In February, the Office of the National Coordinator for Health Information Technology (ONC) began sharing information about a new requirement of the Cures Act Final Rule (Cures Rule) designed to advance interoperability with Fast Healthcare Interoperability Resources (FHIR®) application programming interfaces (APIs). The requirement stipulates that providers of certified health IT must make FHIR APIs available to their clients at no cost and must publish a list of FHIR service base URLs or “endpoints” by December 31, 2022. ONC National Coordinator Micky Tripathi, PhD, MPP, included the FHIR API requirements in a recent overview of interoperability efforts  being implemented in 2022.

The goal behind this requirement is to ensure both providers and patients have easier access to electronic health information and is part of a larger effort to promote interoperability in health care. In this article, we explain more about the FHIR Endpoint publication requirement and what must be done to be ready for the end-of-year deadline.

What are FHIR Endpoints?

To understand what FHIR endpoints are and how they help interoperability, a brief review of what FHIR APIs are will help set the foundation for this latest Cures Rule requirement. FHIR is a set of standards  established by the standards development organization Health Level Seven (HL7®) through a collaborative effort to facilitate the secure exchange of clinical and administrative data among healthcare providers, health information exchanges, health IT vendors, and payers. FHIR APIs are the point of entry for the access and exchange of the data between different systems. A common analogy is that in a restaurant setting, the API is the waiter who takes the order (data request) for the customer (the user), communicates the order to the kitchen, and brings the order (data) to the customer in a consumable format.

A FHIR Endpoint is the specific connection point to the location on the internet where the data is stored. Endpoints are essentially connection points where an API connects to request or submit data. Whether someone is accessing their own health information in a patient portal, or a healthcare provider is seeking information in their hospital’s electronic health record (EHR) system, the endpoints are the locations those programs use to find the information those users need to access. By having developers publish the endpoints using the FHIR Endpoint resource, the ONC intends to advance interoperability with faster and easier data exchange.

How will publication of FHIR Endpoints improve interoperability?

The ONC developed the Lantern tool for monitoring FHIR APIs and for checking endpoint list accessibility. Through this work, the ONC has found that there are several issues that the new FHIR endpoints publication requirement aims to address. For example, currently, developers of health IT can publish an endpoint in any format—from json proprietary format to HTML tables—and this variability in format can require customizations to process the endpoint lists and access the information stored on the server. This can complicate health information exchange, making the process of accessing data slower and more cumbersome. By creating a FHIR Endpoint resource format to standardize how endpoints are published, the exchange of health data will be more secure and streamlined since the directions to locate the data will be structured in the same way. These issues are being addressed via a new FHIR At Scale Taskforce (FAST) FHIR Implementation Guide National Healthcare Directory Endpoint Query that is still in development.

Another issue relates to the managing organization of an endpoint. There are many situations in which one endpoint represents multiple organizations within a provider network. That can become problematic because you need a way to represent each of those provider entities in the endpoint lists for accessibility. The solution the ONC has proposed, based on feedback from stakeholders, is to have organizations publish their endpoint resources (which would include the individual provider entities contained within the endpoint of the managing organization) outside of the FHIR Server authentication and security frameworks. This allows users to access the system to search for data from all entities associated within the larger organization while maintaining the FHIR Endpoint resource format that has already been established.

By leveraging the Lantern tool, the ONC was able to learn about obstacles to interoperability that standardization of FHIR APIs and FHIR Endpoint resources can address. Resolving issues related to FHIR-based endpoint publication ultimately makes it easier for developers to support health IT projects and facilitate information exchange.

Next steps for FHIR Endpoints publication

With all this information in mind, the next question is: what should organizations do to comply with the FHIR Endpoint publication requirement? First, it is important that the publishing organization recognize that most information needed in the FHIR Endpoint resource may be marked as optional but more complete publication information can ease compliance with the Cures Act Final Rule. Providing more of the optional details in addition to the base required information can allow for better communication of issues once connections are attempted and made.

For publishing organizations or entities that must provide information to a developer for the publication of FHIR Endpoints, these are some tips to ensure you are complying with the Cures Rule requirement:

  • Create the endpoint resource with full information about the organization, the business name for the endpoint for reference, and contact information where technical issues can be addressed (such as a help desk contact) to ensure ease of compliance
  • Place the endpoint resource(s) on the FHIR server to be downloaded automatically and ingested
  • Ensure that the organization resource linked within the endpoint managing organization element is also available outside your organization’s FHIR security framework
  • Publish your FHIR server information in publicly available locations, such as your NPPES entry, to allow for ease of locating the resource(s), both for the ONC Lantern project and for other parties looking for that data

The requirement to publish these publicly accessible endpoint lists by the end of 2022 represents one more step towards enhanced interoperability and more streamlined data sharing in healthcare in the U.S.

To learn more about FHIR-related initiatives happening in 2022, review our recent post about the three-year roadmap for incorporating FHIR into TEFCA (“Trusted Exchange Framework and Common Agreement”).

Want to learn more about the FHIR three-year plan?

About the Author

DIana Bauza About The AuthorDiana Bauza is a content writer based in the Greater Philadelphia area. She writes about products and services in the health and technology industries, with the goal of empowering consumers with quality information to help them make decisions that best serve their needs