Most vendors now using APIs to expand EHR functionality, says ONC

Most vendors now using APIs to expand EHR functionality, says ONC

The University of California San Francisco, Office of the National Coordinator for Health Information Technology, the California Health Care Foundation and ScaleHealth developed a survey to learn about application programming interface integrations, barriers faced during API integration and API-relevant policy efforts.


ONC indicated in a HealthIT Buzz blog on Thursday that the study published in JAMIA last month not only showed high levels of adoption of the Fast Healthcare Interoperability Resources standard among the healthcare technology companies surveyed, but EHR companies implemented standards-based APIs and made them available to third-party users “well before” the December 31, 2022, deadline requiring that they use HL7’s FHIR standard for certified APIs.

“This new data reveals the wide use of the technology among the intended users – third-party application and software developers,” said ONC study authors Wes Barker, Catherine Strawley and Benjamin Rosner in the post.

The study also indicated that about 57% of respondents said they used both standards-based and proprietary APIs to integrate with an EHR, with 24% stating they worked about equally with both APIs. 

“Companies face barriers to adopting standards-based APIs, including high fees, lack of realistic clinical testing data and lack of data elements of interest or value,” the researchers said in the study report.

Barker, Strawley and Rosner explained further in ONC’s blog that these results “validate other concerns raised by health IT community members, especially app developers and other digital health companies, about the limited scope of the current certified APIs and barriers to entry like fees, data access and developer support, that affect realization of APIs ‘without special effort’ as called for in the 21st Century Cures Act.”


Certain requirements in ONC’s recent HTI-1 final rule also aim to resolve “some persistent barriers by reducing the effort to use these APIs,” Barker, Strawley and Rosner noted.

“Specifically, standardizing requirements to publish electronic FHIR endpoints and adopt the United States Core Data for Interoperability version 3.” 

HTI-1 established that USCDI v3 would be the only USCDI version required within the Certification Program as of January 1, 2026. The agency published USCDI 4 standards last year. At this time, ONC is seeking comments on Draft USCDI Version 5.

These standards for access, exchange and use of electronic health information are a key resource for nationwide interoperability for information blocking compliance. 

Breach of info blocking rules could cost noncompliant providers thousands.

The Cures ACT, which codified secure, programmatic access to a patient’s electronic health information in 2016, means “information sharing is expected” according to National Coordinator for Health IT Micky Tripathi and CMS Principal Deputy Administrator Jonathan Blum in an article about disincentives for healthcare providers and consequences. 


“Studies like this enable ONC and its partners to better understand the needs of the community and evaluate the implementation of health IT policies,” Barker, Strawley and Rosner said on the agency’s blog.

Andrea Fox is senior editor of Healthcare IT News.

Healthcare IT News is a HIMSS Media publication.

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