FHIR Ecosystem

The capabilities specified in the action plan serve as building blocks for creating a more interoperable and seamless healthcare ecosystem, enabling better interaction and integration for all. While some federal agencies have made more progress in implementing FHIR capabilities than others, the adoption of common components will establish a strong foundation for accelerating the use of next-generation HL7 FHIR specifications.

The continued development and implementation of the Trusted Exchange Framework and Common Agreemen™ (TEFCA™) based on FHIR specifications will further enhance nationwide exchange of healthcare data for clinical, public health, and research purposes.

IGs developed by HL7’s Da Vinci Project Accelerator will play a critical role in reducing prior authorization burden for both payers and providers, improving payers’ ability to share data with patients, reducing reporting burden, and providing greater continuity for patients transitioning between insurance plans.

Emerging FHIR specifications are set to enable patients to access their health information while travelling internationally. Other specifications will focus on improving nationwide public health reporting, providing real-time insights into disease trends to support timely and informed decision-making. New standards will work to standardize cancer data collection and enhance the quality of data provided to disease registries. These advancements will also establish a foundation for expanding the use of FHIR in generating real-world evidence for clinical trials and advancing applications in genomics, further driving innovation in healthcare and research.

As emerging FHIR specifications achieve widespread adoption and become the de facto standard, they will pave the way for transformative innovations in healthcare. These advancements have the potential to significantly improve clinical decision-making, enhance patient outcomes, streamline administrative processes, and bolster public health surveillance. Continuous improvements to FHIR will facilitate this transition, leading to faster data exchange, improved care coordination, and more personalized experiences across diverse systems and applications. The coordinated development, adoption, implementation, and use of FHIR standards will support breaking down the data silos that currently exist in the health IT ecosystem. These data silos hinder patients, providers, payers, public health experts, and researchers from accessing a comprehensive dataset. By addressing these barriers, FHIR will help create a more connected and interoperable healthcare environment.

The FHIR specifications listed in the component tables will form the basis for the next generation of healthcare interoperability. Components have been referenced in federal regulations or initiatives, are in active development in FHIR Accelerators, or are highly anticipated by industry partners. The 31 components are organized into six distinct sections:

• 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.

FHIR specifications were included in the action plan based on four criteria – agency interest, implementation, maturity, and reusability. Inclusion determinations were made based on discussions with ASTP and federal agency partner SMEs, public feedback submitted during the open feedback period, and review of public information. The questions below are representative of the type of information used to determine specification inclusion.

1. Agency Interest. Is the specification referenced in agency publications, initiatives, or regulations? To what extent have agencies invested funds or staff resources on the specification?
2. Implementation. How actively is the specification being used or required by a federal agency?
3. Maturity. What is the maturity level of the specification? Has there been recent development activity to advance or refine the specification?
4. Reusability. How widely is the specification implemented in across different use cases? Is it referenced or used by other specifications?

Agencies should review the capabilities, requirements, and dependencies of these components before investing in new efforts that may duplicate their functions. An appendix table lists all the specifications referenced in the component tables with their “home” areas and the other areas in which they could have been included.

Each specification entry includes its name, assessments of its current maturity level, and development and implementation information. Maturity assessments align with the ASTP Interoperability Standards Advisory (ISA) where available; Standard Process Maturity refers to its development stage (from most to least: Final, Balloted, In Development), while Implementation Maturity refers to its implementation state (Production, Pilot).

Federal agencies are encouraged to:

1. Use Balloted or Final components that are in Production;
2. Advance specifications that are In Development or in a Pilot phase; and
   • Identify “new” areas for future federal investment.

This approach promotes consistency and helps alleviate development and implementation burden, fostering smooth, efficient collaboration in the pursuit of shared goals.

The HL7 FHIR specifications categorized as Core Components serve as the foundation for developing and implementing nearly all FHIR capabilities. These Core Components are designed to be use-case agnostic, providing the flexibility to support a wide range of applications across various healthcare scenarios. The modular nature of the FHIR standard allows elements, such as IGs and Profiles, to be combined in different ways to address diverse needs. Many federal agency initiatives rely on these Core Components, which have undergone extensive testing and are widely utilized in production systems, ensuring their reliability and effectiveness in real-world applications.

