Market Leaders Drive Certified Health IT FHIR-Enabled API Adoption

Health IT market leaders drove much of FHIR-enabled API adoption in 2019, according to new ONC analysis.

As of 2019, 84 percent of hospitals and 61 percent of clinicians had adopted and implemented 2015 Edition certified API technology enabled with FHIR.

Researchers found that 83 percent of hospitals and 58 percent of clinicians adopted certified API technology from a market leader in 2019, representing 99 percent and 95 percent of all FHIR-enabled technology implementations, respectively.

“The findings show that health IT market leaders, who all support FHIR, drove much of the adoption of certified API technology enabled with FHIR in 2019,” Steven Posnack, MS, MHS, deputy National Coordinator for Health Information Technology and Wes Barker, MS, HHS program analyst, wrote in an ONC Health IT Buzz blog post.

These observed API adoption rates came very close to ONC forecasting.

In 2018, ONC estimated that 87 percent of hospitals and 69 percent of clinicians possessed certified technology with a FHIR-enabled 2015 Edition version. These rates did not serve as a prediction, ONC said, but rather an estimated upper bound of who could upgrade their certified technology to a FHIR-enabled 2015 Edition version in 2019.

The ONC analysis revealed that 97 percent of hospitals and 88 percent of clinicians whom it predicted could adopt this technology in 2018 did so in 2019.

Additionally, ONC found that 91 percent of hospitals and 72 percent of clinicians have adopted or could adopt 2015 Edition certified technology enabled with FHIR, a small rise from the 2018 estimate.

This means that in addition to the hospitals and clinicians that adopted technology in 2019, another 7 percent of hospitals and 11 percent of clinicians could potentially upgrade to 2015 Edition certified technology enabled with FHIR through their current health IT vendor.

While the adoption of FHIR-enabled technology is widespread across the country, the analysis found that hospitals in some regions lag behind, such as the southwest and mountain west. Clinician FHIR adoption is also behind the national adoption average in the mountain west.

The 2020 ONC Cures Act Final Rule requires the use of FHIR Release 4 as part of the new certification criterion adopted at 45 CFR 170.315(g)(10), Standardized API for Patient and Population Services.

Additionally, the API Condition and Maintenance of Certification at 45 CFR 170.404(b)(3) requires software developers with health IT previously certified for technical API conformance to provide all customers with upgraded API technology certified to this new certification criterion by December 31, 2022.

“The good news is that while upgrades from FHIR Release 2 to Release 4 are likely to be necessary across many installations, many certified API developers and all health IT market leaders already support the FHIR standard,” Posnack and Barker explained.

“This means that third-party developers are able to connect to these providers’ EHRs using standardized FHIR APIs and health information can flow using the data standard,” they continued. “Not all providers adopted and implemented certified API technology enabled with FHIR in 2019, but, for those who did, the results are encouraging.”

ONC expects the rates of FHIR-enabled certified API technology adoption to continue to rise as more clinicians and hospitals implement the 2015 Edition Cures Update.

“The data show that a majority of health care providers have deployed these standards-based technologies, and we project that more will soon follow,” Posnack and Barker concluded. “Efforts to expand use of FHIR among data and technology users should be encouraged by this data.”