SMART on FHIR Prior Auth: Seamless EMR Integration

The Cost of Fragmented Prior Authorization Workflows

Without a dedicated **SMART on FHIR prior auth** application, clinicians and coordinators often navigate away from the EMR to initiate prior authorizations. This context-switching and manual data transfer, including patient and encounter details, are significant contributors to administrative burden and potential errors. PA workflows typically proceed outside the EMR, with outcomes often recorded inconsistently, leading to fragmented data.

Common Challenges in Traditional PA Workflows

• Clinicians or coordinators must open separate applications, leading to context-switching out of the EHR.
• Manual transfer of patient name, member ID, and clinical context introduces transcription errors.
• Documentation is often pulled via screen scraping or manual retyping, creating gaps and inconsistencies.
• PA status and decisions are frequently recorded as free-text notes, making data unstructured and difficult to query.

Klivira's Automated SMART on FHIR Prior Auth Workflow

Klivira leverages SMART on FHIR to embed prior authorization directly within your EMR, transforming a multi-step, external process into a streamlined, in-context experience. Our solution launches from within major EMRs, pulling patient and encounter data via FHIR R4 and facilitating automated submissions and structured write-backs. This approach ensures the PA workflow is structurally integrated with the EHR's chart, not just a side channel.

Key Steps in Klivira's SMART on FHIR Workflow

• Clinicians launch Klivira directly from the EMR UI via SMART App Launch, with patient and encounter context delivered automatically (src: smart-app-launch).
• Single sign-on uses the clinician's EMR identity through SMART OAuth 2.0, eliminating separate logins.
• Klivira reads US Core resources (src: us-core) directly from the EMR's FHIR endpoint, eliminating manual transcription and screen-scraping.
• PA workflows, including coverage discovery (Da Vinci CRD, src: davinci-crd-ig) and documentation assembly (Da Vinci DTR, src: davinci-dtr-ig), proceed within the launched application.
• PA decisions are written back to the EMR as structured FHIR R4 DocumentReference, Communication, and Task resources, where supported.

Addressing Critical Pain Points with FHIR Standards

Klivira's implementation of SMART on FHIR and Da Vinci standards directly resolves several long-standing issues in prior authorization. By eliminating context-switching and manual data entry, we reduce administrative burden and improve data accuracy. Structured FHIR reads replace error-prone methods like screen-scraping, and consistent FHIR write-backs ensure PA status is queryable within the EMR.

Standards Underpinning Klivira's Solution

• **SMART App Launch (src: smart-app-launch)**: The EHR-launch protocol Klivira implements for secure, context-aware application launch.
• **US Core (src: us-core)**: The baseline FHIR R4 resource profile Klivira reads from EHR endpoints for clinical data.
• **Da Vinci CRD (src: davinci-crd-ig)**: Enables coverage requirements discovery at the point of order entry, integrated into the workflow.
• **Da Vinci DTR (src: davinci-dtr-ig)**: Supports automated documentation template population from EMR data, streamlining evidence collection.
• **Da Vinci PAS (src: davinci-pas-ig)**: Standardizes the submission of prior authorization requests directly from the in-EMR application.