Tutorial: Azure Active Directory SMART on FHIR Proxy

SMART on FHIR is a set of open specifications to integrate third-party applications with FHIR servers and electronic medical records systems that have FHIR interfaces. One of the main purposes of the specifications is to describe how an application should discover authentication endpoints for a FHIR server and initiate an authentication sequence. Authentication is based on OAuth2, but since SMART on FHIR uses parameter naming conventions that are not immediately compatible with Azure Active Directory, the Azure API for FHIR has a built-in Azure Active Directory SMART on FHIR proxy that enables a subset of the SMART on FHIR launch sequences, specifically the EHR launch.

This tutorial describes how to use the proxy to enable SMART on FHIR applications with the Azure API for FHIR.


Configure Azure AD registrations

SMART on FHIR requires that the Audience has an identifier URI equal to the URI of the FHIR service. The standard configuration of the Azure API for FHIR uses an Audience of https://azurehealthcareapis.com. Suppose that the URI for your Azure API for FHIR is https://MYFHIRAPI.azurehealthcareapis.com, you need to configure a resource application registration with that identifier URI.

After setting up a resource application, you also need a client application registration. Most SMART on FHIR applications are single page javascript applications, and therefore you should follow the instructions for configuring a public Azure Active Directory client application.

After completing these steps, you should have:

  1. A resource application with identifier URI https://MYFHIRAPI.azurehealthcareapis.com, where MYFHIRAPI is the name of your Azure API for FHIR instance.
  2. A public client application registration. Make a note of the application id for this client application.

Enable SMART on FHIR proxy

The SMART on FHIR proxy can be enabled in the Authentication settings for your Azure API for FHIR instance:

Enable SMART on FHIR Proxy

Change the Audience to match the URI of your FHIR API and check the SMART on FHIR proxy checkbox.

Enable cross origin resource sharing (CORS)

Since most SMART on FHIR applications are single page javascript apps, you will need to enable CORS for the Azure API for FHIR:

Enable CORS

Configure reply URL

The SMART on FHIR proxy acts as an intermediary between the SMART on FHIR app and Azure Active Directory. Consequently, the authentication reply (the authentication code) must go to the SMART on FHIR proxy instead of the app itself. The proxy will forward it to the app. Because of this two-step relay of the authentication code, you will need to set the reply URL (callback) for your Azure AD client application to a URL that is a combination of the SMART on FHIR proxy reply URL and the reply URL of the SMART on FHIR app. The combined reply URL takes the form:


where aHR0cHM6Ly9sb2NhbGhvc3Q6NTAwMS9zYW1wbGVhcHAvaW5kZXguaHRtbA is a URL safe base64 encoded version of the SMART on FHIR app reply URL. For the SMART app launcher, when running locally, the reply URL of the app is https://localhost:5001/sampleapp/index.html, you can generate the combined reply URL with a script like:

$replyUrl = "https://localhost:5001/sampleapp/index.html"
$fhirServerUrl = "https://MYFHIRAPI.azurewebsites.net"
$bytes = [System.Text.Encoding]::UTF8.GetBytes($ReplyUrl)
$encodedText = [Convert]::ToBase64String($bytes)
$encodedText = $encodedText.TrimEnd('=');
$encodedText = $encodedText.Replace('/','_');
$encodedText = $encodedText.Replace('+','-');

$newReplyUrl = $FhirServerUrl.TrimEnd('/') + "/AadSmartOnFhirProxy/callback/" + $encodedText

Add this reply URL to the Azure Active Directory public client application that you created earlier:

Configure reply URL

Get test patient

To test the Azure API for FHIR and the SMART on FHIR proxy, you'll need to have at least one patient in the database. If you have not interacted with the API yet and you don't have data in the database, follow the FHIR API Postman tutorial to load a patient. Make a note of an id of a specific patient.

Download SMART launch application

The open-source FHIR server for Azure repository includes a simple SMART on FHIR app launcher and a sample SMART on FHIR app. In this tutorial, use can run this SMART on FHIR launcher locally to test the setup.

You can clone the GitHub repository and navigate to the application with:

git clone https://github.com/Microsoft/fhir-server
cd fhir-server/samples/apps/SmartLauncher

The application needs a few configuration settings, which you can set in appsettings.json:

    "FhirServerUrl": "https://MYFHIRAPI.azurehealthcareapis.com",
    "ClientId": "APP-ID",
    "DefaultSmartAppUrl": "/sampleapp/launch.html"

You can also (recommended) use the dotnet user-secrets feature:

dotnet user-secrets set FhirServerUrl https://MYFHIRAPI.azurehealthcareapis.com
dotnet user-secrets set ClientId <APP-ID>

Run the application with:

dotnet run

Test the SMART on FHIR proxy

After starting the SMART on FHIR app launcher, you can point your browser to https://localhost:5001, where you should see the following screen:

SMART on FHIR app launcher

When you enter Patient, Encounter, or Practitioner information, you will notice that the Launch context is updated. When using the Azure API for FHIR, the launch context is simply a JSON document containing information about patient, practitioner, etc. This launch context is base64 encoded and passed to the SMART on FHIR app as the launch query parameter. According to SMART on FHIR specification, this variable is opaque to the SMART on FHIR app and passed on to the identity provider. The Azure API for FHIR SMART on FHIR proxy uses this information to populate fields in the token response. These fields can be used by the SMART on FHIR app to control which patient it requests data for and how it renders the application on the screen. SMART on FHIR proxy supports the following fields:

  • patient
  • encounter
  • practitioner
  • need_patient_banner
  • smart_style_url

These fields are meant to provide guidance to the app, but they don't convey any security information and can be ignored by a given SMART on FHIR application.

You will notice that the SMART on FHIR app launcher updates the Launch URL at the bottom of the page. Hit Launch to start the sample app and you should see something like:


Inspect the token response to see how the launch context fields are passed on to the app.

Next steps

In this tutorial, you've configured the Azure Active Directory SMART on FHIR proxy. To explore the use of SMART on FHIR applications with the Azure API for FHIR and the open-source FHIR server for Azure, explore the FHIR server samples repository on GitHub.