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.
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McKesson Technology - CDS
See the training materials at https://github.com/Mckesson-cds/simplifier-training
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Welcome to the ACME corporation, where we make the best, and we mean the best, and the most reliablest of all products!
(**note**: this is a fake organisation for demonstration purposes only)
Here you can give an overview of your organization and point to all relevant FHIR links and procedures.
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Surescripts & 174;
The Nation's Most Trusted and Capable Health Information Network
For 20 years, we've served the nation with an industrial-strength health information network desgined to increase safety, lower costs and improve quality.
The Surescripts Network Alliance & 174;
The Surescripts Network Alliance unites virtually all electronic health records (EHR) vendors, pharmacy benefit managers (PBMs), pharmacies and clinicians,
plus an increasing number of health plans, long-term and post-acute care organizations, specialty hubs and specialty pharmacy organizations.
The Surescripts network
Every Surescripts solution–and every Surescripts Network Alliance participant–benefits from the industy–leading readability,
security and scalability of the Surescripts network.
For more information, see [surescripts.com](https://surescripts.com)
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The National Committee for Quality Assurance (NCQA).
WHY WE’RE HERE
* Our Mission: Improve the quality of health care.
* Our Vision: Better health care. Better choices. Better health.
NCQA:
* Points the way to health care that science says works.
* Studies how well health plans and doctors provide scientifically recommended care.
* Identifies organizations that are run in ways that make care better.
OUR WORK:
* Saves thousands of lives.
* Helps millions of people stay healthy.
* Saves the country billions of dollars.
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Local FHIR Test
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test
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Mapping HL7 v2 to FHIR STU3
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Formuarly IG
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Something important
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ELLKAY FHIR Profile
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Derived profiles from the ACME Base project explaining the creation and use of FHIR packages.
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This is a project for the Surescripts Health Information Network Interconnect FHIR guide.
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Aligning mCODE cancer data with the CMS Enhancing Oncology Model
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Deep 6 AI Inc FHIR IG
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The US Core Implementation Guide is based on FHIR Version R4 and defines the minimum conformance requirements for accessing patient data. The Argonaut pilot implementations ONC 2015 Edition Common Clinical Data Set (CCDS) and ONC U.S. Core Data for Interoperability (USCDI) v1 provided the requirements for this guide. The prior Argonaut search and vocabulary requirements based on FHIR DSTU2 are updated in this guide to support FHIR Version R4. This guide was used as the basis for further testing and guidance by the Argonaut Project Team to provide additional content and guidance specific to Data Query Access for purpose of ONC Certification testing. These profiles are the foundation for future US Realm FHIR implementation guides. In addition to Argonaut they are used by DAF-Research QI-Core and CIMI. Under the guidance of HL7 and the HL7 US Realm Steering Committee the content will expand in future versions to meet the needs specific to the US Realm. These requirements were originally developed balloted and published in FHIR DSTU2 as part of the Office of the National Coordinator for Health Information Technology (ONC) sponsored Data Access Framework (DAF) project. For more information on how DAF became US Core see the US Core change notes. (built Wed Jun 22 2022 19 44+0000+00 00)
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A project from ACME Corp for a specific use case building on the R4 ACME Base Profiles
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ACME project explaining the creation and use of FHIR profiles using Forge and Simplifier. Mainly used in DevDays 'Let's Build!' workshops.
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ACME Base Profiles R4
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A cowboy and his favorite hat in FHIR Shorthand
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ACME Base Profiles that ACME projects and products can build upon.
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PACIO Re-Assessment Timepoints Implementation Guide (built Wed Sep 28 2022 16 27+0000+00 00)
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The Da Vinci Fast Healthcare Interoperability Resource (FHIR) Risk Adjustment Implementation Guide (this IG) describes exchange of risk-based coding gaps among stakeholders such as payers providers and government care programs in support of driving towards accurate and complete documentation of health conditions that would lead to more accurate risk-adjustment payment calculations. (built Wed Feb 19 2025 15 09+0000+00 00)
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Definition of the Dallas Cowboy
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This is a project for the Surescripts Health Information Network Interconnect FHIR guide.
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