New health record data standard adoption remains stagnant, ONC finds

The study found that administrative apps typically don't support the new standard.
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The number of third-party applications using the federally mandated data exchange standard to connect to certified electronic health records (EHRs) remained virtually stagnant in 2020, according to a recent Office of the National Coordinator for Health IT study.

Only 161 out of 734 unique apps, 21.9%, used the Health Level Seven (HL7) Fast Healthcare Interoperability Resources (FHIR) standard, compared to 112 out of 600 apps, 18.7%, in 2019.

The measurement sets a baseline for ONC to track implementation of its Cures Act Final Rule, which requires many certified health IT developers to support FHIR-based, standardized application programming interfaces (APIs) for patient- and population-level services by the end of 2022.

“While progress has been made, there is still room for growth, and variation exists among some of the largest EHR developers,” reads the study, published in the Journal of the American Medical Informatics Association earlier this month. “Monitoring the impacts of the rule will be important to providing insights into whether the goals to expand patient access to their electronic health information will be realized.”


Potential reasons for the slow adoption of FHIR are the fact administrative apps, the most common, don’t typically support the standard, and the ones that do are developed around a specific set of use cases and data elements. FHIR-enabled apps should grow with new use cases, according to ONC.

On the positive side, the number of unique apps integrating with certified EHRs increased by 134 and the number of developers by 93 in 2020. ONC determined this by analyzing apps in galleries managed by the EHR developers Allscripts, athenahealth, Cerner Corp. and Epic Systems Corp., as well as the SMART App Gallery.

Among all apps, 42% related to scheduling, check-in and billing; 38% to clinical functions like automated tasks, population health, telehealth and clinical decision support; 31% to care management; 20% to patient engagement; and 5% to research.

ONC continues to work with agencies, industry and academia to improve use of and access to electronic health information, including patient access, through FHIR adoption.

The vast array of existing APIs increased costs and barriers to sharing, which is why the 21st Century Cures Act of 2016 required IT developers to publish APIs allowing health information access, exchange and use without “special effort.”


As part of that, ONC’s Cures Act Final Rule published in May 2020 was designed to advance interoperability by creating Health IT Certification Program certification criteria, including requiring use of the FHIR standard.

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