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Section 1c: FHIR®
Section 3: Implementation Guides

HL7 FHIR® Implementation Guide: Bulk Data Access, Edition 3

DESCRIPTION

This Implementation Guide intended to be used by developers of backend services (clients) and FHIR Resource Servers (e.g., EHR systems, data warehouses, and other clinical and administrative systems) that aim to interoperate by sharing large FHIR datasets. It defines secure FHIR export Operations that use this capability to provide an authenticated and authorized client with the ability to register as a backend service and retrieve all data in a FHIR server, data on all patients in a server, or data on a group of patients while optionally specifying data since a certain date. Applications can use the bulk data export functionality to facilitate data transfer among back-end systems, various organizations, and for reporting or public health use cases.

ALTERNATIVE NAMES

HL7 FHIR® Implementation Guide: Bulk Data Access, Edition 3 may also go by the following names or acronyms:

flat fhir, bulk, ndjson, export

TARGETS

  • Clinical and Public Health Laboratories
  • Immunization Registries
  • Quality Reporting Agencies
  • Regulatory Agency
  • Payors
  • Pharmaceutical Vendors
  • EHR, PHR Vendors
  • Clinical Decision Support Systems Vendors
  • Lab Vendors
  • HIS Vendors
  • Local and State Departments of Health
  • Healthcare Institutions (hospitals, long term care, home care, mental health)

 

BENEFITS

  • Defines a standardized, FHIR based approach for exchanging bulk data between a FHIR server and a pre-authorized client, since FHIR REST APIs work well for accessing small amounts of data, but large exports can require hundreds of thousands of requests. 
  • Enables organizations to transmit batches of data for entire populations or cohorts from data systems to apps or other organizations for workflows like provider to payer reporting or data migrations between systems
  • Facilitates regulation for more standardized methods for transmitting all health data and reporting 
  • Example Scenarios
    •  Migration of data between one electronic medical record for clinical data repository and another
    • Transmission of patient records for reporting use cases between payors and providers 
    • Full backup of data contained within a clinical data repository 
    • Exporting groups of patients between systems that should only have certain access based on business contracts
    • Combination of Federated Data Systems for reporting or public health use cases on populations level data

IMPLEMENTATIONS/CASE STUDIES

  • Boston Children’s Hospital
  • Centers for Medicare & Medicaid Services (CMS)
  • 1upHealth
  • Google
  • Microsoft
  • Epic
  • Oracle
  • Meditech

DEVELOPMENT BACKGROUND

Activities such as managing population health, delivering value-based care, and conducting discovery science require access to large population data sets. The existing FHIR and SMART APIs work well for accessing small amounts of data, but large exports perform poorly, requiring an impractical number of API requests to be issued serially. By adding asynchronous primitives to FHIR and defining an export operation, the Bulk Data API enables secure integration of third-party, externally-hosted applications into diverse EHR and data warehouse environments.
 
On behalf of the ONC, The Boston Children’s Hospital Computational Health Informatics Program and SMART hosted a meeting in December 2017 to discuss standardizing bulk data exports from EHR systems and data warehouse environments. This meeting brought together key stakeholders from across health care, including the Director of the Office of the National Coordinator for Health Information Technology (ONC) and other members of the ONC staff, as well as representatives from payers, health systems, EHR vendors, and other health technology innovators. 
 
Subsequently ONC awarded Boston Children's Hospital and 1upHealth the LEAP grant to test Bulk Data APIs at scale for data transmission and analytics which further bolstered the testing and development of the specification up to the balloting of the standard with HL7.

RELATED DOCUMENTS

HL7 FHIR® Implementation Guide: Bulk Data Access, Edition 3

STU DOCUMENTS

HL7 FHIR® Implementation Guide: Bulk Data Access, Edition 3 See the standard at http://hl7.org/fhir/uv/bulkdata/STU3. (Submit Feedback on STU)
HL7 FHIR® Implementation Guide: Bulk Data Access IG, Release 2 See the standard at http://hl7.org/fhir/uv/bulkdata/STU2. Expiration Nov 2023

TOPICS

  • Medical Records
  • Patient Administration
  • Patient Care
  • Patient Referral
  • Public Health
  • Security and Privacy

BALLOT TYPE

  • STU

STATUS DATE

2025-12-11

RESPONSIBLE WORK GROUP

FHIR Infrastructure

PRODUCT TYPE

  • Implementation Guide

STAKEHOLDERS

  • Clinical and Public Health Laboratories
  • Clinical Decision Support Systems Vendors
  • EHR, PHR Vendors
  • Healthcare Institutions
  • HIS Vendors
  • Immunization Registries
  • Lab Vendors
  • Local and State Departments of Health
  • Payors
  • Pharmaceutical Vendors
  • Quality Reporting Agencies
  • Regulatory Agency

FAMILY

  • FHIR

CURRENT STATE

  • Active

REALM

  • Universal