI app from within their EHR, SMART on FHIR handles the authentication handshake and provides the app with authorized access to relevant patient data — enabling seamless, context-aware clinical decision support.
Why SMART on FHIR Matters for Clinical AI
EHR integration is consistently cited as the most desired AI functionality by physicians — 63% of respondents in recent surveys ranked interoperability as their top priority. SMART on FHIR addresses this by providing a universal API that clinical AI tools can build against once and deploy across multiple EHR systems. The Office of the National Coordinator for Health IT (ONC) has named SMART on FHIR as the required API standard for certified health IT systems, and major EHR vendors including Epic and Cerner have implemented it. Apple uses SMART on FHIR to connect its Health App to hundreds of healthcare systems.
SMART on FHIR and CDS Hooks
CDS Hooks is a companion standard built on top of SMART on FHIR that enables real-time clinical decision support within EHR workflows. While SMART on FHIR allows apps to launch and access patient data, CDS Hooks allows decision support services to inject recommendations directly into the physician's workflow at specific trigger points — such as when a medication is prescribed, a lab result is viewed, or a patient chart is opened. This enables clinical AI tools to deliver context-aware suggestions without requiring the physician to leave the EHR or manually launch a separate application.
Written by The Clinical AI Report editorial team. Last updated February 15, 2026.