FHIR Bulk Data Access (Flat FHIR)

General Information

Technologies must be operated and maintained in accordance with Federal and Department security and privacy policies and guidelines. More information on the proper use of the TRM can be found on the TRM Proper Use Tab/Section.

Website:	Go to site
Description:	Providers and organizations accountable for managing the health of populations often need to efficiently access large volumes of information on a group of individuals. For example, a health system may want to periodically retrieve updated clinical data from an EHR to a research database, a provider may want to send clinical data on a roster of patients to their ACO to calculate quality measures, or an EHR may want to display claims data to help close gaps in care. The data exchange often involves extracting a specific subset of fields from the source system, mapping the fields into a structured file format like CSV, and persisting the files in a server from which the requester can then download them into the target system. This multi-step process increases the cost of integration projects and can act as a counter-incentive to data liquidity. Existing FHIR APIs work well for accessing small amounts of data, but large exports can require hundreds of thousands of requests. This implementation guide defines a standardized, FHIR based approach for exporting bulk data from a FHIR server to a pre-authorized client.
Technology/Standard Usage Requirements:	Users must ensure their use of this technology/standard is consistent with VA policies and standards, including, but not limited to, VA Handbooks 6102 and 6500; VA Directives 6004, 6513, and 6517; and National Institute of Standards and Technology (NIST) standards, including Federal Information Processing Standards (FIPS). Users must ensure sensitive data is properly protected in compliance with all VA regulations. Prior to use of this technology, users should check with their supervisor, Information Security Officer (ISO), Facility Chief Information Officer (CIO), or local Office of Information and Technology (OI&T) representative to ensure that all actions are consistent with current VA policies and procedures prior to implementation.
Section 508 Information:
Decision:	View Decisions

Decision Source:	TRM Mgmt Group
Decision Process:	One-VA TRM v23.3
Decision Date:	03/29/2023 at 16:48:43 UTC
Introduced By:	TRM Request
Standards Body:	HL7

Vendor Release Information

The Vendor Release table provides the known releases for the TRM Industry Standard, obtained from the vendor (or from the release source).

Version	Release Date	Vendor End of Life Date	Vendor Desupport Date
v1.0.0: STU 1	08/22/2019
v1.1.0: STU 2	04/16/2021
v2.0.0: STU 2	11/26/2021

Current Decision Matrix (02/24/2023)

Users must ensure their use of this technology/standard is consistent with VA policies and standards, including, but not limited to, VA Handbooks 6102 and 6500; VA Directives 6004, 6513, and 6517; and National Institute of Standards and Technology (NIST) standards, including Federal Information Processing Standards (FIPS). Users must ensure sensitive data is properly protected in compliance with all VA regulations. Prior to use of this technology, users should check with their supervisor, Information Security Officer (ISO), Facility Chief Information Officer (CIO), or local Office of Information and Technology (OI&T) representative to ensure that all actions are consistent with current VA policies and procedures prior to implementation.

The VA Decision Matrix displays the current and future VA IT position regarding different releases of a TRM entry. These decisions are based upon the best information available as of the most current date. The consumer of this information has the responsibility to consult the organizations responsible for the desktop, testing, and/or production environments to ensure that the target version of the technology will be supported. Any major.minor version that is not listed in the VA Decision Matrix is considered unapproved for use.

Legend:

White	Approved: The technology/standard has been approved for use.
Yellow	Approved w/Constraints: The technology/standard can be used within the specified constraints located below the decision matrix in the footnote[1] and on the General tab.
Gray	Unapproved: This technology or standard can be used only if a POA&M review is conducted and signed by the Authorizing Official Designated Representative (AODR) as designated by the Authorizing Official (AO) or designee and based upon a recommendation from the POA&M Compliance Enforcement, has been granted to the project team or organization that wishes to use the technology.
Orange	Divest: VA has decided to divest itself on the use of the technology/standard. As a result, all projects currently utilizing the technology/standard must plan to eliminate their use of the technology/standard. Additional information on when the entry is projected to become unapproved may be found on the Decision tab for the specific entry.
Black	Prohibited: The technology/standard is not (currently) permitted to be used under any circumstances.
Blue	Planning/Evaluation Constraint:The period of time this technology is currently being evaluated, reviewed, and tested in controlled environments. Use of this technology is strictly controlled and not available for use within the general population. If a customer would like to use this technology, please work with your local or Regional OI&T office and contact the appropriate evaluation office displayed in the notes below the decision matrix. The Local or Regional OI&T office should submit an inquiry to the TRM if they require further assistance or if the evaluating office is not listed in the notes below.

Release/Version Information:

VA decisions for specific versions may include a ‘.x’ wildcard, which denotes a decision that pertains to a range of multiple versions.

For example, a technology approved with a decision for 7.x would cover any version of 7.(Anything) - 7.(Anything). However, a 7.4.x decision would cover any version of 7.4.(Anything), but would not cover any version of 7.5.x or 7.6.x on the TRM.

