ArticleJournal of the American Medical Informatics Association : JAMIA2024
Real world performance of the 21st Century Cures Act population-level application programming interface.
Article in Journal of the American Medical Informatics Association : JAMIA, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 8 papers.
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The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
8 citing papers in PubMed.
- A pilot feasibility study of human-centered design for cirrhosis care: Development and pilot testing of SMARTLiver prototype, a FHIR-based clinical decision support system for hepatology.PLOS digital health · 2026Article
- Toward a National Health Digital and Data Architecture: Laying the Foundation for Digital Transformation: Commission on Investment Imperatives for a Healthy Nation.NAM perspectives · 2026Review
- A Review of the Use of Mobile Health Interventions in Patients with Inflammatory Bowel Disease.Journal of multidisciplinary healthcare · 2026Review
- The health data utility and the resurgence of health information exchanges as a national resource.Journal of the American Medical Informatics Association : JAMIA · 2025Article
- Cumulus: a federated electronic health record-based learning system powered by Fast Healthcare Interoperability Resources and artificial intelligence.Journal of the American Medical Informatics Association : JAMIA · 2024Article
- MENDS-on-FHIR: leveraging the OMOP common data model and FHIR standards for national chronic disease surveillance.JAMIA open · 2024Article
- Cumulus: A federated EHR-based learning system powered by FHIR and AI.medRxiv : the preprint server for health sciences · 2024Article
- MENDS-on-FHIR: Leveraging the OMOP common data model and FHIR standards for national chronic disease surveillance.medRxiv : the preprint server for health sciences · 2023Article
Corrections and comments
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Authors and funding
19 authors.
Funding
Abstract
objectiveTo 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
methodsWe 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.
resultsAmong 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 12 000 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.
conclusionTo 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.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.