It’s been just over a year since certified Health IT developers aligned their Health IT Modules with the requirements outlined in the Cures Act Final Rule. As part of this transformative update, developers of certified application programming interface (API) technology completed certification to 45 CFR 170.315(g)(10) Standardized API for patient and population services. We’re excited to report that as of this blog post’s publication, over 290 products have been certified to §170.315(g)(10) within the ONC Health IT Certification Program (Certification Program).

But certification isn’t a one-time event; it’s an ongoing commitment. There are essential obligations to support ongoing conformance to Certification Program requirements. As outlined in 45 CFR 170.404 (the “API Condition and Maintenance of Certification”), certified API developers must, among other things, comply with ongoing transparency, fees, and openness and pro-competitiveness conditions as well as ongoing maintenance requirements associated with certified API technology. This includes making “service base URLs” in a patient access context publicly available through the ONC Certified Health IT Product List (CHPL).

Monitoring Availability of Service Base URL Lists

To ensure service base URL lists continue to be available and accessible to the public, two monitoring tools are available: Lantern and the CHPL Service Base URL List Uptime report. These resources and their functions complement each other and help ensure the accuracy and reliability of health IT products.

Lantern

The ONC-led project, Fast Healthcare Interoperability Resources (FHIR®) API Monitoring Service, otherwise known as Lantern, was created to help ONC monitor and publicly provide nationwide analytics about the availability and standardization of FHIR API service base URLs (“FHIR Endpoints”) deployed by healthcare organizations. Lantern gathers information from FHIR Capability Statements returned by these endpoints and provides visualizations to show FHIR API and patient data availability. As ONC reported in August 2023, Lantern continues to identify challenges that may limit widespread implementation of FHIR-based APIs.

For more information about the data sources, algorithms, and query intervals used by Lantern, please review the available documentation.

CHPL Service Base URL List Uptime Report

The Service Base URL List Uptime report provides information on the public availability of the service base URL provided by the developer of any product listing certified to § 170.315(g)(10) listed on CHPL. These URLs are checked once an hour, Monday through Friday; the report provides information on how many of those checks were returned successfully and flags failed responses. The report captures the total tests and successful tests on these URLs, providing a percentage of successful access to these service base URLs. This report is available on the ONC Program Resources page and is updated monthly to ensure transparency with §170.315(g)(10).

Ensuring Compliance with API Requirements

ONC uses Lantern and the CHPL Service Base URL List Uptime Report to ensure uniform and consistent conformance to API Maintenance of Certification requirements, to coordinate with industry to address challenges, and to make the findings and FHIR API implementation monitoring results open to the public. This ensures the knowledge base is public and that the health IT industry and community can work together to implement APIs without special effort.

While the Service Base URL List Uptime report tracks whether the service base URLs for each listing are regularly accessible, Lantern goes one step further by tracking daily whether endpoints discoverable through the service base URLs are accessible and provide a FHIR capability statement upon request. Together, these tools provide first and second level of oversight to this certification requirement.

While the data from Lantern and the results in the CHPL Service Base URL List Uptime report do not immediately impact a developer’s certification status, the information is publicly available for developers and users to monitor the availability and accessibility of service base URLs.

Developers are ultimately accountable for the information presented in CHPL that enables Lantern and the Service Base URL List Uptime report to assess accessibility of their service base URLs and they are expected to make reasonable efforts to avoid disrupting the use of their API technology. To assist developers service and support the availability of their API technology, ONC intends to contact developers if their URLs are recurrently unavailable so they may work with their ONC-Authorized Certification Body (ONC-ACBs) and take the necessary steps to rectify any identified URL accessibility issue.

We believe that with this combined monitoring and engagement effort, developers of certified API technology will be better able to ensure their API products remain accessible to all users.

As always, certified developers can connect with their ONC-ACBs for more information on how to ensure they maintain compliance with Certification Program requirements. We encourage all stakeholders to familiarize themselves with the resources provided above, and we welcome questions through the ONC Health IT Feedback and Inquiry Portal.