SMART Health IT

What SMART Health IT does

SMART Health IT is an open-standards healthcare interoperability initiative operated by the Computational Health Informatics Program (CHIP) at Boston Children's Hospital in Boston, MA. Founded in 2009, the initiative developed the SMART on FHIR API, a universal, royalty-free application programming interface standard built on HL7 FHIR that enables healthcare applications to securely access clinical data from any certified electronic health record (EHR). The core technology stack includes the SMART App Launch framework, HL7 Bulk FHIR Access API for population-level data, CDS Hooks for clinical decision support, SMART Health Cards and Health Links for verifiable health credentials, and open-source tooling such as CumulusQ and Cumulus for data quality and federated analytics.

The initiative does not operate as a commercial enterprise. Revenue derives from federal research grants, including initial ONC SHARP program funding in 2010, continued ONC Leading Edge Acceleration Projects (LEAP) funding, CDC investments, and ARPA-H support. All specifications are released under the Apache 2.0 license with no licensing fees. The go-to-market approach is community-led and regulatory-driven: the team collaborates with HL7 International on standards development, sustains the Argonaut FHIR Accelerator, and engages in federal rulemaking through public comments and policy advocacy. Adoption is anchored by the 21st Century Cures Act Final Rule (2020), which made SMART on FHIR and Bulk FHIR APIs universal requirements in all ONC-certified EHRs by the end of 2022.

The organization serves a broad healthcare ecosystem rather than discrete paying customers. End users include patients accessing their records via apps (e.g., Apple Health, connected to 500+ health systems), healthcare providers and clinicians integrating third-party tools into EHR workflows, health systems and payers conducting population health analytics, and health app developers building on a standardized API surface. Notable deployments include CMS Blue Button 2.0, CMS Data at the Point of Care (105,000 providers), SMART Health Cards across 15+ countries covering 225M+ US immunization records, and integrations by Apple, Microsoft Azure, and Commure. The team is led by Kenneth D. Mandl (Director), Joshua Mandel, and Dan Gottlieb, with 11-50 personnel hosted within Boston Children's Hospital.

Name

SMART Health IT

Legal name

Computational Health Informatics Program, Boston Children's Hospital

Website

https://smarthealthit.org

Company type

Private

Founded year

2009

Operating status

Operating

Headcount range

11–50 employees

Short description

SMART Health IT, operated by Boston Children's Hospital CHIP, develops the open-source SMART on FHIR API standard for healthcare interoperability, mandated in all US certified EHRs and adopted by Apple, CMS, and 500+ health systems.

Ownership category

akta.pro rank

Product category

Healthcare Interoperability APIs

NAICS

Computer Systems Design and Related Services (5415)

SIC

Services-Computer Programming, Data Processing, Etc. (7370)

akta.pro primary industry

Interoperability Standards, Profiles & Implementation (HL7/FHIR/IHE) (HLACABAA)

akta.pro secondary industries

EHR Extensions, APIs, App Marketplaces & SMART-on-FHIR Apps (HLACAAAN), API Management & Developer Portals for Health Data (HLACABAD), FHIR/HL7 Data Repositories & Canonical Data Models (HLACAIAI)

Keywords

• Healthcare interoperability APIs
• FHIR standards development
• Clinical data exchange
• EHR integration standards
• Healthcare application platforms

Headquarters

HQ city

Boston

HQ country

United States

HQ region

North America

Offices1 record

Markets served

GTM type

B2B

Offering type

Software

Cost components

Personnel, Technology or R&D, Operations

Revenue model

1. Federal Research Funding: SMART Health IT is funded through ONC SHARP program grants, CDC funding, ARPA-H funding, and other federal R&D investments. The initiative is hosted by Boston Children's Hospital Computational Health Informatics Program (CHIP) and does not generate commercial revenue. Development was supported by HITECH Act/ONC SHARP program funding in 2010, and continued ONC Leading Edge Acceleration Projects (LEAP) funding.

Go-to-market motion2 records

Distribution channels3 records

Marketing channels6 records

Core offering

SMART Health IT develops and maintains an open, standards-based healthcare interoperability API ecosystem built on HL7 FHIR. Its core offering is the SMART on FHIR API, which lets applications written once run against any certified EHR, complemented by the HL7 Bulk FHIR (Flat FHIR) API for population-level data export, the EHI Export API for complete patient record retrieval, CDS Hooks for clinical decision support, and SMART Health Cards/Links for verifiable health credentials. All specifications are released under Apache 2 license and mandated in U.S. certified EHRs by the 21st Century Cures Act Final Rule.

