Appendix A: Questions and Answers

The listening session included opportunities for participants to ask questions of the speakers.

Q1: How can the public health workforce learn more about FHIR?

FHIR is an open, web-based standard that aligns with the libraries and software tools developers commonly use today. The entire specification is available online for free at, and anyone can join the conversation at icon.

The open licensing and active community around FHIR make it easier to learn and apply FHIR than older healthcare-specific standards. Tutorials are freely available on the web. On the EHR vendor side, Epic external iconand Cerner external iconhave detailed tutorials and on the cloud side Googleexternal icon, IBMexternal icon, Microsoftexternal icon, and Amazon external iconall have detailed tutorials. In addition, the community gathers on an ongoing basis through conferences, Connect-a-thon events, and workgroups to learn and share what they know.

Q2: How might federated, cloud-based systems reduce burden on state health departments in terms of data collection, cleaning, and analysis?

One main benefit of adopting a common, web-based standard across a federated system is that you can leverage the power of the cloud to build tools and services on top of a common foundation. Once the data are mapped to FHIR, then basic data wrangling processes, such as transformations, data quality checks, and initial data explorations, can run on data from across multiple health systems in the same way.

In the way federated networks are often built now, there’s usually an intense data wrangling process at every healthcare institution where they develop their own mappings into a proprietary schema or a schema that is specific to that network, resulting in a significant duplication of effort. Mapping data into a common standard that can be used to support multiple purposes can help streamline the data cleaning process and make it easier to build tools that public health departments can use to access, analyze, and act on cleaned and processed data.

Q3: How might bulk FHIR help to improve electronic case reporting?

Bulk FHIR is a common way of accessing USCDI data elements across the country. This includes both the structured data elements from EHRs and laboratory results as well as detailed clinical notes. Imagine an example where there is a case of probable COVID, and no laboratory results are available. Parsing clinical notes using high throughput computing can help to detect these cases. This can help automate not only the collection of the initial case report but also more detailed follow-up that currently happens in case reporting. Additional work would need to be done to assess the sensitivity and the specificity of these classifiers.

Q4: Can bulk FHIR implementation timelines be accelerated in the face of the current pandemic?

It is something that can be done if there is a will and an interest. Some systems have put bulk FHIR capabilities into production already. The rest have a two-year timeline to meet the regulatory requirements.

Q5: What are state and local public health obligations with respect to patient access to data via FHIR, and what is the timeline for enforcement of those provisions?

Developers of Certified Health IT, Health Information Exchanges and Health Information Networks, and Providers are subject to the information blocking provisions of ONC’s final rule. Public health agencies, particularly those who provide health services, may be considered healthcare providers as defined for information blocking provisions. Similarly, some public health program networks and exchanges may be considered health information networks and exchanges as defined for information blocking provisions. Compliance is required by November 2, 2020, which is 6 months after ONC Final Rule publication.

The Office of the Inspector General at the Department of Health and Human Services issued a rule on how it will oversee enforcement of the information blocking provision in the 21st Century Cures Act.

Q6: How can public health provide input into USCDI?

As part of the Standards Version Advancement Process, ONC has prepared a process for engaging the public that includes a data elements submission system external iconto identify potential data elements to be promoted into the next version of USCDI. Evidence of implementation is an important factor in determining what data elements will be added to the core. Public health partners are encouraged to get involved to help shape future iterations of USCDI and other standards eligible for advancement through the ONC defined processes.

Q7: How can public health learn more about ONC’s Cures Act Final Rule, The Standards Version advancement process, and interoperability standards?

Interested parties can follow along at: