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Healthcare management and treatment decisions are complex, with uncertain tradeoffs for patients and evolving evidence and guidelines for providers. For patients with multiple chronic conditions and those suffering from chronic pain, the challenges are more complex. This panel will discuss the development and implementation of three SMART on FHIR applications and will detail the development and implementation trade-offs and stewardship considerations needed to move from the sandbox environment to the test and production environments in these real-world settings. The objectives of the presentation are to understand the complex challenges health systems face in integrating shareable SMART on FHIR applications, to evaluate the potential pitfalls and barriers to standards-based approaches for developing and implementing CDS using FHIR resources, and to assess the advantages for interoperability and knowledge sharing using the FAIR principles and the CDS five rights based on the progress in the areas of CDS and FHIR based applications.