Product overview

SMART Health IT, operated by the Computational Health Informatics Program (CHIP) at Boston Children's Hospital, provides an open, standards-based ecosystem of healthcare interoperability APIs and developer tools. The core offering is the SMART on FHIR API—a universal, substitutable app platform that enables applications to securely access clinical data from any certified EHR. Complementing this are the Bulk FHIR API for population-level data access, EHI Export API for complete patient record retrieval, and CDS Hooks for clinical decision support integration. The product portfolio includes specialized APIs for genomics, patient-generated data (SMART Markers), and health credentials (SMART Health Cards/Links). Developer support is provided through the SMART App Gallery sandbox, Good Neighbor community platform, and open-source tools including CumulusQ for data quality assessment. All APIs are required in certified EHRs under the 21st Century Cures Act and are freely available under Apache 2.0 license.

Differentiator

Problem solved

Functional benefit

Brands

• SMART on FHIR API: A standards-based, interoperable apps platform for electronic health records enabling substitutable healthcare applications.
• SMART/HL7 Bulk Data Access (Flat FHIR)
• CDS Hooks
• Health Cards
• Cumulus

Products and services

• SMART on FHIR API Foundational standards-based API enabling web and mobile healthcare applications to securely access clinical data from any certified EHR. Apps written once can run anywhere in the healthcare system without special effort, supporting both iOS and Android clients.
• SMART/HL7 Bulk Data Access (Flat FHIR) Population-level data access API enabling push-button retrieval of large datasets from EHRs in standardized FHIR format. Supports population health management, value-based care delivery, research, and AI applications across organizations.
• Electronic Health Information (EHI) Export API API enabling patients to request and receive their complete Electronic Health Information via standardized API, including structured data, narrative clinical notes, and diagnostic-quality medical images.
• CDS Hooks HL7 standard enabling real-time, context-aware clinical decision support recommendations inside EHR workflows through a standards-based, interoperable interface for AI-driven guidance.
• Sync for Science NIH-funded project enabling patients to share their EHR data with researchers through SMART on FHIR, including imaging API specifications.
• SMART Health Cards Specification enabling sharing of health data such as immunization records and lab results using FHIR and W3C Verifiable Credentials, supporting verifiable and portable health credentials.
• SMART Health Links Specification building on SMART Health Cards format that enables sharing of larger data sets such as full immunization history and patient summaries, plus dynamic data sets that can be augmented over time.
• SMART on FHIR Genomics Standards-based API specification enabling genomic data access and integration with clinical EHR systems through the SMART on FHIR framework.
• SMART Markers Framework enabling Patient Generated Data (PGHD) to be integrated into healthcare records through SMART on FHIR APIs.
• Cumulus Universal sidecar for a SMART Learning Healthcare System - a federated EHR-based learning system powered by FHIR and AI that enables population-level analytics across healthcare institutions, including unlocking insights from clinical notes using LLMs.
• CumulusQ FHIR Native USCDI Data Quality and Characterization tool for assessing data quality in bulk FHIR exports, funded by ONC/ASTP.
• SMART Backend Services API API enabling automated system-level access to FHIR data for population health analytics, payer-provider data exchange, and large-scale measurement, using 'system/*.*' scopes for backend authorization.

Quantifiable outcome

• Apps written once can run anywhere in the healthcare system without special effort
• +3 more outcomes

Named customers6 records

Segments4 records

Ideal customer profiles4 records

Technology focussed Yes

API detail

Has API

Yes

API docs

API detail

Core technology

AI maturity

App detail

Integration9 records

AI capability5 records

Feature7 records

Partnerships

Nine partnerships are on record, tiered core and secondary.

