Abstract
The 21st Century Cures Act requires that certified health information technology have an application programming interface (API) giving access to all data elements of a patient’s electronic health record, “without special effort”. In the spring of 2020, the Office of the National Coordinator of Health Information Technology (ONC) published a rule—21st Century Cures Act Interoperability, Information Blocking, and the ONC Health IT Certification Program—regulating the API requirement along with protections against information blocking. The rule specifies the SMART/HL7 FHIR Bulk Data Access API, which enables access to patient-level data across a patient population, supporting myriad use cases across healthcare, research, and public health ecosystems. The API enables “push button population health” in that core data elements can readily and standardly be extracted from electronic health records, enabling local, regional, and national-scale data-driven innovation.
Highlights
A new Department of Health and Human Services rule[1], implementing health information technology provisions of the21st Century Cures Act, has potential to greatly accelerate the use of population data at health-system scale
Designed to handle large datasets, the SMART/HL7 FHIR Bulk Data Access application programming interface (API) is an asynchronous request framework with multiple operations controlled via parameters that leverage a standardized system-to-system authorization framework—SMART Backend Services Authentication and Authorization[13]
The original SMART on FHIR project took nearly 11 years from the initial proposal of an open and universal healthcare API10 to being instantiated in the ONC Final Rule[1]. It was only a few months after the initial kickoff that CMS was piloting FHIR bulk data for provisioning claims to ACOs, and just over 2 years before the API was required under the Department of Health and Human Services regulations
Summary
Designed to handle large datasets, the SMART/HL7 FHIR Bulk Data Access API is an asynchronous request framework with multiple operations controlled via parameters that leverage a standardized system-to-system authorization framework—SMART Backend Services Authentication and Authorization[13]. The Beneficiary Claims Data API (https://bcda.cms.gov/), provides accountable care organizations that participate in a Shared Savings Program access to specific Medicare claims data, in bulk FHIR format, for their assignable/prospectively assigned beneficiaries. On the basis of these commitments for support, we anticipate that healthcare providers and payors, working with technology vendors, will make testing endpoints available over the 12 months, allowing for feedback ahead of the 2022 regulatory deadline for support During this same time period, the Argonaut Project has undertaken to consolidate feedback and propose API improvements in the form of a “v1.5” release of the Bulk Data IG. There is substantial community interest in defining a robust $import operation and standard analytic approaches along with associated reference implementations
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