Real world performance of the 21st Century Cures Act population-level application programming interface (2024)

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Volume 31 Issue 5 May 2024
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James R Jones, MPhil

Computational Health Informatics Program, Boston Children’s Hospital

, Boston, MA 02215,

United States

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Daniel Gottlieb, MPA

Computational Health Informatics Program, Boston Children’s Hospital

, Boston, MA 02215,

United States

Department of Biomedical Informatics, Harvard Medical School

, Boston, MA 02115,

United States

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Andrew J McMurry, PhD

Computational Health Informatics Program, Boston Children’s Hospital

, Boston, MA 02215,

United States

Department of Pediatrics, Harvard Medical School

, Boston, MA 02115,

United States

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Ashish Atreja, MD, MPH

Department of Health Innovation Technology, UC Davis Health

, Rancho Cardova, CA 95670,

United States

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Pankaja M Desai, PhD

Department of Internal Medicine, Rush University Medical Center

, Chicago, IL 60612,

United States

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Brian E Dixon, PhD, MPA

Department of Health Policy and Management, Fairbanks School of Public Health, Indiana University

, Indianapolis, IN 46202,

United States

Center for Biomedical Informatics, Regenstrief Institute

, Indianapolis, IN 46202,

United States

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Anil J Saldanha, MS

Department of Health Innovation, Rush University Medical Center

, Chicago, IL 60612,

United States

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Prabhu Shankar, MD, MS

Department of Health Innovation Technology, UC Davis Health

, Rancho Cardova, CA 95670,

United States

Department of Public Health Sciences, UC Davis Health

, Davis, CA 95817,

United States

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Yauheni Solad, MD, MHS, MBA

Department of Health Innovation Technology, UC Davis Health

, Rancho Cardova, CA 95670,

United States

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Adam B Wilcox, PhD

Department of Medicine, Washington University in St Louis

, St Louis, MO 63110,

United States

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Momeena S Ali, MS

Department of Health Innovation Technology, UC Davis Health

, Rancho Cardova, CA 95670,

United States

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Eugene Kang, BS

Department of Health Innovation Technology, UC Davis Health

, Rancho Cardova, CA 95670,

United States

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Andrew M Martin, MS

Department of Technical Services, Regenstrief Institute

, Indianapolis, IN 46202,

United States

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Elizabeth Sprouse, MPH

Double Lantern Informatics

, Atlanta, GA 30305,

United States

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David E Taylor, BS

Department of Technical Services, Regenstrief Institute

, Indianapolis, IN 46202,

United States

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Michael Terry, MS

Computational Health Informatics Program, Boston Children’s Hospital

, Boston, MA 02215,

United States

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, SMART Cumulus Network

Vladimir Ignatov, MFA

Computational Health Informatics Program, Boston Children’s Hospital

, Boston, MA 02215,

United States

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Kenneth D Mandl, MD, MPH

Computational Health Informatics Program, Boston Children’s Hospital

, Boston, MA 02215,

United States

Department of Biomedical Informatics, Harvard Medical School

, Boston, MA 02115,

United States

Corresponding author: Kenneth D. Mandl, MD, MPH, Computational Health Informatics Program, Boston Children’s Hospital, 401 Park Drive LM5506, Mail Stop BCH3187, Boston, MA 02215, United States (kenneth_mandl@harvard.edu)

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Journal of the American Medical Informatics Association, Volume 31, Issue 5, May 2024, Pages 1144–1150, https://doi.org/10.1093/jamia/ocae040

Published:

06 March 2024

Article history

Received:

24 October 2023

Revision received:

02 February 2024

Editorial decision:

16 February 2024

Accepted:

19 February 2024

Published:

06 March 2024

Corrected and typeset:

12 April 2024

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    James R Jones, Daniel Gottlieb, Andrew J McMurry, Ashish Atreja, Pankaja M Desai, Brian E Dixon, Philip R O Payne, Anil J Saldanha, Prabhu Shankar, Yauheni Solad, Adam B Wilcox, Momeena S Ali, Eugene Kang, Andrew M Martin, Elizabeth Sprouse, David E Taylor, Michael Terry, Vladimir Ignatov, Kenneth D Mandl, SMART Cumulus Network, Real world performance of the 21st Century Cures Act population-level application programming interface, Journal of the American Medical Informatics Association, Volume 31, Issue 5, May 2024, Pages 1144–1150, https://doi.org/10.1093/jamia/ocae040

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Abstract

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 12000 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.

medical informatics, public health informatics, health information interoperability, health information systems, medical records systems, computerized

© The Author(s) 2024. Published by Oxford University Press on behalf of the American Medical Informatics Association. All rights reserved. For permissions, please email: journals.permissions@oup.com

This article is published and distributed under the terms of the Oxford University Press, Standard Journals Publication Model (https://academic.oup.com/pages/standard-publication-reuse-rights)

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