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Q. In the United States, I understand that the ONC allows us to charge a fee for 3rd parties to access our FHIR APIs, especially if it is to offset the costs to support the APIs. For example, if we needed a developer support team to review and triage issues and questions.

Is anyone doing this in practice in the FHIR community in the U.S.A? How has that gone with your 3rd party developers?

Keep in mind that within the United States context, you cannot charge for patient API access… although it is permissible to charge reasonable and non-discriminatory fees for API usage by clinician facing apps.

I think the details were more around who you can charge and what you can charge for.

My understanding is that you can charge app developers for value added services, and you can charge customers (healthcare organizations, not 3rd party app developers) for USCDI / patient access. “Developer support, issue triage, and answering questions” are a bit of a grey area. If you have stellar documentation and a working sandbox, than I think answering questions could fall under “value added services” and could be charged for. However, if your documentation is lacking and you have no test sandbox, then answering questions is probably essential for using your APIs, and you probably can’t charge? Issue triage may fall under the normal work you’d do to maintain a product, so likely would be covered by the fees you’d bill the health system.

Our goal is to not have to answer questions or provide dev support to USCDI app developers. But since the first pass (or first dozen passes) of documentation isn’t perfect, we answer (for free) questions from app developers and use that process to help drive documentation improvements, so we get fewer questions over time.

Also, based on my experience, often we get questions from app developers that start with USCDI, but quickly move into non-USCDI. So you can sometimes jump between 21CCA pricing rules and value added services in the same conversation. It gets fun…

*Special disclaimer: I’m not an expert on the pricing aspect of 21CCA. There are other folks that pay closer attention to this to make sure we comply, but I think my comments reflect our general approach.

170.404 - Application programming interfaces is the applicable section (the Cornell Law version has better formatting). Specifically, section (a)(3).