SMART Markers is standards based software framework for creating health system integrated apps for patient generated health data that includes– patient reported outcomes (PROs), PROMIS®, smartphone based activity exercises and device sensor data.

Building upon SMART on FHIR, SMART Markers is fully standards compliant with FHIR version R4. All data in and out is FHIR.

Designed for Patient & Practitioner apps

While the framework is fully functional with open FHIR servers, it can enable user-type dependent functionality– specific to either patients or practitioners and hence, both patient facing and practitioner facing apps can be created.

Requirements

The framework is written entirely in Swift and requires Xcode 11.0 or newer and supports iOS devices with base SDK version of 12.1 (SMART Markers framework can run on devices with iOS 12.1 or newer). Two essential submodules are required for compiling: Swift-SMART– a SMART on FHIR swift library, and ResearchKit– for data generating user interfaces.

Getting Started

➔ Installation
➔ EASIPRO Clinic App
➔ EASIPRO Patient App

Protocols and Modules

SMART Markers follows a model of request & report. The framework's core functionality is abstracted into the following three protocols and supporting controller classes. Simplified event change would be (1.) Request: Fetching or generating FHIR resources to dispatch a request for data. (2) PGHD Instrument resolution from the request and survey session administration with output. (3) Report creation from the instrument's out and submission to the FHIR server.

Request Protocol

Defines a set of variables needed to parse an incoming, practitioner dispatched request resource. For R4, the default support is for FHIR ServiceRequest, but adding more Request compliant resources is possible. This protocol further resolves the Instrument (PROs, surveys, PROMIS, activity reports, etc..) and also the associated schedule.
➔ Request
➔ Schedule

import SMARTMarkers

let requests = [Request]() // can also be [ServiceRequest]() 

// Get PGHD requests for `patient` from `server`
ServiceRequest.PGHDRequests(from: server, for: patient, options: nil) { [weak self] (serviceRequests, error) in
                if let serviceRequests = serviceRequests {
                    self?.requests = serviceRequests
                }
                if let error = error { 
                    print(error)
                }
}

Instrument Protocol

Classes conforming to Instrument define the metadata with methods needed for initiating an interactive user session for generating data. A variety of instruments are supported out of the box with capability to add more downstream. Instrument classes determine the type of FHIR resources generated after a task session packaged as FHIR Bundle. Curently all instruments are required to be proactive data generating sessions. For consistent UX, ResearchKit's ORKTaskViewController created for all instruments.
➔ Instrument
➔ Instrument List

// Resolve Instrument embedded in the `Request`
request?.rq_resolveInstrument(callback: { (instrument, error) in
            if let instrument = instrument { 
                // Resolved: Can be any class that conforms to `Instrument`
                // eg: FHIR Questionnaire, Adaptive Questionnaire 
                self.instrument = instrument
            }
            else {
                print(error) 
            }
        })

// Or.. Instantiate an Instrument locally

// FHIR Questionnaire resource:
let questionnaire = Questionnaire() // initialized already

// StepCount  
let stepCount = Instruments.HealthKit.StepCount.instance

// Amsler Grid (task from ResearchKit)
let amslerGrid = Instruments.ActiveTasks.AmslerGrid.instance

// Omron requires its OAuth2 credentials and a callback handler
// a `CallbackManager` class can optionally handle incoming redirect calls after authorization
let omron = Instruments.Web.Omron(authSettings: [:], callbackManager: CallbackManager()) 

// intiating a data generating task session
instrument.sm_taskController { (taskViewController, error) in
            if let taskView = taskViewController {
                // Present taskView
            }
            else {
                // error creating a task user session controller
                print(error)
            }
    }

Report Protocol

FHIR Resources generated as results for a given instrument conform to Report. Eg. QuestionnaireResponse, Observation, Mediaetc. A report collector class Reports builds historical FHIR resources from a FHIR Server for a given Instrument or a Request or both. Also manages reporting of newly created FHIR Bundles to the server after tagging with Patient and, if available, Practitioner.
➔ Report
➔ Reports

// Instantiate Reports class (gathers and submits Report types)
let reports = Reports(instrument, for: patient, request: request)

// Fetches historical FHIR resources for the given instrument & patient
reports.fetch(for: patient, server: server, options: nil) { (fhirReports, error) in {
    if let fhirReports = fhirReports {
        print(fhirReports)
    }
}

// Submit newly generated FHIR outout 
reports.submit(to: server, patient: patient) { (success, errors) in { 
    print(success)
}

---

TaskController

Controller to manage all aspects of Request, Instrument and Report based classes and makes it easier to fetch PGHD requests, administer instrument session and report back to the FHIR server.
➔ TaskController

// Instantiate TaskController with an Instrument; An instance or type should hold onto the variable
self.controller = TaskController(instrument: instrument)

// prepare User Session Task Controller; powered by ResearchKit
controller.prepareSession() { taskViewController, error in 

    if let taskViewController = taskViewController { 
        self.present(taskViewController, animated: true, completion: nil)
    } 
    else { 
        // check error:
        print(error)
    } 
} 

// Session completion callback; the `SubmissionBundle` is retained by receiver's reports, can be submitted.
controller.onTaskCompletion = { submissionBundle, error in 
    if let submissionBundle = submissionBundle { 
        // Output: FHIR Bundle 
        print(submissionBundle.bundle)
        
        // submit: 
        controller.reports.submit() //as above
    } 
    else { 
        print(error)
    }
}

Multiple Sessions & Submission to FHIR Server

For multiple, back to back interactive sessions, a set of TaskControllers can be passed onto a SessionController to create a single presentable UIViewController. The output from these sessions are collected by SubmissionTask– a ORKTaskViewController based UI layer to facilitate writing the resources to the FHIR Server
➔ SessionController

License

This work is Apache 2 licensed. Also take look at NOTICE.txt. Please include licensing information of the submodulessomewhere in your product.

• ResearchKit