How to Build a SMART on FHIR App That Integrates with Epic
Table of Contents
- Introduction to SMART on FHIR
- Why Epic Integration Matters
- Understanding the SMART on FHIR Framework
- Key Challenges in Building Healthcare Apps
- The Role of Epic’s App Orchard and Connection Points
- Security and Compliance Considerations
- Designing for Clinician and Patient Workflows
- Technical Steps to Building Your App
- Testing and Validation in Epic Environments
- Insights from Itirra’s Experience
- Best Practices for Long-Term Success
- Conclusion
1. Introduction to SMART on FHIR
The healthcare industry is undergoing rapid transformation, and interoperability is at the heart of this change. One of the leading standards enabling this shift is SMART on FHIR, which allows apps to plug into major EHRs like Epic. For healthcare organizations, this means improved efficiency, better decision-making, and more personalized patient care. However, building a SMART on FHIR app requires careful planning and a deep understanding of both technical and clinical workflows. Therefore, it is essential to approach development strategically rather than rushing into code. In this blog, we will explore how to build a SMART on FHIR app that integrates seamlessly with Epic.
2. Why Epic Integration Matters
Epic is one of the largest and most widely used electronic health record (EHR) systems in the world. Because of its scale, integrating with Epic offers unparalleled opportunities to reach healthcare providers, administrators, and patients. Furthermore, Epic’s ecosystem is growing with apps that bring new value to clinicians and improve patient outcomes. However, without proper planning, attempting to integrate can lead to wasted resources and failed projects. That is why understanding Epic’s requirements and processes is essential before development begins. In short, Epic integration is not just valuable—it’s a strategic necessity.
3. Understanding the SMART on FHIR Framework
To build effectively, developers must first understand the SMART on FHIR framework. SMART, which stands for “Substitutable Medical Applications and Reusable Technologies,” is layered on top of the FHIR (Fast Healthcare Interoperability Resources) standard. Together, they enable secure, standards-based access to patient data through APIs. Importantly, SMART on FHIR also supports single sign-on and user authentication, making it clinician-friendly. This combination allows apps to function within Epic’s workflows without requiring separate logins or redundant data entry. Consequently, understanding this framework is the foundation for success.
4. Key Challenges in Building Healthcare Apps
Although the SMART on FHIR framework provides a blueprint, real-world development still involves significant hurdles. Common challenges include handling different FHIR versions, managing Epic-specific extensions, and ensuring data security. In addition, developers must build apps that meet the strict requirements of healthcare compliance frameworks like HIPAA. From a usability standpoint, apps must be designed so that clinicians can adopt them without disrupting existing workflows. Furthermore, the complexity of healthcare data means testing and iteration take longer than in other industries. As a result, careful planning is needed to overcome these challenges.
5. The Role of Epic’s App Orchard and Connection Points
Epic provides a platform called App Orchard now Epic Showroom, which acts as a marketplace and developer hub for third-party apps. Registering your app with App Orchard is critical to ensuring visibility and compliance. Moreover, App Orchard provides documentation, sandbox environments, and validation tools to help developers test their integrations. Beyond the marketplace, understanding Epic’s connection points—such as APIs, launch contexts, and authentication processes—is vital. These elements dictate how your app exchanges information with Epic in real time. By mastering App Orchard, developers can streamline the approval and adoption process.
6. Security and Compliance Considerations
Healthcare apps operate in one of the most regulated industries in the world. Consequently, security and compliance are non-negotiable when building a SMART on FHIR app for Epic. Developers must implement strict data encryption, audit logging, and access controls to remain compliant with HIPAA and other standards. Additionally, Epic requires its partners to follow rigorous protocols during integration. This ensures that sensitive patient information remains protected at every stage. By prioritizing compliance from the beginning, organizations can avoid costly delays and build trust with healthcare partners.
7. Designing for Clinician and Patient Workflows
Technology succeeds in healthcare only if it improves workflows for clinicians and patients. For example, an app that retrieves lab results must present data in a way that supports quick, informed decision-making. Similarly, patient-facing apps must provide clarity without overwhelming users with jargon. Furthermore, integration with Epic ensures data is presented within the same interface clinicians already use, minimizing friction. By focusing on usability, developers create apps that are not just technically sound but also practically valuable. In other words, thoughtful design equals adoption.
8. Technical Steps to Building Your App
The development journey begins with defining use cases and identifying relevant FHIR resources. Next, developers set up a secure authorization flow, often using OAuth2 protocols supported by SMART on FHIR. Afterward, the app is configured to launch within Epic using provided launch contexts. At this stage, developers test data retrieval, authentication, and role-based access to ensure accuracy. Iteration is crucial, as Epic environments can vary and require refinement. Ultimately, following these steps creates a technically robust foundation for Epic integration.
9. Testing and Validation in Epic Environments
Testing is a phase where many projects succeed or fail. Epic provides sandbox environments where developers can validate their SMART on FHIR apps. These environments simulate clinical workflows, ensuring that data flows correctly between the app and Epic. Beyond technical testing, user acceptance testing (UAT) with clinicians and administrators is equally important. Their feedback ensures the app aligns with real-world needs rather than just theoretical designs. Consequently, thorough testing shortens the path to approval and successful deployment.
10. Insights from Itirra’s Experience
This is where partnering with experienced teams makes a significant difference. Itirra, a Washington State health tech lab with over a decade of experience, has successfully designed, developed, and deployed bespoke EMR and EHR integration solutions. Their expertise spans physician advisors, third-party medical consultants, and revenue cycle management companies. Over the years, Itirra has helped organizations overcome the technical, compliance, and workflow challenges of Epic integrations. By leveraging their knowledge, healthcare organizations avoid common pitfalls and accelerate development. In short, Itirra brings both technical and strategic expertise to the table.
11. Best Practices for Long-Term Success
Once your SMART on FHIR app is live, the journey is not over. Continuous monitoring is essential to ensure performance and compliance remain strong. Moreover, Epic and FHIR standards evolve, which means apps must be updated regularly to remain compatible. Establishing feedback loops with clinicians ensures your app stays aligned with user needs. Additionally, tracking metrics like adoption rates and workflow improvements helps measure success. By following these best practices, your app can achieve sustained value in the healthcare ecosystem.
12. Conclusion
Building a SMART on FHIR app that integrates with Epic is a challenging but rewarding endeavor. With the right technical foundation, security measures, and user-centered design, organizations can unlock enormous potential for better care delivery. However, the process is complex, and success often requires experienced guidance. This is where partnering with experts like Itirra can make all the difference. If your organization is ready to bring a SMART on FHIR app to life and integrate seamlessly with Epic, Itirra is here to help. Contact Itirra today to start building your future in healthcare innovation.