Traditional HL7 integrations can cost anywhere from $50,000 to over $750,000, while modern API-based integrations range from just $25,000 to $400,000. This stark cost difference highlights a core challenge for healthcare organizations: legacy systems are not only inefficient but also a significant financial drain. The path forward lies in adopting modern standards like the Fast Healthcare Interoperability Resources (FHIR) Bulk API, a framework designed to support large-scale data exchange securely and cost-effectively. 

At ENTER, we specialize in applying these next-generation APIs to create AI-enabled revenue cycle management solutions that eliminate data silos and strengthen financial performance through structured human oversight.

This article explores how healthcare organizations can harness the FHIR Bulk API to modernize their revenue management. We cover the fundamentals of FHIR, key use cases in population health and research, and practical integration strategies for major electronic health record (EHR) systems like Epic and Cerner. By understanding the cost-saving benefits and operational advantages of the FHIR Bulk API, your organization can stay competitive in a rapidly evolving, data-driven healthcare ecosystem.

Understanding FHIR Bulk API

FHIR is a standard for exchanging healthcare information electronically. The Bulk API is a specialized component of the standard designed specifically for large-scale data exports.

Basics of FHIR Standards

Developed by Health Level Seven International (HL7), FHIR is built on modern web standards, including RESTful APIs and JSON, making it more flexible and easier to implement than older standards like HL7 V2. It defines a set of "Resources," such as Patient, Observation, and Claim, that represent discrete clinical and administrative concepts.

What Is the FHIR Bulk API?

The FHIR Bulk Data Access (Bulk API) specification provides a standardized, secure method for exporting large volumes of data from a FHIR server. Instead of retrieving records one at a time, clients can request an entire dataset for a group of patients, which is then exported into a secure file container for download and processing.

Benefits of Using FHIR Bulk API

The FHIR Bulk API improves interoperability by enabling more seamless data exchange between disparate systems, reducing the fragmentation that often slows down clinical and financial operations. The API also enhances operational efficiency by automating large-scale data exports, which reduces manual extraction tasks and accelerates reporting and analytics. Additionally, the Bulk API supports regulatory compliance by meeting the interoperability requirements outlined in the 21st Century Cures Act, helping organizations maintain audit-ready, API-driven patient data access.

Key Use Cases of FHIR Bulk API

The FHIR Bulk API supports several high-impact use cases across healthcare, enabling organizations to work with large datasets more efficiently..

In population health management, organizations can export datasets for entire patient groups, allowing care teams to analyze trends, coordinate services, and intervene earlier in chronic disease pathways. Clinical research teams also benefit, gaining the ability to efficiently access de-identified EHR data to support trials and observational studies, which significantly accelerates discovery and reduces operational friction. Public health agencies can also securely collect data from multiple healthcare organizations for disease surveillance, emergency response, and public health initiatives using the Bulk API.

Together, these capabilities make the Bulk API an essential tool for any organization seeking to use data more strategically.

Implementing FHIR with Major EHR Systems

Leading EHR platforms now have extensive support for FHIR, enabling more streamlined integration models.

Integration With Epic

Epic provides a robust set of FHIR APIs, including support for bulk data export. Developers can access FHIR resources and the developer sandbox to build and test applications that align with operational and security requirements.

Integration With Cerner

Cerner (now part of Oracle Health) also supports extensive FHIR API capabilities and maintains a developer program with documentation for Bulk API workflows. Their implementation enables broad access to clinical and administrative resources for more efficient data exchange.

Comparing FHIR and Traditional HL7 Integrations

The shift from legacy HL7 to modern FHIR APIs represents a fundamental evolution in how healthcare data is exchanged today.

Differences in Data Exchange Processes

Traditional HL7 V2 messages are often complex, pipe-and-hat-delimited strings that require custom parsing and point-to-point interfaces. In contrast, FHIR uses modern, web-standard RESTful APIs that are easier for developers to work with and far more flexible and scalable. This modern approach simplifies integration, builds, and reduces long-term maintenance demands.

