TY - JOUR
T1 - Real world performance of the 21st Century Cures Act population-level application programming interface
AU - SMART Cumulus Network
AU - Jones, James R.
AU - Gottlieb, Daniel
AU - McMurry, Andrew J.
AU - Atreja, Ashish
AU - Desai, Pankaja M.
AU - Dixon, Brian E.
AU - Payne, Philip R.O.
AU - Saldanha, Anil J.
AU - Shankar, Prabhu
AU - Solad, Yauheni
AU - Wilcox, Adam B.
AU - Ali, Momeena S.
AU - Kang, Eugene
AU - Martin, Andrew M.
AU - Sprouse, Elizabeth
AU - Taylor, David E.
AU - Terry, Michael
AU - Ignatov, Vladimir
AU - Mandl, Kenneth D.
N1 - Publisher Copyright:
# The Author(s) 2024. Published by Oxford University Press on behalf of the American Medical Informatics Association.
PY - 2024/5/1
Y1 - 2024/5/1
N2 - Objective: To evaluate the real-world performance of the SMART/HL7 Bulk Fast Health Interoperability Resources (FHIR) Access Application Programming Interface (API), developed to enable push button access to electronic health record data on large populations, and required under the 21st Century Cures Act Rule. Materials and Methods: We used an open-source Bulk FHIR Testing Suite at 5 healthcare sites from April to September 2023, including 4 hospitals using electronic health records (EHRs) certified for interoperability, and 1 Health Information Exchange (HIE) using a custom, standards-compliant API build. We measured export speeds, data sizes, and completeness across 6 types of FHIR. Results: Among the certified platforms, Oracle Cerner led in speed, managing 5-16 million resources at over 8000 resources/min. Three Epic sites exported a FHIR data subset, achieving 1-12 million resources at 1555-2500 resources/min. Notably, the HIE’s custom API outperformed, generating over 141 million resources at 12 000 resources/min. Discussion: The HIE’s custom API showcased superior performance, endorsing the effectiveness of SMART/HL7 Bulk FHIR in enabling large-scale data exchange while underlining the need for optimization in existing EHR platforms. Agility and scalability are essential for diverse health, research, and public health use cases. Conclusion: To fully realize the interoperability goals of the 21st Century Cures Act, addressing the performance limitations of Bulk FHIR API is critical. It would be beneficial to include performance metrics in both certification and reporting processes.
AB - Objective: To evaluate the real-world performance of the SMART/HL7 Bulk Fast Health Interoperability Resources (FHIR) Access Application Programming Interface (API), developed to enable push button access to electronic health record data on large populations, and required under the 21st Century Cures Act Rule. Materials and Methods: We used an open-source Bulk FHIR Testing Suite at 5 healthcare sites from April to September 2023, including 4 hospitals using electronic health records (EHRs) certified for interoperability, and 1 Health Information Exchange (HIE) using a custom, standards-compliant API build. We measured export speeds, data sizes, and completeness across 6 types of FHIR. Results: Among the certified platforms, Oracle Cerner led in speed, managing 5-16 million resources at over 8000 resources/min. Three Epic sites exported a FHIR data subset, achieving 1-12 million resources at 1555-2500 resources/min. Notably, the HIE’s custom API outperformed, generating over 141 million resources at 12 000 resources/min. Discussion: The HIE’s custom API showcased superior performance, endorsing the effectiveness of SMART/HL7 Bulk FHIR in enabling large-scale data exchange while underlining the need for optimization in existing EHR platforms. Agility and scalability are essential for diverse health, research, and public health use cases. Conclusion: To fully realize the interoperability goals of the 21st Century Cures Act, addressing the performance limitations of Bulk FHIR API is critical. It would be beneficial to include performance metrics in both certification and reporting processes.
KW - computerized
KW - health information interoperability
KW - health information systems
KW - medical informatics
KW - medical records systems
KW - public health informatics
UR - http://www.scopus.com/inward/record.url?scp=85190952634&partnerID=8YFLogxK
U2 - 10.1093/jamia/ocae040
DO - 10.1093/jamia/ocae040
M3 - Article
C2 - 38447593
AN - SCOPUS:85190952634
SN - 1067-5027
VL - 31
SP - 1144
EP - 1150
JO - Journal of the American Medical Informatics Association
JF - Journal of the American Medical Informatics Association
IS - 5
ER -