Adoption and implementation of the Health Level Seven (HL7) Fast Healthcare Interoperability Resources (FHIR) standard in health IT is steadily progressing, according to a blog post from leaders at the Office of the National Coordinator for Health Information Technology (ONC).
The post, penned by Steven Posnack, executive director of the Office of Technology, and Wes Barker, noted that using CMS (the Centers for Medicare & Medicaid Services) and ONC data, the health IT agency analyzed how health IT developers used FHIR to meet 2015 Edition certification requirements. Additionally, they assessed how hospitals and clinicians’ access to 2015 Edition certified-APIs vary across the U.S. Based on this analysis, they found:
- Approximately 32 percent of certified health IT vendors said that they are using FHIR, specifically the “FHIR Release 2” API (application programming interface) standard.
- Nearly 51 percent of health IT developers appear to be using a version of FHIR combined with the OAuth 2.0 standard
As the ONC officials pointed out, while the 32 percent figure may seem “low” at face value, the estimated market share of the health IT developers using FHIR is large. They explained that the 10 certified health IT vendors with the largest market share across hospitals and clinicians (eligible for participation in the CMS Promoting Interoperability Programs)—and which encompass about 82 percent of hospitals and 64 percent of clinicians—all use at least the FHIR Release 2 as their API standard. These vendors include some of the biggest industry names such as Epic, Cerner, Allscripts, athenahealth, and others.
As such, overall, of the hospitals and Merit-based Incentive Payment System (MIPS) eligible clinicians that use certified products, ONC found that almost 87 percent of hospitals and 69 percent of MIPS-eligible clinicians are served by health IT developers with products certified to any FHIR version. When estimated for just FHIR Release 2, the hospital percentage remains the same while the clinician percentage drops a bit to 57 percent.
Background
In 2015, ONC issued the 2015 Edition certification criteria that included functional API certification criteria, but no specific standards were required for the API. Just prior to that, The Argonaut Project kicked off as a market-driven FHIR accelerator to develop industry consensus around a set of FHIR Release 2 implementation specifications that could be used to meet the 2015 Edition’s API certification criteria.
Today, many companies have gone into production with FHIR Release 2 profiled according to the Argonaut implementation specifications. Apple (with a FHIR-based “client” app) may be the most notable, but there are indications that many other big tech companies are also planning to use the standard, the ONC blog stated.
What’s more, CMS has reaffirmed in its rules affecting the Promoting Interoperability Programs (formerly known as the EHR Incentive Programs) that the 2015 Edition will be required in 2019. Also, CMS has also invested in FHIR through its own Blue Button 2.0
In a responding statement to the ONC analysis, Blair Childs, senior vice president of public affairs at the Charlotte, N.C.-based Premier, Inc., noted that while it’s promising that many app developers appear to be coalescing around developing consumer apps using FHIR, “we urge the administration to prioritize achieving a similar degree of development across provider-facing applications. These applications will support providers with predictive analytics, clinical decision support and other workflow technologies.”
Childs’ statement continued, “A strict focus on consuming-facing apps provides a limited view into the state of interoperability. It gives false hope of reaching the tipping point for free and unencumbered data exchange in healthcare. The reality is that we are nowhere near reaching our goal of a data-enabled health system. We need an immediate focus not just on consumer-facing technologies, but on those relied on by the provider community as well. This is why we continue to press for the timely implementation of 21st Century Cures Act interoperability and data standards provisions.”
Childs added, “Until all data is unlocked from EHRs and integrated into clinical workflows, we will continue to face walled gardens of vital information.”
ONC’s Posnack and Barker admitted themselves in the post, “While these data are encouraging, it’s not time to pop any champagne. Industry-wide, much work remains from standards development to implementation.”