Cost Implications and Potential Savings

As noted earlier, the cost differences are significant. A traditional HL7 interface may require more than $50,000 up front, with additional ongoing maintenance fees. FHIR API integrations, built on standardized resources and modern web protocols, can cost as little as $25,000. This reduction is driven by FHIR’s simplified development model, reusable components, and more efficient testing and deployment workflows.

Challenges in Implementing FHIR Bulk API

Despite its advantages, implementing the FHIR Bulk API introduces several considerations that require planning and technical expertise.

Data security remains a core concern, as exporting large volumes of PHI introduces significant security risks. Organizations must implement strong access controls, encryption, and audit logging to protect data.

Integration complexity can also present challenges. While FHIR is more intuitive than HL7, organizations must still map internal data models to standardize FHIR resources and coordinate API workflows across systems.

Organizational resistance is another common hurdle. Shifting from legacy systems to a modern, API-first approach requires a change in mindset and can face concerns from IT staff accustomed to traditional methods.

Best Practices for Successful FHIR Integration

A strategic implementation plan is essential to maximize the value and impact of FHIR-based integrations.

Successful organizations begin with a clear use case, such as automating prior authorization or improving eligibility verification, and adopt a phased rollout that starts with a minimum viable product (MVP) to demonstrate early value. Throughout the process, maintaining strong security and compliance controls is critical. This includes encryption of data in transit and at rest, well-designed access governance, and robust audit trails to support accountability and oversight.

Leveraging FHIR for Improved Revenue Management

The FHIR Bulk API provides significant opportunities to enhance revenue cycle efficiency and financial performance.

FHIR enables faster, more automated exchange of claims, eligibility, and remittance information, which accelerates payment cycles and reduces administrative workload. Its standardized data structures also improve accuracy across systems, helping prevent the documentation and coding inconsistencies that often lead to claim denials, rework, and lost revenue.

Driving Cost-Effective Revenue Management With Modern FHIR Architecture

The FHIR Bulk API offers a clear path forward for healthcare organizations looking to move beyond the high costs and inefficiencies of legacy data exchange. By adopting this modern interoperability standard, you can unlock meaningful cost savings, enhance operational efficiency, and build a more data-driven foundation for revenue cycle management. While the transition requires thoughtful planning and a security-first approach, the operational and financial returns make it a strategic investment for any organization preparing for the future of healthcare data exchange.

Ready to move past costly, outdated integrations? Contact ENTER today to learn how our FHIR-native, AI-powered platform can help you modernize your data infrastructure and transform your revenue cycle.

Frequently Asked Questions 

What Is the Cost Breakdown of EHR Implementation? 

EHR implementation costs vary significantly, ranging from tens of thousands for small practices to millions for large hospital systems. Expenses include software licensing, hardware, implementation services, training, and ongoing maintenance. Using standardized APIs like FHIR can reduce integration costs and shorten deployment timelines.

What Is the Purpose of the FHIR Program? 

The FHIR program, developed by HL7, aims to establish a universal standard for exchanging healthcare data electronically. Its purpose is to simplify interoperability and enable systems from different healthcare vendors to communicate more seamlessly.

How Can a Healthcare Organization Improve Its Revenue Cycle Management? 

Organizations can strengthen their revenue cycle management by automating manual tasks, enhancing data accuracy, streamlining communication with payers, and leveraging analytics to identify and address bottlenecks.  Modern technologies, including FHIR APIs and AI-driven automation, play a central role in optimizing claims workflows and accelerating reimbursement.

What Are the Benefits of Having a Robust Health Information Infrastructure? 

A strong health information infrastructure supports better care coordination, enhances patient safety, improves population health initiatives, enables clinical research, and reduces administrative overhead. It also ensures a more reliable foundation for compliant, audit-ready data operations.

How Does the FHIR Bulk API Support Audit-Readiness and Compliance?

​The FHIR Bulk API facilitates cleaner, standardized data flows, which improve traceability and reduce discrepancies across systems. This consistency strengthens audit trails, supports regulatory reporting, and reduces the risk of errors that can lead to compliance issues or reimbursement delays.