Notice of Intent to Sole Source Development and Implementation of FHIR Infrastructure

Performance Work Statement Base Period: 9/01/2026 – 08/31/2027 Title: Development and Implementation of FHIR Infrastructure to Support EHR Data Collection for the National Health Care Surveys SECTION 1 – BACKGROUND AND NEED The National Health Care Surveys Data Modernization initiative aims to improve the timeliness, volume, and quality of electronic health record (EHR) data received for health care surveys, while modernizing workflows and reducing reporting burden for health care data providers. This initiative uses a multi-pronged strategy that includes: Adoption of widely used health information exchange standards (e.g., CDA and FHIR) Collaboration with key partners, including EHR vendors and standards development organizations such as HL7 Alignment with current Health IT policies and regulatory requirements The National Health Care Surveys currently receive production EHR data aligned with the Clinical Document Architecture (CDA) standard. However, a central goal of the modernization effort is to transition toward more contemporary standards, particularly Fast Healthcare Interoperability Resources (FHIR). FHIR is becoming the de facto standard in Health IT regulation for enabling interoperability across health care and public health systems. Continued advancement toward FHIR-based exchange is therefore essential for the National Health Care Surveys to remain current and aligned with evolving regulatory expectations. In 2024, the Division of Health Care Statistics (DHCS), National Center for Health Statistics (NCHS) conducted a pilot with three health care sites (across two clinical sites) to evaluate the timeliness and quality of FHIR-based interoperability between EHR systems and NCHS. This pilot leveraged the Health Data Exchange Application (HDEA), the Health Care Surveys (HCS) FHIR Implementation Guide, and its associated Reference Architecture (RA). From a process perspective, the pilot assessed the feasibility of more real-time, automated data exchange approaches compared with the existing, more manual CDA-based workflows. Although the pilot showed promise, EHR vendors were hesitant to adopt the HDEA and subscription-based model due to concerns about clinical data security, limiting our ability to fully evaluate its impact on data timeliness and volume since submissions remained largely manual. These concerns would likely persist or intensify if scaled to more providers and vendors. Additionally, while the HDEA enables near real-time, encounter-level reporting, this approach may not align with the National Health Care Surveys’ preference for periodic (e.g., weekly or monthly) submissions to support data modernization goals, suggesting that an automated batch solution such as Bulk FHIR may be better suited to DHCS’ needs. To that end, Bulk FHIR is designed for population-level data exchange. It retrieves thousands to millions of records in a single export job at predetermined intervals (e.g., weekly) with asynchronous processing. The use of Bulk FHIR, which delivers data in large batches at periodic intervals, drastically reduces API calls and network traffic when working with large populations and enables scalable population level analytics. From a regulatory standpoint, the ONC 21st Century Cures Act Final Rule requires health IT developers to support both the FHIR Rest API and the Bulk FHIR API by December 31, 2025. As such both options should be widely available across certified EHRs. To that end, it is essential for the National Health Care Surveys to build a robust FHIR infrastructure that aligns with evolving regulatory requirements to include both FHIR Rest API and Bulk FHIR API. Doing so will ensure readiness to test and receive FHIR test and production data, while enabling continued progress in systems modernization as regulations advance. Having this infrastructure in place is essential to advancing FHIR testing with EHR systems. It is equally important to remain adaptable, as technology and requirements evolve rapidly; we must be prepared to adjust and design systems that can be readily configured to align with an evolving regulatory and technical landscape. Reference: The ONC 21st Century Cures Act Final Rule added a certification criterion (§ 170.315(g)(10)) that requires standardized APIs based on HL7® FHIR® Release 4 for patient and population services. Certified API technology must implement these FHIR-based APIs to meet certification requirements for EHRs and other certified health IT. Therefore, to achieve our objectives, the National Health Care Surveys needs to procure contractor support to build out this robust, responsive, and adaptable FHIR infrastructure and advance FHIR testing in electronic health record systems located in ambulatory care and hospital settings, using (in part) the previously mentioned APIs. To complete this work, the Contractor must at a minimum be familiar with the following tools and technologies in order to work on the Healthcare Electronic Health Records (HEHR) platform: Java, Python, and its corresponding server-side technologies (e.g., JDK 1.8.0, Micro Services, Spring REST, Spring JPA/Hibernate, Enterprise Messaging, Web Application Development, and Web Services Architectures). SQL Server 2016, 2017, and 2019. No SQL database management systems. Microsoft Azure Cloud technologies include but not limited to Databricks with Azure DevOps for continuous integration and continuous delivery. R, SAS 9.4 or higher versions. HTML5, Angular JS 8.0; and Tomcat 9.0. Initially, the HEHR platform was hosted by CDC on premises. More recently, it successfully migrated to the Enterprise Data Analytics and Visualization (EDAV) platform utilizing Microsoft Azure Services. EDAV has an isolated Confidential Information Protection and Statistical Efficiency Act (CIPSEA, 44 U.S.C. 3561-3583) enclave for storing and processing CIPSEA-protected data. The HEHR capabilities still exist on premise…