In September 2024, the Assistant Secretary for Technology Policy/Office of the National Coordinator for Health Information Technology (ASTP/ONC) released a Draft Federal FHIR Action Plan for public comment – the Federal government has declared FHIR “ready for prime time.” Aimed in particular at progress by 2026, the plan forms the basis both for identifying and describing the current state of FHIR artifacts and their implementation as well as encouraging Federal agencies and their partners to accelerate the implementation of FHIR.
The Core Components section of the plan describes the currently-published FHIR standards including the current release of FHIR (R4) and implementation guides currently available for the US Core, SMART App Launch and SMART Health Cards, Bulk FHIR, CDS Hooks, and FHIR Subscription. Additional components are identified for Public Health and Emergency Response, including the US Profiles Library and implementation guides for electronic case reporting (eCR), cancer registry reporting and pathology data sharing, vital reports and fetal death reporting, healthcare surveys, and transfusion and vaccination adverse events. While all but the last are “in production” as indicated, there is very little actual use of these standards for public health purposes – at best, the maturity state is indicated as “in pilot.”
Despite its limited use in public health, this plan is a worthwhile articulation of the Federal government’s intentions and shows strong leadership in this area. As much of public health reporting continues to use HL7 v2 messages and the HL7 Clinical Document Architecture (CDA), with limited funding available for migration to newer FHIR standards, complete migration to FHIR will be an uphill battle (see some of our comments on the ASTP/ONC HTI-2 proposed rule). The implementation of FHIR within TEFCA (referenced in the plan) will also help. What we can expect is a much slower, though steady march towards broader adoption of FHIR over at least a five to ten year period.