• HL7 InternationalcoreStrategic or Co-development PartnerSMART on FHIR is developed in collaboration with HL7 International. The SMART Health IT team works with HL7 to define and ballot FHIR standards including Bulk Data Access API specification. FHIR is now an ANSI-accredited standard with SMART as part of the official specification.
• Argonaut ProjectcoreStrategic or Co-development PartnerSMART team launched and sustains the Argonaut FHIR Accelerator, the first industry FHIR accelerator. Argonaut establishes SMART and Bulk FHIR as standards incorporated into ONC Cures Rule. Refined token introspection model and developed imaging access specifications.
• Office of the National Coordinator for Health IT (ONC)coreStrategic or Co-development PartnerONC granted funds for SMART on FHIR API development in 2010 under SHARP program. Continued ONC LEAP funding supported SMART-PopHealth development. ONC incorporated SMART requirements into 21st Century Cures Act certification rules.
• Centers for Medicare and Medicaid Services (CMS)coreStrategic or Co-development PartnerCMS adopted Bulk FHIR within months of API release to share claims data with Accountable Care Organizations. CMS DPC initiative advancing to national deployment. CMS Blue Button 2.0 and ACO Beneficiary Claims Data pilot using SMART standards.
• ApplecoreTechnology or IntegrationApple Health Records API integrated SMART on FHIR enabling patients to securely download medical records to iPhones. Apple's implementation connected to 500+ health systems creating demand signal for broad FHIR endpoint adoption.
• Microsoft AzuresecondaryTechnology or IntegrationMicrosoft Azure SMART API provides FHIR API services built on SMART on FHIR standards for cloud healthcare implementations.
• Sync for SciencesecondaryStrategic or Co-development PartnerNIH-funded project pioneering token introspection model refined by Argonaut Project in 2023. Developed imaging API specification for SMART app access to imaging data.
• Regenstrief InstitutesecondaryTechnology or IntegrationHigh-performing informatics team demonstrated rapid implementation of highly performant Bulk FHIR API in matter of weeks using existing code mapping to US Core FHIR profiles.
• CDC (Centers for Disease Control and Prevention)secondaryStrategic or Co-development PartnerCDC-funded real-world testing of Bulk FHIR and supporting new software components at scale through CDC Data Modernization Initiative. CDC listening sessions exploring public health applications of standardized APIs.

Scale indicators8 records

Recent moves6 records

Expansion highlights6 records

Emerging players

• 1upHealth: FHIR-based healthcare data platform offering patient access APIs and bulk data export. Competes in the same EHR-to-app connectivity space SMART standardizes, but as a commercial vendor building on top of the standards SMART defines.
• Redox: Healthcare API integration platform that sits on top of FHIR and SMART on FHIR endpoints to help app developers connect to multiple EHRs. Operates in the same substitutable-apps market SMART enables, but as a commercial integration layer.

Direct peers

• FHIR Foundation: Non-profit foundation stewarding the FHIR specification globally. Shares the same interoperability mission as SMART and often collaborates on developer education and community events around the same developer audience SMART targets.
• HL7 International: Standards body that jointly develops and ballots the FHIR specifications SMART is built on. SMART works directly with HL7 to define Bulk FHIR, CDS Hooks, and the SMART App Launch framework, and FHIR is now ANSI-accredited through HL7 — making it the closest standards-body peer.
• Regenstrief Institute: Health informatics research institute that rapidly implemented a high-performing Bulk FHIR API mapped to US Core FHIR profiles. Operates in the same healthcare-standards implementation research space as SMART and is explicitly referenced as a peer implementer.
• Office of the National Coordinator for Health IT (ONC): Federal agency that funds SMART's development and embeds its APIs into U.S. certification rules. Operates the U.S. interoperability policy framework that SMART's specifications operationalize.
• Argonaut Project: FHIR accelerator launched and sustained by the SMART team itself; a community of EHR vendors and providers implementing the SMART/Bulk FHIR specifications. Effectively the industry implementation counterpart to SMART's spec work.

Broad incumbents

• Google Cloud Healthcare API: Google Cloud's FHIR-based healthcare data service supporting SMART implementation. Competes with Azure SMART API for cloud-hosted healthcare interoperability workloads built on the SMART standard.
• Epic Systems: Largest U.S. EHR vendor and a mandatory implementer of SMART on FHIR APIs in its certified product. Comparable because Epic's own App Orchard and API strategy operates within the standards framework SMART defines, and Epic is a member of the Argonaut Project.
• Microsoft Azure Healthcare APIs: Cloud-hosted FHIR API service from Microsoft Azure that implements the SMART on FHIR proxy. Operates as a commercial cloud provider in the same interoperability infrastructure category and explicitly builds on SMART specifications.

Market position

Strengths5 records

Weaknesses5 records

Competitive moat5 records

Key risks6 records

Key highlights7 records

Customer concentration

• Xx.com/smarthealthit
• LinkedInlinkedin.com/company/smart-health-it

Compliance1 record

Revenue estimate

Valuation estimate

Number of profiles

Profiles3 records

Funding overview

Funding rounds

Investors

Funding detail is available on the Subscription and Enterprise plan.Contact sales →

M&A

Investments

M&A and investment is available on the Subscription and Enterprise plan.Contact sales →

Frequently asked questions about SMART Health IT