SMART Health Card

Short description: Vaccine passport framework

SMART Health Card

Type of project| Immunity passport
Owner| SMART Health IT (Boston Children's Hospital)
Founder| Kenneth Mandl, Isaac Kohane
Country| United States
Established| 2010
Website| https://smarthealth.cards/en/

The SMART Health Card framework is an open source[1] immunity passport program designed to store and share medical information in paper or digital form.[2] It was initially launched as a vaccine passport during the COVID-19 pandemic, but is envisioned for use for other infectious diseases.[3] SMART Health Cards include a QR code which can be scanned and verified using the official SMART Health Card Verifier mobile app.[4] It was rolled out by the Vaccination Credential Initiative (VCI) based on technology developed at Boston Children's Hospital,[5] and standards set by Health Level Seven International (HL7) and the World Wide Web Consortium (W3C).[6]

## Contents

* 1 History
* 1.1 Founding
* 1.2 21st Century Cures Act
* 1.3 COVID-19
* 2 Participants
* 2.1 Developers
* 2.2 Issuers
* 3 See also
* 4 References

## History

### Founding

In February 2009, United States president Barack Obama signed an economic stimulus package which included $19 billion in funds for investment in health information technology. The following month, researchers from Boston Children's Hospital and Harvard Medical School, Kenneth Mandl and Isaac Kohane, published an article in The New England Journal of Medicine calling for the modernization of electronic health records through API integrations on mobile devices.[7] In April 2010, the pair secured a $15 million grant through the Office of the National Coordinator for Health Information Technology's Strategic Health IT Advanced Research Projects (SHARP) program.[8] With this federal funding, the researchers began development of an interoperable healthcare IT platform they called "Substitutable Medical Applications and Reusable Technologies" (SMART). The first iteration of the platform API was previewed later that year,[9] and "SMART Classic" was released in 2011.[10]

In 2013, SMART adopted the open-source Fast Health Interoperability Resources (FHIR) standard developed by Health Level Seven International (HL7). The newly named SMART on FHIR platform was debuted in February 2014 at the Health Information Management Systems Society conference.[10]

### 21st Century Cures Act

According to SMART Health IT, Mandl successfully lobbied for the inclusion of a universal API requirement in the 21st Century Cures Act, signed into law on December 13, 2016.[8][11] The team also advocated for a federal rule establishing SMART as the universal API.[12] In 2019, the Office of the National Coordinator for Health Information Technology published the "final rule" specifying the SMART framework as the standard to satisfy the requirements of the 21st Century Cures Act; the rule was implemented in June 2020.[13]

### COVID-19

The SMART Health Card framework was deployed as a "de facto standard" for vaccine passports in the COVID-19 pandemic in the United States and other international jurisdictions.[5][14][15][16] On January 14, 2021, the Mitre Corporation announced the launch of a new public–private partnership called the Vaccination Credential Initiative (VCI) alongside the CARIN Alliance, Cerner, Change Healthcare, The Commons Project Foundation, Epic Systems, Evernorth, Mayo Clinic, Microsoft, Oracle, Safe Health, and Salesforce.[17] VCI's purpose was to employ the SMART Health Card framework in order to create a unified proof-of-vaccination system for COVID-19 vaccines.[18]

Sample proof of vaccination from British Columbia using SMART Health Card framework

The California Department of Public Health introduced a Digital Covid-19 Vaccine Record portal in June 2021, allowing individuals to verify their vaccination status using the SMART Health Card reader.[15][19][20]

On August 5, 2021, New York Governor Andrew Cuomo announced the introduction of the "Excelsior Pass Plus" which would expand its Excelsior Pass program into other states and internationally by connecting it to the SMART Health Card system.[14][21] As of August 27, 2021, 415,000 citizens of Louisiana had added their COVID-19 vaccination status to their state-run, SMART Health Card enabled LA Wallet.[22] On September 8, 2021, Hawaii governor David Ige announced the rollout of the state's Hawaiʻi SMART Health Card.[23][16] County-level health departments across the United States partnered with VaccineCheck to issue SMART Health Cards by verifying vaccine cards provided by the Centers for Disease Control and Prevention.[24][25][26]

