The Federal Fast Healthcare Interoperability Resources® (FHIR®) Action Plan (“action plan”) is intended to inform federal investment in and adoption of the Health Level 7 (HL7®) International® FHIR standard. In 2019, the Assistant Secretary for Technology Policy/Office of the National Coordinator for Health IT (formerly ONC and hereafter ASTP) convened a FHIR Work Group under the Federal Health IT Coordinating Council (FHITCC); this work group gathered knowledge and insights to support implementation and decision-making of FHIR. The action plan builds upon considerations developed by the work group and provides strategic direction for using a mature FHIR standard across federal agencies to enhance shared decision-making, improve care coordination, and deepen patient engagement.
The following recent publications by ASTP and the Centers for Medicare & Medicaid Services (CMS) further outline the path for advancing FHIR capabilities:
- CMS/ASTP Request for Information: Health Technology Ecosystem
- ASTP Health, Technology, and Interoperability: Certification Program Updates, Algorithm Transparency, and Information Sharing Final Rule (HTI-1 Final Rule); and
- CMS Interoperability and Prior Authorization Final Rule (CMS-0057-F).
The action plan was developed with input from federal agencies, the standards development community, and subject matter experts (SMEs). It will be updated periodically based on future investments and interests of the federal agencies
GOALS
The action plan’s primary goal is to align federal agencies’ adoption and use of FHIR around a set of essential components and capabilities that agencies have implemented or are planning to implement in the next two years. Many of these components are mature and are already used in production. ASTP designed the action plan to provide clear, consistent, and predictable information regarding the standards and implementation specifications prioritized by federal agencies.
In publishing the action plan, ASTP seeks to identify federal use cases and areas needing additional development and investment.
Federal agencies and implementation partners are encouraged to use the action plan to help:
- Identify and address common needs across agencies;
- Coordinate requests and focus areas for the FHIR standards community and implementation partners; and
- Optimize investments by reusing and advancing widely adopted capabilities, avoiding duplication in federal use cases.
WHO SHOULD READ
The action plan is intended primarily for federal partner agencies and their industry partners. Interested parties who administer government programs that involve clinical health information technology interoperability components should review this action plan to help inform any technical decisions.
We hope the action plan can also serve as a valuable resource for organizations and users outside the federal sphere. For example, Standards Development Organizations (SDOs) can use the action plan to identify areas of federal interest that require development of new or improved specifications. This insight helps them align their efforts with federal priorities and address emerging interoperability needs. Health IT developers can gain greater clarity and certainty regarding the FHIR components prioritized by federal agencies to better plan and build technical solutions that align with federal agency needs. A wide range of users – including providers, payers, researchers, public health entities, laboratories, State, Tribal, Local, and Territorial (STLT) health departments, clearinghouses, and integrators – can benefit from the transparency provided by the action plan. By understanding the baseline FHIR components that federal partners are investing in, they can make more informed decisions about capabilities that are currently in the works.
CONTENTS
The core of the action plan lies in the component tables found within the FHIR Ecosystem section, in which the “unit of measure” is largely FHIR Implementation Guides (IGs). These tables organize FHIR specifications into six distinct categories:
- Core Components
These foundational FHIR specifications have broad applicability across health care services. They support fundamental operations and are reusable building blocks for multiple use cases. - Network Components
Network specifications focus on FHIR capabilities for accessing and exchanging data securely between health information networks, in service of nationwide data sharing. - Payment and Health Quality Components
FHIR specifications in this category aim to alleviate reporting burden for clinicians and caregivers. - Care Delivery and Engagement Components
These FHIR specifications are designed to enhance patients’ access to their health data and to the health care system. They also reduce provider burden and assist providers in areas such as decision support. - Public Health and Emergency Response Components
FHIR specifications in this category aim to modernize public health infrastructure and data needs. - Research Components
Research specifications drive toward a fully digital health system that uses FHIR to support access to data for research activities and innovation.
The individual specifications described in the component tables represent those that ASTP has identified as best suited to meet current agency needs and that they can use with confidence. These selections are based on several factors, including agency interest, implementation, maturity level, and reusability.
RELATIONSHIP TO INTEROPERABILITY STANDARDS ADVISORY (ISA)
Both the action plan and the Interoperability Standards Advisory (ISA) are part of ASTP’s Interoperability Standards Platform (ISP) and share the common goal of advancing health information interoperability using standards and implementation specifications developed by SDOs. Specifically, the information contained in the action plan tables have been collected from and integrated into the ISA, in consultation with federal agency partners who track the IGs.
However, the focus and content of the action plan is meant to address narrower needs that are not apparent in the ISA – which is to identify FHIR-specific implementation specifications that are of interest to U.S. federal agencies. In contrast, the ISA includes standards and implementation specification that are not limited to FHIR and includes a much broader range of needs than those identified by federal agencies.
With the focus on FHIR and federal agency needs, our aim is to provide the public with a curated list of FHIR specifications that supports U.S. federal agency goals.
The action plan does not include the many non-FHIR standards used in healthcare, nor does it specifically call out terminology standards that are referenced in the FHIR specifications. We acknowledge that these standards are critical for ensuring consistent and accurate communication of clinical data and anticipate users continue to leverage the ISA to cover the breadth of interoperability needs – over 75 different standards areas in the latest edition – that are supported by various standards, not limited to FHIR.
UPDATES
ASTP will regularly update the action plan through established federal activities and coordination efforts. These updates will ensure the action plan remains aligned with advancements in the FHIR standard and changing federal agency priorities. Mechanisms for updates include the Federal Health IT Coordinating Council, Federal Health IT Strategic Plan, ongoing coordination with agencies, and feedback provided by the public on the ISA. Regular updates will indicate the progress of FHIR specification maturity, adoption trends across federal agencies and programs, and federal activities supporting interoperability and data exchange. This will ensure the action plan remains responsive to community input and reflects the latest developments in interoperability standards.
HOW TO COMMENT ON THE FEDERAL FHIR® ACTION PLAN
The action plan is integrated into the ISA and will follow the ISA comment and update process. Comments on the action plan are accepted year-round.
An Interoperability Standards Platform (ISP) site account is required to comment on the action plan.
- If you already have an account, click here or click the “LOG IN” button at the top right of the ISP and enter your log in information.
- To create an account, click here or click the “LOG IN” button, then “Create new account” tab above the log in window. Account approval is required and is generally completed within 24 hours.
ASTP will review comments with SMEs and consider suggested revisions.
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