SMART on FHIR applications are standards-based tools integrated with electronic health record (EHR) systems and intended for dissemination across EHR platforms. A key challenge for disseminating many apps is that EHR vendors provide different levels of support for FHIR. Thus, app developers must balance functionality versus portability. In this case study, a feature-rich app for neonatal bilirubin management was developed prioritizing physician-requested functionality, with custom FHIR interfaces implemented within the EHR as needed. Following wide intra-institutional use, several approaches are being pursued for adapting the app for cross-institutional dissemination: user surveys and interviews to identify least-valued app features which could potentially be omitted; enabling the application to provide differential features depending on available EHR FHIR capabilities; replacing custom FHIR interfaces with native EHR FHIR interfaces as they became available; and using a canonical logical data model known as QUICK that can be mapped to different FHIR versions and profiles.
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