The Government of Canada spent CAD$4.6 million to develop a proof-of-vaccination credential on the SMART Health Card framework, enabling its ArriveCAN travel application to store, recognize and verify credentials from every province, territory and foreign country.[27] Since October 2021,[28] Canadian provinces and territories used the SMART Health Card format as a requirement by the federal government, including British Columbia,[29] Ontario,[30] Saskatchewan[31] and the Yukon.[32]

On October 13, 2021, the American Immunization Registry Association published a statement encouraging adoption of SMART Health Cards as a common standard "where allowed by local law and policy."[33]

A SMART Health Cards Global Forum was held on October 28, 2021.[34] The event featured keynote speakers Andy Slavitt (former Senior Pandemic Advisor to President Joe Biden’s COVID-19 pandemic response team) and Mike Leavitt (former United States Secretary of Health and Human Services).[35][24]

On December 20, 2021, Japan's Ministry of Health, Labour and Welfare launched its COVID-19 Vaccination Certificate Application using the SMART Health Card.[36][37]

By January 2022, about 80% of Americans who had received a COVID-19 vaccine had access to a SMART Health Card through their state governments, local businesses, universities and healthcare systems.[15]

## Participants

### Developers

SMART Health IT is based out of the Computational Health Informatics Program (CHIP) at the Boston Children's Hospital. CHIP's related projects include Apache cTAKES, Genomic Information Commons, HealthMap, and VaccineFinder.[38]

The SMART Health Card's project sponsor is HL7 International's Public Health Work Group,[39] consisting of representatives from Allscripts, the Altarum Institute, Tennessee Department of Health and Washington State Department of Health.[40]

### Issuers

Official registries of authorized SMART Health Card issuers are maintained by SMART Health IT, the Vaccination Credential Initiative, and the CommonTrust Network. Authorized issuers include:[41][42][43]

## See also

* COVID-19 apps
* COVID-19 vaccine
* Digital identity
* Electronic health record
* Immunity passport
* Vaccine passports during the COVID-19 pandemic

