In today’s digital age, healthcare is undergoing a major transformation. At the heart of this shift is the Electronic Health Record (EHR), a digital version of a patient’s paper chart. For developers, building applications that can interact with these systems is a crucial yet often complex task. This guide will walk you through a step-by-step approach to implementing EHR integrations, focusing on using the SMART Health IT Sandbox for a smoother start.
The SMART Health IT Sandbox is a publicly available, free, and open-source platform that provides a simulated EHR environment. It’s designed specifically for developers to test their FHIR and SMART-enabled applications.
Here’s why the SMART Health IT Sandbox is an excellent choice for getting started:
Head to the SMART Health IT App Launcher. Configure your app by providing:
Before exchanging codes, your app should discover the correct authorization and token endpoints dynamically, as outlined in the SMART App Launch documentation:
Commonly found at – {FHIR_BASE_URL}/.well-known/smart-configuration.
Example
async function fetchSmartConfig(iss: string) {
const res = await fetch(`${iss}/.well-known/smart-configuration`);
if (!res.ok) throw new Error("Failed to fetch SMART configuration");
return res.json();
}This returns JSON with important fields such as authorization_endpoint and token_endpoint.
Building a proof-of-concept is just the beginning. Scaling into a production-ready, compliant EHR integration requires expertise in workflows, compliance, and interoperability.
When your app is launched, it will receive query parameters like iss and launch. After the user authorizes, the EHR redirects to your Redirect URL with code and state. Your app must exchange this code for an access token.
Example:
async function exchangeCodeForToken(
tokenUrl: string,
code: string,
redirectUri: string,
clientId: string
) {
const params = new URLSearchParams({
grant_type: "authorization_code",
code,
redirect_uri: redirectUri,
client_id: clientId,
});
const res = await fetch(tokenUrl, {
method: "POST",
headers: {
"Content-Type": "application/x-www-form-urlencoded",
},
body: params.toString(),
});
if (!res.ok) throw new Error("Token request failed");
return res.json();
}Once you have the access token, you can make authenticated calls to the FHIR server:
async function fetchPatient(iss: string, token: string, patientId: string) {
const res = await fetch(`${iss}/Patient/${patientId}`, {
headers: {
Authorization: `Bearer ${token}`,
},
});
if (!res.ok) throw new Error("Failed to fetch patient");
return res.json();The SMART Health IT Sandbox provides a SMART App Launcher that makes testing incredibly easy. Once your client app is configured:
This is your chance to test that your app can successfully authenticate, parse the context, and correctly fetch and display the patient’s data from the sandbox’s FHIR server.
By following these steps, you will have created a working proof-of-concept for an EHR integration without the need for a complex backend. The SMART Health IT Sandbox provides a reliable, standards-compliant environment that lets you focus on building the front-end features and clinical workflows of your application. Once you’re comfortable with the process, you can transition to a full-fledged EHR platform or a dedicated healthcare backend like Medplum, knowing your application’s logic is already sound.
Starting with a purpose-built platform and leveraging the SMART on FHIR standard dramatically accelerates development, allowing you to focus on creating the innovative solutions that will truly transform healthcare.
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