ONC Showcases Federal Agency Progress on API Usage

Dec. 2, 2020
Director Don Rucker, M.D., points to potential of bulk FHIR standard to transform measurement of value in healthcare

In a year-end meeting on Dec. 1, the Office of the Coordinator for Health IT hosted presentations from across the federal government to demonstrate how momentum is building for the use of the FHIR standard and application programming interfaces (APIs).

Don Rucker, M.D., the national coordinator, began the meeting by suggesting that the healthcare sector in general should give itself a collective pat on the back for the progress made over the past few years to develop interoperability standards and put them into regulations. He said he is particularly excited about bulk FHIR standards for transferring population-level data. An example might be if providers want to access claims data to see care patients are receiving outside the network. To bring that data into the EHR, it would be beneficial to be able to pull in bulk data from claims.

“We will finally have the data substrates for a learning healthcare system,” Rucker said. “It is very exciting.” He said bulk FHIR capabilities would allow for new ways to assess value in healthcare. “We can go with rich data sets rather than narrowly defined quality measures – the best we could do before.” Rucker said it would allow for integrating clinical and financial data in a single stream. “We can’t look in the mirror and say we are doing a great job on value when the data streams don't even meet. And rather than cumbersome prior authorization requirements, we are going to have these decisions adjudicated in real time in a fully computable way.” He said there also is progress on read/write APIs as well as using APIs and health information exchanges to make public health data sharing easier.

Amy Abernethy, M.D., Ph.D., the Food & Drug Administration’s principal deputy commissioner and acting CIO, gave a presentation about how the FDA is working to modernize its infrastructure for the submission and review of regulatory data from the pharmaceutical industry. She described how currently companies submit potential safety issues about investigational drugs via PDF and that clinical reviewers click through these files as they try to determine whether regulatory action should be taken. They keep track of this work using sticky notes or Excel files, she said. The new system will allow reviewers to take advantage of new tools to track reports. “It will allow us to have scalable processes across all those reports submitted, she said, adding that APIs are key to future IT infrastructure planning at the FDA.

Jude Soundararajan, executive director of health information technology at the  Social Security Administration said that SSA, in its disability determination work is testing the USCDI with partners as available and making recommendations for future enhancement. “We are evaluating the potential to make more accurate and timely disability decisions. We are exploring all options. That would include enabling FHIR throughout our partner network and creating a portal to ingest data from consumers.”

Paula Braun, entrepreneur-in-residence at the Centers for Disease Control and Prevention, described work on SimpleReport, a free tool that makes it easy for COVID-19 testing sites to record results for rapid point-of-care tests and quickly report required data to public health departments. The tool, which just went live, was built by the CDC in partnership with the U.S. Digital Service.

Gil Alterovitz, Ph.D., director of artificial intelligence at the National Artificial Intelligence Institute at the Department of Veterans Affairs, spoke about the 2020-2021 AI Tech Sprint, centered around interventions for veterans not currently served by the Department of Veterans Affairs. The sprint is a 12-week engagement designed to foster collaboration with industry and academic partners by iteratively designing an AI-enabled tool that leverages federal data to address a need for veterans.

Finally, Patricia Flatley Brennan, R.N., Ph.D., director of the National Library of Medicine, outlined how the National Institutes of Health (NIH)  has signaled the importance of FHIR and APIs. Last year NIH issued a notice encouraging all investigators to make use of the FHIR standard to accelerate the use of clinical data for research and to promote integration and reuse of data collected during primary investigations.

Brennan said NIH is stimulating FHIR applications through contracts and grants that support the development of FHIR-enabled Red Cap resources and Phenopackets on FHIR. Future developments include VSAC-on-FHIR (the Value Set Authority Center) and extended applications for research.

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