What’s Coming in 2022 and What Opportunities Does This Present for Public Health?

Ken Mandl (Boston Children’s Hospital & Harvard Medical School) Introduced by Steven Posnack (ONC)


Important progress has been made over the last decade to standardize the exchange of health data. The 21st Century Cures Act, passed in 2016, includes a focus on application programming interfaces (APIs) and sets the expectation that those APIs will allow information from medical records and other certified IT products to be accessed without special effort.

The Health Level Seven(HL7®) Fast Healthcare Interoperability Resources (FHIR®) standard has matured and is now used across the globe. In recent regulations, the Office of the National

Coordinator for Health IT (ONC) and the Centers for Medicare & Medicaid Services (CMS) named FHIR Release 4 as the standard required to fulfill the requirements of the 21st Century Cures Act. Additionally, ONC’s regulation established a common and consistent set of expectations regarding what data elements will be structured and made available to fulfill multiple purposes. ONC’s rule also requires certified health IT vendors to support the bulk FHIR API to enable access to data on groups, cohorts, and populations.

This enhanced data environment will roll out nationwide and is set to become a reality by 2022. Collectively, the standardization that is coming into play could help make it easier for public health to access data, drive decision making, and inform the public more quickly and with greater precision.

Key Takeaways

Much Richer, Standardized Electronic Health Data will soon be Available Nationwide to Meet Multiple Needs

Regulations recently finalized by ONC external iconand CMS external iconestablish a set of common and consistent data expectations that certified health IT vendors (e.g., electronic health record vendors such as Epic, Cerner, and Allscripts) are required to support. These upgrades will focus initially on a common set of data elements known as the US Core Data for Interoperability (USCDI). USCDI data elements will be available and consistently formatted to the FHIR Release 4 standard, which will aid in the interoperability of that data. ONC’s regulation also mandates that large, population-level data in USCDI be made available via a mechanism known as a bulk FHIR API.

Developers of certified health IT products now have approximately two years to update their software and roll that software out to their customers.

Public Health can Leverage Federally Required Standards and Other Broadly Adopted Capabilities

In effect, these federal requirements a) set expectations around data liquidity, and b) create a baseline for what data will be readily available and what functionality will be supported nationwide. This functionality includes both access to fine-grained data on one patient at a time as well as access to data on entire groups, cohorts, or populations. By leveraging FHIR-based approaches, the standards are open, freely available, and agnostic to the underlying systems where the data are stored. This provides public health an opportunity to reuse and extend what is already being built instead of operating and maintaining a separate, niche-specific infrastructure.

Modern Technologies are Available to Support Public Health Priorities from The Local to the National Level

Widespread adoption of FHIR-based standards will provide additional capacity to support modern computing interactions that could help bring advanced data science capabilities to public health. These capabilities may include, but are not limited to:

  • Predictive Analytics: Advanced analytics on data from notes, medication orders, lab results, procedure codes, and other data commonly captured in EHRs as well as additional data elements making their way into EHRs, such as social determinants of health
  • Enhanced Surveillance:
    • Refining and seamlessly deploying case definitions as they evolve without burdensome and time-consuming integrations at each site
    • Spatial clustering and enhanced temporal predictions powered by machine learning and artificial intelligence that can link and process data from multiple sources
    • Up-to-date information on populations with chronic diseases and behavioral health needs
  • Personalized Communications: Personalized (even two-way) public health communications with care providers and patients
  • Streamlined Data Sharing While Preserving Patient Privacy: Ensure users at multiple levels (federal, state, local) can only access the data they need and are authorized to access

Modern, cloud-based technologies make it possible for public health to leverage and contribute to   a distributed system (i.e., a broad, federated network) that makes data accessible in analytics-ready environments to address multiple needs. These needs range from treatment, payment, healthcare operations, requests from patients, post-market surveillance, research, public health, and other authorized uses of the data. Public health has the opportunity to re-use this emerging, regulated set of capabilities to address federal, state, and local needs in a way that is satisfactory and mutually beneficial to users at multiple levels of the ecosystem, without relying on a single vendor or a single technology company.