ASTP collaborates closely with HL7 to ensure coordination, awareness, and insight into significant activities and advancements in FHIR standards. This partnership covers the full range of use cases that FHIR is designed to address, with ASTP placing particular emphasis on the Core Components that are applicable across the broadest range of subject matter areas. Developers and users of FHIR are encouraged to consult ASTP before committing resources to Core Component specifications to ensure alignment with federal priorities and guidance.

Many of these specifications interface with other essential standards and policies including USCDI/USCDI+, the ISA, and the Health IT Alignment Policy. In addition, several of them are also used in federal programs or initiatives including the ASTP Certification Program, ASTP’s Inferno tool, and CMS’ Electronic Clinical Quality Measures (eCQMs).

Interested parties should use the latest version of the listed specification if a version is not referenced in the specification description.

Network specifications are FHIR capabilities for exchanging and discovering data across extensive, multi-nodal networks. Currently, these specifications are most prominently seen in the evolution of the Trusted Exchange Framework and Common AgreementTM (TEFCATM) infrastructure to a FHIR-based system, though they are expected to play a significant role in future advancements in network applications. Given ASTP's involvement in TEFCA™, Network Component developers are encouraged to coordinate and consult with ASTP to ensure alignment in standards development and adoption efforts.

Interested parties should use the latest version of the listed specification if a specific version is not referenced in the specification description.

FHIR-based Payment and Health Quality specifications are designed to streamline processes and reduce the reporting burden for clinicians, caregivers, patients, and payers. These specifications focus on enabling efficient claims data exchange and improving interoperability in payment and quality reporting workflows. Many of these specifications have been developed through the Da Vinci Project, an HL7 FHIR Accelerator that focuses on creating FHIR-based solutions for value-based care and payment models. The Da Vinci Project's work revolves around capabilities that facilitate claims data exchange, making it easier for healthcare stakeholders to share and process payment and quality-related information. Given the emphasis on claims and payment data, agencies working in this space are encouraged to involve the Centers for Medicare & Medicaid Services (CMS) as a key partner. CMS's expertise and role in healthcare payment systems can help ensure that these specifications align with regulatory requirements.

Several of these specifications are used in federal programs or initiatives including the CMS electronic Clinical Quality Improvement (eCQI) electronic Clinical Quality Measures (eCQMs) Program and ASTP’s Inferno tool.

Interested parties should use the latest version of the listed specification if a specific version is not referenced in the specification description.

FHIR-based Care Delivery and Engagement specifications are designed to improve patient access to their health data and interactions with the healthcare system. These specifications aim to empower patients by providing them with easier and more secure access to their medical information while also reducing administrative burdens on healthcare providers. Additionally, they support providers in areas such as clinical decision support, enhancing the quality and efficiency of care delivery. Key agencies involved in advancing these specifications include CMS, HRSA, and CDC.

Interested parties should use the latest version of the listed specification if a specific version is not referenced in the specification description.

Public Health and Emergency Response HL7 FHIR specifications seek to modernize public health data systems and infrastructure enabling more efficient and effective data exchange and management. With its responsibilities to public health, CDC plays a key role in the development of new FHIR capabilities in this area.

Several of these specifications are used in federal programs or initiatives including the ASTP Certification Program, CDC NCHS National Vitals Statistics System (NVSS), CDC National Health Care Surveys Registry, CDC National Program of Cancer Registries, CDC Public Health FHIR Playbook (2023).

Interested parties should refer to the latest version of the listed specification if a specific version is not referenced in the specification description.

Research specifications aim to advance the development of a fully digital health system that leverages FHIR for research-related activities. Given the open-ended nature of research, these specifications have the potential to create multiple downstream impacts across healthcare and scientific domains. Key agencies within the HHS —including NIH and its component institutes, CDC, and FDA — play significant roles in shaping the development of FHIR capabilities. Their input ensures that these specifications are optimized for future implementation and use, supporting robust and interoperable research processes across the healthcare ecosystem.

Interested parties should refer to the latest version of the listed specification if a specific version is not referenced in the specification description.