Real world performance of the 21st Century Cures Act population-level application programming interface

Area of Science:

• Health Informatics
• Health Data Interoperability
• Health Information Exchange

Background:

• The 21st Century Cures Act mandates improved access to electronic health record (EHR) data.
• SMART/HL7 Bulk Fast Health Interoperability Resources (FHIR) API was developed to facilitate large-scale data access.
• Real-world performance evaluation is crucial for widespread adoption and effectiveness.

Purpose of the Study:

• To evaluate the real-world performance of the SMART/HL7 Bulk FHIR Access API.
• To assess its capability in enabling push-button access to EHR data for large populations.
• To identify performance benchmarks and areas for improvement.

Main Methods:

• Utilized an open-source Bulk FHIR Testing Suite across 5 healthcare sites (April-September 2023).
• Included 4 hospitals with certified EHRs and 1 Health Information Exchange (HIE) with a custom API.
• Measured export speeds, data volumes, and completeness for 6 FHIR resource types.

Main Results:

• Oracle Cerner demonstrated speeds of over 8000 resources/min for 5-16 million resources.
• Epic sites achieved 1555-2500 resources/min for 1-12 million resources.
• The HIE's custom API significantly outperformed, generating over 141 million resources at 12,000 resources/min.

Conclusions:

• The HIE's custom API demonstrated superior performance, validating Bulk FHIR for large-scale data exchange.
• Existing EHR platforms require optimization to meet performance demands.
• Addressing Bulk FHIR API performance limitations is critical for achieving Cures Act interoperability goals.