{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,22]],"date-time":"2026-03-22T05:33:44Z","timestamp":1774157624095,"version":"3.50.1"},"reference-count":13,"publisher":"Oxford University Press (OUP)","issue":"5","license":[{"start":{"date-parts":[[2024,3,6]],"date-time":"2024-03-06T00:00:00Z","timestamp":1709683200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"funder":[{"name":"Office of the National Coordinator of Health Information Technology","award":["90AX0031\/01-00"],"award-info":[{"award-number":["90AX0031\/01-00"]}]},{"name":"Office of the National Coordinator of Health Information Technology","award":["90AX0022\/01-00"],"award-info":[{"award-number":["90AX0022\/01-00"]}]},{"name":"Office of the National Coordinator of Health Information Technology","award":["90AX0040\/01-00"],"award-info":[{"award-number":["90AX0040\/01-00"]}]},{"DOI":"10.13039\/100000030","name":"Centers for Disease Control and Prevention","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100000030","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000016","name":"United States Department of Health and Human Services","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100000016","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100006108","name":"National Center for Advancing Translational Sciences","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100006108","id-type":"DOI","asserted-by":"publisher"}]},{"name":"National Institutes of Health Cooperative","award":["U01TR002623"],"award-info":[{"award-number":["U01TR002623"]}]},{"name":"National Institutes of Health Cooperative","award":["U01TR002997"],"award-info":[{"award-number":["U01TR002997"]}]},{"DOI":"10.13039\/100028773","name":"National Association of Chronic Disease Directors","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100028773","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000030","name":"Centers for Disease Control and Prevention","doi-asserted-by":"publisher","award":["NU38OT000286"],"award-info":[{"award-number":["NU38OT000286"]}],"id":[{"id":"10.13039\/100000030","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000030","name":"Centers for Disease Control and Prevention","doi-asserted-by":"publisher","award":["U18DP006500"],"award-info":[{"award-number":["U18DP006500"]}],"id":[{"id":"10.13039\/100000030","id-type":"DOI","asserted-by":"publisher"}]},{"name":"Centers for Disease Control and Prevention Cooperative","award":["NU58IP000004"],"award-info":[{"award-number":["NU58IP000004"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2024,4,19]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To evaluate the real-world performance of the SMART\/HL7 Bulk Fast Health Interoperability Resources (FHIR) Access Application Programming Interface (API), developed to enable push button access to electronic health record data on large populations, and required under the 21st Century Cures Act Rule.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Materials and Methods<\/jats:title>\n                    <jats:p>We used an open-source Bulk FHIR Testing Suite at 5 healthcare sites from April to September 2023, including 4 hospitals using electronic health records (EHRs) certified for interoperability, and 1 Health Information Exchange (HIE) using a custom, standards-compliant API build. We measured export speeds, data sizes, and completeness across 6 types of FHIR.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Among the certified platforms, Oracle Cerner led in speed, managing 5-16 million resources at over 8000 resources\/min. Three Epic sites exported a FHIR data subset, achieving 1-12 million resources at 1555-2500 resources\/min. Notably, the HIE\u2019s custom API outperformed, generating over 141 million resources at 12\u00a0000 resources\/min.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Discussion<\/jats:title>\n                    <jats:p>The HIE\u2019s custom API showcased superior performance, endorsing the effectiveness of SMART\/HL7 Bulk FHIR in enabling large-scale data exchange while underlining the need for optimization in existing EHR platforms. Agility and scalability are essential for diverse health, research, and public health use cases.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>To fully realize the interoperability goals of the 21st Century Cures Act, addressing the performance limitations of Bulk FHIR API is critical. It would be beneficial to include performance metrics in both certification and reporting processes.