Learn health data interoperability vocabulary: SMART on FHIR, health information exchange (HIE), CCD, data blocking, and the 21st Century Cures Act for IT professionals.
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What does 'SMART on FHIR' enable in health IT applications?
SMART on FHIR (Substitutable Medical Applications, Reusable Technologies) combines the FHIR data standard with OAuth2/OpenID Connect authorisation. It lets third-party apps (patient portals, clinical decision tools, analytics platforms) securely authenticate against an EHR and access FHIR resources — enabling a healthcare app ecosystem analogous to app stores.
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A Health Information Exchange (HIE) is best described as:
HIEs enable hospitals, clinics, labs, pharmacies, and public health agencies to exchange clinical information about shared patients — reducing duplicate testing, improving care coordination, and enabling population health. They can be centralised (hub-and-spoke), decentralised (federated query), or hybrid. IT teams building HIE integrations work with standards like HL7 v2, C-CDA, and FHIR.
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What is a CCD (Continuity of Care Document) in health data exchange?
The CCD (Continuity of Care Document) is a HL7 CDA (Clinical Document Architecture) document that packages a patient's key health summary for handoffs: hospital discharge, referrals, care transitions. It uses the C-CDA (Consolidated CDA) template standard. IT teams implement CCD generation and parsing when integrating EHR systems with HIEs, care coordination platforms, or patient portals.
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In the context of the 21st Century Cures Act, what is 'data blocking'?
The 21st Century Cures Act (2016, implemented via ONC rules 2020–2022) defines information blocking as practices that 'are likely to interfere with access, exchange, or use of electronic health information'. Penalties apply to EHR vendors, health IT developers, HIEs, and providers. This drives requirements for FHIR APIs, patient data access rights, and prohibitions on EHR contracts that restrict data portability.
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Under the 21st Century Cures Act, what must certified EHR systems provide via FHIR APIs?
ONC's 21st Century Cures Act Final Rule (2020) requires ONC-certified EHR systems to implement HL7 FHIR R4 Patient Access APIs and Provider Directory APIs. This enables patients to connect third-party apps to their EHR data — a right-of-access mandate. EHR vendors that block this (e.g. via contract restrictions, technical barriers, excessive fees) risk information blocking violations.