VA decisions for specific versions may include ‘+’ symbols; which denotes that the decision for the version specified also includes versions greater than what is specified but is not to exceed or affect previous decimal places.

For example, a technology approved with a decision for 12.6.4+ would cover any version that is greater than 12.6.4, but would not exceed the .6 decimal ie: 12.6.401 is ok, 12.6.5 is ok, 12.6.9 is ok, however 12.7.0 or 13.0 is not.

Release	Q1	Q2	Q3	Q4	Q1	Q2	Q3	Q4	Q1	Q2	Q3	Q4
<Past	CY2023				CY2024				CY2025				Future>
v1.0.0: STU 1	Approved	Approved	Approved	Approved	Approved	Approved	Approved	Approved	Approved	Approved	Approved	Approved
v2.0.0: STU 2	Approved	Approved	Approved	Approved	Approved	Approved	Approved	Approved	Approved	Approved	Approved	Approved
Note:	This standard is backwards compatible and recommended implementation of most current version. Please contact the VHA Office of Standards & Interoperability (Mailgroup: vhas&iresponseteam@va.gov) prior to implementation to obtain guidance and the VHA-endorsed version of this standard.

References

The following reference(s) are associated with this entry:
Type	Name	Source	Description
Policy	Standards Version Advancement Process	ONC	ONC has established the voluntary Standards Version Advancement Process (SVAP)1 to enable health IT developers’ ability to incorporate newer versions of Secretary-adopted standards and implementation specifications, as part of the “Real World Testing” Condition and Maintenance of Certification requirement (§ 170.405) of the 21st Century Cures Act.
Policy	170.215(a)(4) Application Programming Interface Standards Implementation Spefication	Code of Federal Regulations	FHIR Bulk Data Access (Flat FHIR) (v1.0.0: STU 1), including mandatory support for the “group-export” “OperationDefinition” (incorporated by reference in § 170.299).
Requirement	170.315(g)(10) - Standardized API for patient and population services	ONC	This Certification Companion Guide (CCG) is an informative document designed to assist with health IT product development. The CCG is not a substitute for the 21st Century Cures Act: Interoperability, Information Blocking, and the ONC Health IT Certification Program Final Rule (ONC Cures Act Final Rule). It includes extracts of preamble and regulation text from the ONC Cures Act Final Rule with accompanying clarifying interpretations. To access the full context of regulatory intent please consult the ONC Cures Act Final Rule or other included regulatory reference. This CCG is for public use and should not be sold or redistributed.
Policy	Information Blocking	ONC	Most clinical information is digitized, accessible, and shareable thanks to several technology and policy advances making interoperable, electronic health record systems widely available. In 2016, the 21st Century Cures Act (Cures Act) made sharing electronic health information the expected norm in health care by authorizing the Secretary of Health and Human Services (HHS) to identify `reasonable and necessary activities that do not constitute information blocking.` ONC``s 2020 Cures Act Final Rule established information blocking exceptions to implement the law.
Vendor Provided*	Bulk Data Access IG	HL7	Providers and organizations accountable for managing the health of populations often need to efficiently access large volumes of information on a group of individuals. For example, a health system may want to periodically retrieve updated clinical data from an EHR to a research database, a provider may want to send clinical data on a roster of patients to their ACO to calculate quality measures, or an EHR may want to display claims data to help close gaps in care. The data exchange often involves extracting a specific subset of fields from the source system, mapping the fields into a structured file format like CSV, and persisting the files in a server from which the requester can then download them into the target system. This multi-step process increases the cost of integration projects and can act as a counter-incentive to data liquidity. Existing FHIR APIs work well for accessing small amounts of data, but large exports can require hundreds of thousands of requests. This implementation guide defines a standardized, FHIR based approach for exporting bulk data from a FHIR server to a pre-authorized client.
*NOTE: Vendor provided information is subject to the accuracy of the manufacturer.

Standard Components

Note: This list may not be complete. No component, listed or unlisted, may be used outside of the technology in which it is released. The usage decision for a component is found in the Decision and Decision Constraints.
Source	Name	Description
No components have been identified for this entry.

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Domain Area	Category	Customer Guidance	Category Locked By ELT Date
Health Care Standard	Health Care Standards
Information Management Technologies Data Integration	Data in Motion (Common Message Terminology and Semantics)

Technologies/Standards Relationships

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VA Technical Reference Model v 24.3

General Information

Vendor Release Information

Current Decision Matrix (02/24/2023)

References

Standard Components

VA Categories View the VA Categorization Framework

Technologies/Standards Relationships

Implemented By/Verified With:

Comparable Standards:

Associated Standards:

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VA Technical Reference Model v 24.3

General Information

Vendor Release Information

Current Decision Matrix (02/24/2023)

References

Standard Components

VA Categories View the VA Categorization Framework

Technologies/Standards Relationships

Implemented By/Verified With:

Comparable Standards:

Associated Standards:

General Analysis

Adoption Benefits

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