Investigating the Use of the Fast Health Care Interoperability Resources (FHIR) Standard to Support Data Activities Across the PCORnet® Infrastructure: Lessons Learned From the FHIR Pilots of the Coordinating Center for PCORnet®.
Date
2026-02
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Abstract
Background
Institutions that participate in PCORnet® transform their local electronic health record (EHR) data into the PCORnet® Common Data Model (CDM), which is then used to generate data extracts for PCORnet® Studies. PCORnet® Studies can also include institutions that do not participate in PCORnet, and for these organizations, the cost of instantiating a PCORnet® CDM can be prohibitive. Fast Health care Interoperability Resources (FHIR) provides an alternative method of obtaining EHR data.Objective
To determine whether data obtained through FHIR might be a viable study solution for those sites that do not participate in PCORnet.® This mixed-methods project had 2 objectives: (1) survey sites participating in PCORnet on the availability of FHIR (FHIR survey); (2) compare the coverage of a FHIR-based data extract using REDCap with one from the PCORnet® CDM across 3 sites (FHIR extract).Methods
(1) FHIR survey: A series of questions were asked about the use of FHIR in a production capacity. (2) FHIR extract: REDCap FHIR and PCORnet® CDM extracts were created based on study variables from 2 prior PCORnet® Studies. Data were extracted for 40 patients and concordance measures were computed between the 2 sources.Results
(1) FHIR survey: Of responding organizations, 73% (n=49) reported that FHIR was deployed in a production capacity. (2) FHIR extract: Results were highly variable. Cohen kappa ranged from 0.01 to 0.76 for certain diagnoses, 0.24 to 0.84 for laboratory results, and 0.1 to 0.87 for medications.Conclusions
Despite differences in data, certain studies may be well-suited for FHIR-based extracts.Type
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Publication Info
Marsolo, Keith, Darcy Louzao, Kim Hart, Peter Shrader, Jeffrey Hawley, Francesco Delacqua, Ellis Thomas, Joseph Wick, et al. (2026). Investigating the Use of the Fast Health Care Interoperability Resources (FHIR) Standard to Support Data Activities Across the PCORnet® Infrastructure: Lessons Learned From the FHIR Pilots of the Coordinating Center for PCORnet®. Medical care, 64(2S Suppl 3). pp. S233–S241. 10.1097/mlr.0000000000002236 Retrieved from https://hdl.handle.net/10161/34262.
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Scholars@Duke
Keith Allen Marsolo
Dr. Marsolo is a faculty member in the Department of Population Health Sciences (DPHS) and a member of the Duke Clinical Research Institute (DCRI). His current research focuses on infrastructure to support the use of electronic health records (EHRs) and other real-world data sources in observational and comparative effectiveness research and public health surveillance, as well as standards and architectures for multi-center learning health systems. He serves as faculty advisor to the DPHS DataShare Shared Facility and faculty lead for the Pragmatic Health Services Research (PHSR) functional group within the DCRI. Dr. Marsolo received his PhD in Computer Science from The Ohio State University, with a dissertation on data mining, specifically the modeling and classification of biomedical data.
Prior to joining DPHS, Dr. Marsolo was an an Associate Professor in the Division of Biomedical Informatics (BMI) at Cincinnati Children’s Hospital Medical Center (CCHMC). While at CCHMC, Dr. Marsolo served as faculty advisor for BMI Data Services, a shared facility that supported distributed data sharing networks and also developed registry platforms to support learning networks. These included a configurable system for capturing summary or practice-level measures, and a “data-in-once” architecture that allowed information to be collected in the EHR and then be automatically transferred to a registry in order to support chronic care management, quality improvement and research.Area of Expertise: Informatics, Data Quality, Common Data Models, Data Standards and Data Harmonization
Darcy Louzao
William Schuyler Jones
I am an interventional cardiologist with a specific focus on the diagnosis and treatment of patients with cardiovascular disease. As a clinician, I see patients in the office and do coronary and peripheral vascular procedures (angiography and interventions) in the Duke Cardiac Catheterization Laboratory. I have served as the Medical Director of the cath lab at Duke since 2016. Alongside my partners in the cath lab, we collaborate with our cardiothoracic surgeons to hold Heart Team meetings each week, and we frequently are asked to address complex cardiovascular issues as a multidisciplinary team.
I also have a broad background in cardiovascular site-based research, multicenter clinical trials, clinical event classification, and observational analyses. I have helped to lead clinical trial efforts at the Duke Clinical Research Institute (DCRI) by designing and conducting studies evaluating new and existing treatments for patients with coronary artery disease and peripheral artery disease. My specific research interests include examining access to care and disparities in care for patients with peripheral artery disease and the design and conduct of pragmatic clinical trials in cardiovascular disease.
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