Bulk FHIR ($export): Population-Level FHIR Data Export
Bulk FHIR is the FHIR Backend Services specification for asynchronous population-level data export. Three core operations: $export (kick off), $export-poll-status (check progress), $export-cancel. Required by ONC certification criteria.
How Bulk FHIR works
A backend service authenticates via SMART Backend Services (a JWT-based OAuth flow) and issues an $export request — at the system, group, or patient level. The EHR processes the export asynchronously, packages the resulting FHIR resources as NDJSON files, and exposes the files for download. The client polls $export-poll-status until ready, then downloads the NDJSON files.
Why Bulk FHIR matters
Population-level analytics requires exporting large numbers of patient records. Pre-Bulk-FHIR, this required either custom EHR data extracts or row-by-row FHIR API calls (impractical at population scale). Bulk FHIR standardizes the population export — same protocol across Epic, Cerner / Oracle Health, AthenaHealth, and other certified EHRs.
Where Bulk FHIR appears
- ACO data exchanges (CMS Claim and Claim Line Feed alternatives, payer-to-provider exchanges).
- Public health surveillance pulls.
- Population-level quality measure calculation.
- Research data extracts under appropriate IRB and consent frameworks.
Where Vizier fits
Vizier's Epic and Oracle Health connectors use Bulk FHIR for population-scale data refresh where supported. Bulk FHIR + targeted incremental updates is the most efficient way to keep large populations in sync with the analytics layer.