## References

1. ↑ "VCI Directory". 10 January 2022. https://github.com/the-commons-project/vci-directory.
2. ↑ "Home". https://smarthealth.cards/en/.
3. ↑ "SMART Health Cards: Vaccination & Testing Implementation Guide.". 2023-08-04. https://build.fhir.org/ig/HL7/fhir-shc-vaccination-ig/.
4. ↑ "SMART Health Card Verifier". https://www.thecommonsproject.org/smart-health-card-verifier.
5. ↑ 5.0 5.1 "SMART Health Card Uses Technology Developed At Boston Children's Hospital" (in en). 2021-08-06. https://wbznewsradio.iheart.com/content/smart-health-card-uses-technology-developed-at-boston-childrens-hospital/.
6. ↑ "About". https://vci.org/about.
7. ↑ Mandl, Kenneth D.; Kohane, Isaac S. (2009-03-26). "No Small Change for the Health Information Economy" (in en). New England Journal of Medicine 360 (13): 1278–1281. doi:10.1056/NEJMp0900411. ISSN 0028-4793. http://www.nejm.org/doi/abs/10.1056/NEJMp0900411.
8. ↑ 8.0 8.1 "About SMART" (in en-US). 2019-10-29. https://smarthealthit.org/about-smart-2/.
9. ↑ "SMART, FHIR, and a Plan for Achieving Healthcare IT Interoperability" (in en-US). 2013-11-15. https://smarthealthit.org/2013/11/smart-fhir-and-a-plan-for-achieving-healthcare-it-interoperability/.
10. ↑ 10.0 10.1 Mandel, Joshua C; Kreda, David A; Mandl, Kenneth D; Kohane, Isaac S; Ramoni, Rachel B (2016-09-01). "SMART on FHIR: a standards-based, interoperable apps platform for electronic health records" (in en). Journal of the American Medical Informatics Association 23 (5): 899–908. doi:10.1093/jamia/ocv189. ISSN 1527-974X. PMID 26911829. PMC 4997036. https://academic.oup.com/jamia/article/23/5/899/2379865.
11. ↑ Mandl, Kenneth D.; Kohane, Isaac S. (2019-10-03). "Data standards may be wonky, but they will transform health care" (in en-US). https://www.statnews.com/2019/10/03/data-standards-wonky-transform-health-care/.
12. ↑ Mandl, Kenneth D.; Gottlieb, Dan; Mandel, Josh C. (2018-10-16). "Ensuring that the 21st Century Cures Act Health IT Provisions Promotes Interoperability and Data Exchange" (in en-US). https://thehealthcareblog.com/blog/2018/10/16/ensuring-that-the-21st-century-cures-act-health-it-provisions-promote-interoperability-and-data-exchange/.
13. ↑ "21st Century Cures Act: Interoperability, Information Blocking, and the ONC Health IT Certification Program". United States Department of Health and Human Services. 2020-05-01. https://www.federalregister.gov/documents/2020/05/01/2020-07419/21st-century-cures-act-interoperability-information-blocking-and-the-onc-health-it-certification.
14. ↑ 14.0 14.1 "Excelsior Pass Plus to be recognized out of state, internationally" (in en-US). 2021-08-05. https://www.wgrz.com/article/news/local/excelsior-pass-plus-to-be-recognized-out-of-state-internationally/71-434f8c6f-cbac-4d61-a732-ac0e0769efa3.
15. ↑ 15.0 15.1 15.2 Ingram, David (2022-01-13). "Quietly and over some objections, a national digital vaccine card has emerged" (in en). https://www.nbcnews.com/tech/tech-news/national-covid-vaccine-card-quietly-emerged-rcna11678.
16. ↑ 16.0 16.1 Kelleher, Suzanne Rowan (2021-09-11). "How To Get Digital Proof Of Your Vaccine Record — No Matter Where You Live" (in en). https://www.forbes.com/sites/suzannerowankelleher/2021/09/11/digital-proof-of-vaccine-record-usa/.
17. ↑ "Broad Coalition of Health and Technology Industry Leaders Announce Vaccination Credential Initiative to Accelerate Digital Access to COVID-19 Vaccination Records". 2021-01-14. https://www.mitre.org/news-insights/news-release/broad-coalition-health-and-technology-industry-leaders-announce.
18. ↑ Landi, Heather (2021-01-14). "Microsoft, Epic, Mayo Clinic join effort to accelerate digital COVID-19 vaccine records". https://www.fiercehealthcare.com/tech/microsoft-epic-and-mayo-clinic-join-effort-to-accelerate-digital-covid-19-vaccine-records.