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/jamia\/ocae040","type":"journal-article","created":{"date-parts":[[2024,2,20]],"date-time":"2024-02-20T00:51:07Z","timestamp":1708390267000},"page":"1144-1150","source":"Crossref","is-referenced-by-count":7,"title":["Real world performance of the 21st Century Cures Act population-level application programming interface"],"prefix":"10.1093","volume":"31","author":[{"given":"James R","family":"Jones","sequence":"first","affiliation":[{"name":"Computational Health Informatics Program, Boston Children\u2019s Hospital , Boston, MA 02215, United States"}]},{"given":"Daniel","family":"Gottlieb","sequence":"additional","affiliation":[{"name":"Computational Health Informatics Program, Boston Children\u2019s Hospital , Boston, MA 02215, United States"},{"name":"Department of Biomedical Informatics, Harvard Medical School , Boston, MA 02115, United States"}]},{"given":"Andrew J","family":"McMurry","sequence":"additional","affiliation":[{"name":"Computational Health Informatics Program, Boston Children\u2019s Hospital , Boston, MA 02215, United States"},{"name":"Department of Pediatrics, Harvard Medical School , Boston, MA 02115, United States"}]},{"given":"Ashish","family":"Atreja","sequence":"additional","affiliation":[{"name":"Department of Health Innovation Technology, UC Davis Health , Rancho Cardova, CA 95670, United States"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0904-5905","authenticated-orcid":false,"given":"Pankaja M","family":"Desai","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Rush University Medical Center , Chicago, IL 60612, United States"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1121-0607","authenticated-orcid":false,"given":"Brian E","family":"Dixon","sequence":"additional","affiliation":[{"name":"Department of Health Policy and Management, Fairbanks School of Public Health, Indiana University , Indianapolis, IN 46202, United States"},{"name":"Center for Biomedical Informatics, Regenstrief Institute , Indianapolis, IN 46202, United States"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9532-2998","authenticated-orcid":false,"given":"Philip R O","family":"Payne","sequence":"additional","affiliation":[{"name":"Department of Medicine, Washington University in St Louis , St Louis, MO 63110, United States"}]},{"given":"Anil J","family":"Saldanha","sequence":"additional","affiliation":[{"name":"Department of Health Innovation, Rush University Medical Center , Chicago, IL 60612, United States"}]},{"given":"Prabhu","family":"Shankar","sequence":"additional","affiliation":[{"name":"Department of Health Innovation Technology, UC Davis Health , Rancho Cardova, CA 95670, United States"},{"name":"Department of Public Health Sciences, UC Davis Health , Davis, CA 95817, United States"}]},{"given":"Yauheni","family":"Solad","sequence":"additional","affiliation":[{"name":"Department of Health Innovation Technology, UC Davis Health , Rancho Cardova, CA 95670, United States"}]},{"given":"Adam B","family":"Wilcox","sequence":"additional","affiliation":[{"name":"Department of Medicine, Washington University in St Louis , St Louis, MO 63110, United States"}]},{"given":"Momeena S","family":"Ali","sequence":"additional","affiliation":[{"name":"Department of Health Innovation Technology, UC Davis Health , Rancho Cardova, CA 95670, United States"}]},{"given":"Eugene","family":"Kang","sequence":"additional","affiliation":[{"name":"Department of Health Innovation Technology, UC Davis Health , Rancho Cardova, CA 95670, United States"}]},{"given":"Andrew M","family":"Martin","sequence":"additional","affiliation":[{"name":"Department of Technical Services, Regenstrief Institute , Indianapolis, IN 46202, United States"}]},{"given":"Elizabeth","family":"Sprouse","sequence":"additional","affiliation":[{"name":"Double Lantern Informatics , Atlanta, GA 30305, United States"}]},{"given":"David E","family":"Taylor","sequence":"additional","affiliation":[{"name":"Department of Technical Services, Regenstrief Institute , Indianapolis, IN 46202, United States"}]},{"given":"Michael","family":"Terry","sequence":"additional","affiliation":[{"name":"Computational Health Informatics Program, Boston Children\u2019s Hospital , Boston, MA 02215, United States"}]},{"given":"Vladimir","family":"Ignatov","sequence":"additional","affiliation":[{"name":"Computational Health Informatics Program, Boston Children\u2019s Hospital , Boston, MA 02215, United States"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9781-0477","authenticated-orcid":false,"given":"Kenneth D","family":"Mandl","sequence":"additional","affiliation":[{"name":"Computational Health Informatics Program, Boston Children\u2019s Hospital , Boston, MA 02215, United States"},{"name":"Department of Biomedical Informatics, Harvard Medical School , Boston, MA 02115, United States"}]}],"member":"286","published-online":{"date-parts":[[2024,3,6]]},"reference":[{"issue":"1","key":"2024041923344478100_ocae040-B1","doi-asserted-by":"crossref","first-page":"151","DOI":"10.1038\/s41746-020-00358-4","article-title":"Push button population health: the SMART\/HL7 FHIR bulk data access application programming interface","volume":"3","author":"Mandl","year":"2020","journal-title":"NPJ Digit Med"},{"key":"2024041923344478100_ocae040-B2","author":"21st Century Cures Act","year":"2016"},{"key":"2024041923344478100_ocae040-B3","author":"Health and Human Services Department","year":"2020"},{"key":"2024041923344478100_ocae040-B4","author":"Office of the National Coordinator of Health Information Technology","year":"2023"},{"key":"2024041923344478100_ocae040-B5","author":"Promoting Interoperability 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