2019 SMART Flat FHIR / Bulk Data Meeting

The universal health data application programming interfaces called for in the 21st Century Cures Act present an opportunity to create the learning healthcare system that has been long envisioned. A learning healthcare system must be able to do more than conduct individual queries on one patient; it requires the ability to aggregate and analyze data at a population level. Activities such as managing population health, delivering value-based care, and conducting discovery science requires access to large population data sets. Population level data combined with new technologies such as machine learning and AI has extraordinary potential to improve the health and lives of Americans.

To address this need, the SMART team and HL7 have jointly developed the SMART/HL7 Bulk Data/Flat FHIR standard and associated tools.

Building on the momentum our 2017 Population Level Data Export / FLAT FHIR Meeting, the Office of the National Coordinator for Health Information Technology asked the Computational Health Informatics Program (CHIP) and SMART Health IT team to host a second meeting to measure interval progress on use and uptake of the SMART/HL7 Bulk Data/Flat FHIR standard and tools, understand where the rough edges are, explore federal use cases, and drive toward effective regulation.

The 2019 SMART Flat FHIR / Bulk Data meeting was held on November 6th at the Harvard Medical School Countway Library. Sixty stakeholders from across the healthcare ecosystem gathered to talk about bulk data use cases and experience, and plan next steps for the standard and its use. 

Key Takeaways:

  • Demand for standardized bulk data export in the Flat FHIR format is growing rapidly.

    • Within eight months of the 2017 meeting, the Centers for Medicare and Medicaid Services (CMS) were already using the standard in pilots to provision data to ACOs. 
    • An astounding 105,000 providers have requested access to Flat FHIR data via the CMS Data at Point of Care Project.

  • The substantial efforts, via the Argonaut project, to implement the SMART on FHIR API advances us significantly toward implementing the bulk data API at scale. Notably, the Argonaut process was one year long and can serve as a yardstick for the length of time required for implementation of bulk data capabilities. 
  • More than 20 health systems and health plans have committed to move the HL7 balloted standard into real-world testing. 
  • The community has access to a suite of free and open-source products to facilitate FHIR bulk data implementation, including the SMART reference implementation, SMART sample client, and the SMART bulk data testing tool to verify server compliance. 

A detailed report is available below.