Real World Performance of the 21st Century Cures Act Population Level Application Programming Interface

Area of Science:

• Health Informatics
• Health Data Interoperability
• Electronic Health Records (EHRs)

Background:

• The 21st Century Cures Act mandates Electronic Health Records (EHRs) to support the SMART/HL7 Bulk FHIR Access API for population-level patient data delivery.
• Evaluating the real-world performance of this API is crucial for achieving interoperability goals.

Approach:

• A comparative analysis was conducted using an open-source Bulk FHIR Testing Suite across five healthcare sites.
• Performance was assessed by measuring export speeds, data sizes, and completeness for six FHIR resource types.
• Sites included four hospitals with certified EHRs and one Health Information Exchange (HIE) with a custom API.

Key Points:

• Oracle Cerner EHRs achieved speeds of over 8,000 resources/min for 5-16 million resources.
• Epic EHRs processed 1-12 million resources at 1,555-2,500 resources/min.
• The HIE's custom API significantly outperformed EHRs, processing over 141 million resources at 12,000 resources/min.

Conclusions:

• The HIE's custom API demonstrated the potential of SMART/HL7 Bulk FHIR for large-scale data exchange.
• Existing EHR platforms require optimization to enhance Bulk FHIR API performance.
• Incorporating performance metrics into certification and reporting is vital for realizing the 21st Century Cures Act's interoperability objectives.