Stratum Health ยท Field Guide

Where FHIR fits in the health data lifecycle

A plain-language map for public health and EHR-savvy readers. No engineering background required.

FHIR (Fast Healthcare Interoperability Resources) is the technical standard that lets different health systems share data in the same format: a common language instead of hundreds of one-off translations.
Health data still moves inconsistently between the systems that create it and the systems that need it, including the county and state agencies doing population health work. FHIR is the federal government’s chosen fix for that, and as of 2026 it’s no longer optional in several parts of the pipeline. Here’s where it’s required, where it isn’t yet, and why each stage matters.
1
Point of care
A patient visit gets documented
Where FHIR shows up Not yet. This is inside the EHR itself, where the visit note, diagnosis, medications, and labs get entered. Since January 2026, federal rules require this information to be captured using a standard set of categories and codes (USCDI), so it can be turned into FHIR data cleanly at the next step.
Why it matters If this step isn’t standardized, nothing downstream works well, including public health reporting. Inconsistent data at the exam room becomes inconsistent data everywhere it travels after.
2
Required, universal
The EHR opens a standard door
Where FHIR shows up Every certified EHR (Epic, Oracle Health/Cerner, athenahealth, and others) is required to expose a FHIR-based connection point. The requirement comes from ONC, the HHS office that sets EHR certification standards, and it holds in practice because providers need a certified EHR to qualify for Medicare and Medicaid incentive payments. Think of it as a universal plug replacing hundreds of proprietary sockets.
Why it matters This is the step that actually makes modern data-sharing possible. Apps, registries, and researchers can now request data the same way, no matter which EHR a clinic happens to use.
3
Fastest-moving, right now
Data moves between organizations
Where FHIR shows up Regional health information exchanges and the new national network (TEFCA) are increasingly required to support FHIR-based requests, alongside older document-based methods still common today. New security requirements took effect in January 2026, tightening how organizations verify each other before data can flow.
Why it matters This is where federal deadlines are actively pushing hospitals, health systems, and insurers this year. It’s also where friction still lives: not every network has caught up, and older formats are still doing a lot of the real work behind the scenes.
4
Three destinations, three speeds
The data reaches its destination

Public health reporting

Case reporting for reportable diseases already runs on FHIR and works well. Routine hospital admission and lab-result feeds that counties rely on day-to-day often still run on older formats.

The biggest real gap for public health work today. Case reporting is more modern than the everyday feeds a county actually needs.

Payer & quality

Insurance plans, including Medicaid, must now give patients FHIR-based access to their own claims and care history, and support electronic prior authorization.

Faster record access for patients and providers, though driven by insurance compliance, a different track with different incentives than public health.

Research & population health

No requirement to use FHIR here. Whatever arrives, FHIR-based or not, gets converted into formats built for population-level analysis, not individual care.

The step that turns raw records into the county-level picture public health teams actually need, and the one most often left out of the interoperability conversation.

The big picture

FHIR is now mandatory at the EHR’s front door and is being pushed hard at the exchange layer by 2026 federal deadlines. But it thins out fast once data reaches public health and research use, which is exactly where the last-mile work still has to happen by hand today.