By Kate Monica

October 05, 2018 - Nearly a third of EHR vendors are using the Fast Healthcare Interoperability Resources (FHIR) standard to meet 2015 Edition certification requirements, according to ONC officials.

FHIR is an internet-based standard developed and maintained by HL7. The standard is designed to connect different discrete data elements.

Allscripts, athenahealth, CPSI, Cerner, eClinicalWorks, Epic, MEDITECH, and GE are among the EHR vendors currently offering health IT products that utilize the health data exchange standard.

While only a fraction of EHR vendors use FHIR to meet the application programming interface (API) capability requirements part of the ONC Health IT Certification Program, the vendors that do use the standard hold the majority of the market share.

About 82 percent of hospitals and 64 percent of clinicians eligible for participation in the CMS Promoting Interoperability (PI) Programs use certified health IT products from vendors that use FHIR.

According to data from ONC and CMS, the highest percentage of hospitals — 21 percent — fulfill federal reporting requirements using CEHRT from Epic or Cerner. MEDITECH ranks as the second-most frequently used EHR vendor among eligible clinicians at 20 percent.

“Overall, of the hospitals and Merit-based Incentive Payment System (MIPS) eligible clinicians that use certified products, we find that almost 87% of hospitals and 69% of MIPS eligible clinicians are served by health IT developers with product(s) certified to any FHIR version,” wrote Director of the Office of Standards and Technology Steve Posnack and HHS program analyst Wes Barker in an ONC blogpost.

“When estimated for just FHIR Release 2, the hospital percentage remains the same while the clinician percentage drops a bit to 57%,” the duo added.

According to an infographic provided by ONC, more than 50 percent of hospitals are using the standard in nearly every state.

In addition to EHR vendors, other large tech companies such as Apple have also been developing products that utilize FHIR.

“While these data are encouraging, it’s not time to pop any champagne,” cautioned Posnack and Barker. “Industry-wide, much work remains from standards development to implementation.”

To further use of the FHIR standard, ONC released a new set of FHIR-based testing tools — called Inferno — earlier this week.

“Inferno offers a rich and rigorous set of testing tools to help health IT developers make sure the FHIR standard is consistently implemented,” explained Posnack and Health IT Certification Program Senior Technical Advisor John Snyder in an October 2 blogpost.

The suite of testing tools will be especially helpful for ensuring health IT innovators implement the FHIR standard consistently when developing FHIR servers. FHIR servers provide health data to clinician-facing and patient-facing apps.

Inferno is designed to verify when a FHIR server meets industry standards in line with the Argonaut Implementation Guide, OAuth 2.0, Open ID Connect, and other best-practices.

“It also includes some bells and whistles, such as testing for Dynamic Client Registration, and has a step-by-step approach for testing each of the standardized interactions needed for apps to register and securely connect to a FHIR server,” wrote Posnack and Snyder.

By improving health data standards testing and implementation, ONC is working to promote API use and support the goals of the 21st Century Cures Act.

While FHIR has the potential to enable structural and semantic interoperability, EHR vendors do not implement FHIR specifications consistently. Using different versions of FHIR can inhibit interoperability.

Ensuring health data standards are adopted and implemented in a consistent, comprehensive manner can help to avoid these complications and advance seamless health data exchange.