A landscape survey of planned SMART/HL7 bulk FHIR data access API implementations and tools

Abstract

The Office of National Coordinator for Health Information Technology final rule implementing the interoperability and information blocking provisions of the 21st Century Cures Act requires support for two SMART (Substitutable Medical Applications, Reusable Technologies) application programming interfaces (APIs) and instantiates Health Level Seven International (HL7) Fast Healthcare Interoperability Resources (FHIR) as a lingua franca for health data. We sought to assess the current state and near-term plans for the SMART/HL7 Bulk FHIR Access API implementation across organizations including electronic health record vendors, cloud vendors, public health contractors, research institutions, payors, FHIR tooling developers, and other purveyors of health information technology platforms. We learned that many organizations not required through regulation to use standardized bulk data are rapidly implementing the API for a wide array of use cases. This may portend an unprecedented level of standardized population-level health data exchange that will support an apps and analytics ecosystem. Feedback from early adopters on the API’s limitations and unsolved problems in the space of population health are highlighted.

GARDE: a standards-based clinical decision support platform for identifying population health management cohorts

“…Currently, the FHIR Bulk Data Access standard has some limitations, such as not yet being available for production use in many EHR platforms and having limited capabilities for restricting the scope of the extracted resources (eg, an inability to limit the extraction to specified lab results as opposed to all lab results). Nevertheless, with increasing capabilities being specified and emerging EHR vendor support underway, 31 we plan to explore supporting FHIR Bulk Data Access in an upcoming release.…”

Pathling: analytics on FHIR

“…The Import Operation is designed to accept data that has been extracted from systems through the HL7 FHIR Bulk Data Access interface [19]. This specification is achieving rapid implementation within vendor implementations [20], providing a standard way of sharing bulk data with other systems, including analytics tools. This operation is also based upon the Draft Bulk Import Implementation Guide [21], an effort by the FHIR community to design a standard operation for the efficient import of large data sets.…”

Four “E”s to speed adoption of mHealth and promote cardiovascular behavioral medicine.

“…Seamless and secure transfer of patient-collected data into the EHR will be critical for adoption and effective use of mHealth for 2 cardiovascular behavioral medicine (Murphy et al, 2021). Toward that goal, the 2019 Federal Stage III "meaningful use" requirements for EHR certification called for greater interoperability with external devices and software through an open data-exchange standard called Fast-Health care Interoperability Resources (FHIR; Jones et al, 2021). As envisioned, FHIR will enable output from third-party mHealth apps and devices to integrate into routine EHR workflows without exporting data directly into these system's database.…”