19. ↑ Collier, Kevin (2021-06-18). "California rolls out digital vaccine verification — but don't call it a passport" (in en). https://www.nbcnews.com/tech/tech-news/california-rolls-digital-vaccine-verification-dont-call-passport-rcna1224.
20. ↑ "Digital Vaccine Record portal" (in en). https://myvaccinerecord.cdph.ca.gov/.
21. ↑ "Governor Cuomo Announces Launch of Excelsior Pass Plus to Support the Safe, Secure Return of Tourism and Business Travel" (in en). 2021-08-05. https://www.governor.ny.gov/news/governor-cuomo-announces-launch-excelsior-pass-plus-support-safe-secure-return-tourism-and.
22. ↑ "COVID-19 Information". 2021-08-27. https://lawallet.com/covid19/.
23. ↑ "Office of the Governor News Release: State Launches Hawai'i SMART Health Card for Digital Vaccination Certificate". 2021-09-08. https://governor.hawaii.gov/newsroom/office-of-the-governor-news-release-state-launches-hawaii-smart-health-card-for-digital-vaccination-verification/.
24. ↑ 24.0 24.1 Kelleher, Suzanne Rowan (2021-11-15). "How To Get Digital Proof Of Vaccination—And Why You’re Going To Need It More Often" (in en). https://www.forbes.com/sites/suzannerowankelleher/2021/11/15/digital-proof-of-vaccination-testing-smart-health-card-bindle/.
25. ↑ "Partners" (in en-US). https://vaccinecheck.us/partners/.
26. ↑ Mahmud, Aqil Haziq (2021-11-12). "Singaporeans hoping to return from US on VTL face challenges getting proof of COVID-19 jabs" (in en). https://www.channelnewsasia.com/singapore/us-vtl-singapore-vaccine-smart-health-card-2306361.
27. ↑ "ArriveCAN costs". 2022-10-24. https://www.cbsa-asfc.gc.ca/agency-agence/reports-rapports/fs-ef/2022/acc-cac-eng.html.
28. ↑ Osman, Laura (2021-10-21). "Feds, provinces agree on vaccine passport for domestic, international travel: PM". CP24. The Canadian Press. https://www.cp24.com/news/feds-provinces-agree-on-vaccine-passport-for-domestic-international-travel-pm-1.5632766.
29. ↑ "Proof of vaccination". 2021-12-24. https://www2.gov.bc.ca/gov/content/covid-19/vaccine/proof.
30. ↑ "Apple Wallet Update Now Compatible with Ontario Vaccine Certificate". 2021-10-29. https://news.ontario.ca/en/release/1001080/apple-wallet-update-now-compatible-with-ontario-vaccine-certificate.
31. ↑ "Accessing your COVID-19 Vaccination Record with QR Code from your mobile device". https://www.ehealthsask.ca/MySaskHealthRecord/MySaskHealthRecord/Pages/QRCodeC19Mobile.aspx.
32. ↑ "Sample proof of vaccination credential". 2021-11-17. https://yukon.ca/sites/yukon.ca/files/hss/hss-imgs/hss-sample-credential.pdf.
33. ↑ "AIRA, IIS and VCI/Smart Health Cards Support". 2021-10-13. https://repository.immregistries.org/files/resources/616f2c8063257/aira_statement_of_support_smart_health_cards_final.pdf.
34. ↑ "Events". https://vci.org/events.
35. ↑ "Meeting Notes: Health Information Technology Advisory Committee (HITAC)". 2021-10-13. https://www.healthit.gov/sites/default/files/facas/2021-10-13_HITAC_Meeting_Notes_508.pdf.
36. ↑ Takahara, Kanako (2021-12-20). "Japan has released its digital vaccine passport. Here's what you need to know." (in en). https://www.japantimes.co.jp/news/2021/12/20/national/japan-digital-vaccine-passport-app-explainer/.
37. ↑ "COVID-19 vaccination certificate" (in ja, en). https://www.mhlw.go.jp/stf/covid-19/certificate.html.
38. ↑ "About CHIP". https://www.chip.org/.
39. ↑ Denning, Paul (2021-11-24). "SMART Health Cards - Vaccination and Testing IG Project Page". https://confluence.hl7.org/display/PHWG/SMART+Health+Cards+-+Vaccination+and+Testing+IG+Project+Page.
40. ↑ Johnson, David (2023-04-13). "Public Health Work Group". https://confluence.hl7.org/display/PHWG/Public+Health+Work+Group.
41. ↑ "Issuers". https://vci.org/issuers.
42. ↑ "SMART Health Issuers". https://smarthealth.cards/en/issuers.html.
43. ↑ "SMART Health Card Registry" (in en-US). https://www.commontrustnetwork.org/verifier-list.

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