About the Draft Federal FHIR® Action Plan

The Draft Federal FHIR® Action Plan (“draft action plan”) is intended to help guide federal investment in and adoption of the Health Level 7 (HL7®) Fast Health Interoperability Resources (FHIR®) standard. In 2019, the Assistant Secretary for Technology Policy/Office of the National Coordinator for Health IT (formerly ONC and hereafter ASTP) convened a FHIR Work Group under the Federal Health IT Coordinating Council (FHITCC) to coordinate knowledge, implementation, and decision-making around the role and use of FHIR. This draft action plan builds off the work of that group and provides additional direction now that FHIR has matured and is being used more broadly by federal agencies to help facilitate shared decision-making, improve care coordination, and deepen patient engagement. (HL7® and FHIR® are the registered trademarks of Health Level Seven International and use of these trademarks does not constitute endorsement by HL7.)

In addition, recent regulations published by ASTP and CMS – ASTP’s Health, Technology, and Interoperability: Certification Program Updates, Algorithm Transparency, and Information Sharing (HTI-1) Final Rule; the Centers for Medicare & Medicaid Services' (CMS) Interoperability and Prior Authorization Final Rule; and ASTP’s Health, Technology, and Interoperability: Patient Engagement, Information Sharing, and Public Health Interoperability (HTI-2) proposed rule – begin to lay out a path for the next generation of FHIR capabilities.

Federal agencies and implementation partners are encouraged to use this draft action plan to help:

• Identify and address common needs.
• Coordinate asks of the FHIR standards community and implementation partners.
• Reuse and advance capabilities that have widespread adoption across industry and federal use cases to help benefit each other’s funded initiatives, avoiding redundancy and duplication of efforts.

In this draft version of the action plan, ASTP welcomes feedback from federal agencies, the standards development community, and subject matter experts. It will be updated to reflect improvements based on the recommendations received and periodically thereafter.

GOALS

This draft action plan’s primary goal is to align federal agencies’ adoption and use of FHIR around a set of essential components and capabilities that agencies have implemented or are planning to implement in the next two years. Many of these components are mature and already being used in production.

By publishing the draft action plan, we also seek to identify those areas in which additional development and investment is needed and to spur federal partners and the standards community to identify new components for their uses.

PURPOSE

The heart of the draft action plan lies in the component tables in the FHIR Ecosystem section. These tables group FHIR components into six categories:

• Core Components
  Core FHIR specifications and components are the most foundational and have the broadest applicability across healthcare services. They are used for fundamental operations and serve as reusable building blocks to support many use cases.
• Network Components
  Network specifications apply to FHIR capabilities for accessing and exchanging data between health information networks for securely sharing data on a nationwide scale.
• Payment and Health Quality Components
  FHIR-based Payment and Health Quality specifications have been developed to reduce reporting burden for clinicians and caregivers.
• Care Delivery and Engagement Components
  Care Delivery and Engagement specifications based on FHIR seek to ease patients’ access to their health data and to the healthcare system. They also seek to reduce provider burden and assist providers in areas such as decision support.
• Public Health and Emergency Response Components
  Public Health and Emergency Response FHIR specifications seek to modernize public health data and infrastructure.
• Research Components
  Research specifications are intended to drive toward a fully digital health system that uses FHIR for research activities.

The individual components described in the tables are those that ASTP considers to be best suited to address current agency needs, factoring in the level of current implementation in industry, regulatory requirement, component maturity, and readiness for future capability.

The draft action plan is designed to provide clarity, consistency, and predictability for the public regarding the standards and implementation specifications that are being considered by federal agencies.

Interested parties who administer government programs with clinical health IT interoperability components are encouraged to look first to the draft action plan to more fully inform their goals.

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DRAFT FEDERAL FHIR ACTION PLAN AND RELATIONSHIP TO ISA

The draft action plan represents the model by which ASTP will align federal agencies’ adoption and use of FHIR standards and related implementation specifications for meeting agency needs.

While the Interoperability Standards Advisory (ISA) and the draft action plan share similarities, including being published on the ASTP’s Interoperability Standards Platform (ISP), there are notable differences in the content and focus of these two activities.

The draft action plan focuses on a limited set of interoperability needs identified by federal agencies that are supported using the FHIR standard and related implementation specifications. On the other hand, the ISA has been designed to cover the breadth of interoperability needs (over 75 different standards areas in the latest edition) that are supported by various standards that are not limited to FHIR.

Another notable difference is the manner in which the draft action plan will be updated based on ASTP’s coordination with federal agencies as part of the HHS Health IT Alignment Policy.

ASTP will publish updated plans based on federal agency needs identified through existing activities including the Federal Health IT Coordinating Council, Federal Health IT Strategic Plan, and ongoing coordination with agencies.

We plan to work with federal agencies to institute a public feedback process in the future. In the meantime, we encourage interested parties to work with federal agency partners to further refine the action plan.

HOW TO COMMENT ON THE DRAFT FEDERAL FHIR® ACTION PLAN

Comments on the draft action plan are accepted year-round; changes will be made periodically based on comments and other changes to the health IT standards environment as ASTP becomes aware of them.

An ISP site account is required in order to comment on the draft action plan.

• If you have an account already, click here or click the “LOG IN” button at the top right of the ISP and enter your log in information.
• To create an account, click here or click the “LOG IN” button, then “Create new account” tab above the log in window. Account approval is required and is generally completed within 24 hours.

Once you’re authenticated to the ISP site, you can submit comments – scroll to the bottom of the page, enter the text of your comment (or provide attachments, if needed), and submit. Your comment will be reviewed by ONC or other HHS subject matter experts and considered for publication to the draft action plan.