Development and implementation of a SMART on FHIR application to enhance the clinical utility of quality indicators in residential long-term care.

Abstract

The National Aged Care Quality Indicator Program (QI Program) in Australia mandates quarterly review of aged care residents' records and reporting relevant data as part of quality measurement. Despite the program's intent to drive continuous improvement, the use of resident-level quality indicator data for direct care remains limited due to fragmented data sources and lack of decision support tools. Our goal was to develop and implement a SMART on FHIR application (app) to enhance the clinical utility of QI Program data in residential aged care and conduct a qualitative study to identify barriers and facilitators for successful implementation. A collaboration of academic, industry, and provider stakeholders codeveloped a SMART on FHIR app integrating with a proprietary clinical information system (CIS). The app securely accessed individual CIS records and displayed real-time detailed and summarised clinical data. Semi-structured interviews with development and deployment teams were conducted post-deployment and analysed using deductive qualitative methods to identify barriers and facilitators. The app successfully consolidated resident-level quality indicator data into a single, intuitive interface. The app produced a visual summary of the resident status for the clinical data assessed, which is designed to support person-centred care planning. Thematic analysis of interviews revealed three themes: the potential of SMART on FHIR to bridge gaps in aged care informatics, the importance of collaboration, and the need for agility in navigating complexity. Key enablers included multidisciplinary collaboration, adaptive project management, and reuse of open-source tools. Barriers included low digital maturity, proprietary system constraints, and lack of write-back functionality. SMART on FHIR applications are feasible in residential aged care. However, meaningful impact will depend on integration into clinical workflows, improvements in data standardisation, vendor engagement, and capabilities such as write-back. Future work will pilot the solution with care staff to assess usability and optimise workflows for routine care.