This overview is based on the insights gathered from the DevDays 2024 State of FHIR survey, with a comparison to the 2023 survey to highlight the progress and changes.

Regulation

The United States has made significant strides in regulating the use of FHIR standards within electronic health data exchange. The pivotal Health Data, Technology, and Interoperability: Certification Program Updates, Algorithm Transparency, and Information Sharing (HTI-1) Final Rule mandates the use of FHIR, with a compliance deadline now extended to December 31, 2025, reflecting updated regulatory timelines from the previous 2022 deadline. The enforcement of these regulations is bolstered by substantial funding opportunities such as the LEAP Grants, TEFCA, and various cooperative agreements between ONC and HL7. These efforts are closely monitored by the Office of the National Coordinator for Health IT (ONC) and other agencies like CMS and CDC, ensuring a broad and effective implementation across sectors.

Adoption

FHIR's adoption in the United States is progressing robustly, particularly as the primary standard for electronic health data exchange. The prevalent use of FHIR R4 showcases a strong commitment to keeping up with recent specifications and updates. Importantly, the expected rate of FHIR adoption has increased from a score of 3 in 2023 to a more optimistic 4 in 2024, indicating growing confidence and momentum in the healthcare community. Main adopters continue to include care providers, insurers, EHR vendors, and app developers, all contributing to a dynamic ecosystem poised for further expansion.

Authoritative Bodies

Key authoritative bodies governing the FHIR landscape in the United States include the Office of the National Coordinator for Health IT (ONC) and the HL7 US Realm Steering Committee. These entities play crucial roles in certifying health IT and mandating the use of FHIR through comprehensive regulations and incentivizing programs.

Relevant Institutes

Organizations such as HL7 International and various research institutes are integral in driving FHIR implementation forward. Specific contributors mentioned include Brett Marquard from HL7 and Matt Rahn from HHS/ONC, illustrating the collaborative efforts between public and private sectors to harness the potential of FHIR.

National Standards Development

The United States boasts a robust national standards development framework anchored by the widely adopted US Core 7.0.0 and the USCDI. These core models serve as the foundation for numerous specific FHIR standards, which are meticulously derived to suit various use cases, ensuring coherence and interoperability across the healthcare system. The development of these standards is ongoing, reflecting the dynamic nature of health IT requirements.

Terminology Usage

Terminology within FHIR in the United States is highly standardized, adhering to national data models and implementation guides. This standardization is critical for ensuring interoperability and facilitating seamless data exchange between different healthcare systems and applications.

Infrastructure

The infrastructure supporting FHIR in the United States is extensive, featuring regional and national frameworks that healthcare providers and technology vendors can integrate with. Participation in these networks often requires adherence to specific technical and regulatory standards, ensuring consistency and reliability in data exchange processes. The National Infrastructure includes significant initiatives like TEFCA, providing a cohesive strategy for broad interoperability.

FHIR Implementation

The main parties adopting FHIR in the United States remain consistent, encompassing care providers, insurers, EHR vendors, and app developers. Main drivers for adoption include regulation, grants, improved care, and innovation. Challenges such as high investment costs, unclear benefits, and a lack of FHIR knowledge persist, but the landscape remains optimistic with a notable increase in the expected rate of adoption.

Specific Techniques

Detailed insights from the 2024 survey highlight the widespread use of SMART on FHIR and FHIR Rest API, which are rated highly among adopters. Other techniques such as CDS Hooks, FHIR Bulk Data, and FHIRcast show varied levels of implementation, indicating areas of growth and improvement within the community.

Additional Information

Patient advocacy remains a critical aspect of healthcare data availability, although not specifically focused on FHIR. Successful use cases, particularly in patient and provider access via apps, continue to demonstrate improvements in cost efficiency, healthcare outcomes, and information accessibility.

In conclusion, the state of FHIR in the United States reflects a solid framework of regulation, adoption, and infrastructure, underscored by collaborative efforts from key national organizations and stakeholders. With ongoing enhancements and a forward-looking approach, the FHIR ecosystem in the U.S. is well-positioned to drive significant advancements in healthcare interoperability and innovation.

This summary presents the current state of Fast Healthcare Interoperability Resources (FHIR) in the United States of America based on the HL7 FHIR DevDays 2024 State of FHIR survey results provided by Matt Rahn of Health and Human Services/Office of the National Coordinator for Health Information Technology and HL7 US Realm Steering Committee Co-Chair Brett Marquard. Additional background was added based on the answers to the HL7 FHIR DevDays State of FHIR survey 2023 by Realm Steering Committee Co-chairs Brett Marquard and Steve Posnack.