FHIR Ecosystem

FHIR Connectathon: Your Healthcare Information is in Good Hands

The future for you as a patient, a healthcare provider, or a vendor of healthcare software is going to be impacted by FHIR. 

And I am happy to report that your healthcare information is in good hands – 590 pairs of good hands to be exact!

I recently spent three days online with 589 other healthcare data interoperability experts at the 29th HL7 FHIR Connectathon working on data standards for enabling you to share your healthcare information with all your healthcare providers. In all, we participated in 43 different tracks and tested 54 FHIR Implementation Guides!

While we did not have your individual healthcare information to work with, we are designing a FHIR Interoperability Ecosystem that can capture the base facts about your health status, the diagnoses by your healthcare providers, the goals for improving your health, the medications and treatments needed, and the outcome from those medications and treatments.  And, just as importantly, ensuring that specific portions of this information can be shared, when necessary, with your various healthcare providers.

I have been participating in the HL7 development of the FHIR standard since its initiation in 2013. Throughout my career as a software architect, I have periodically participated in data standards efforts starting in 1989 with the formation of the SQL Access Group with database vendors such as Oracle and Ingres to standardize the SQL query language and standardize a Call Level Interface to enable client/server applications to access data stored in any relational database system. 

Sound familiar? That standard has evolved over the last 33 years to support the relational database ecosystem we have today. I also participated in several other standards efforts between 1989 and 2013. Each of these efforts leveraged new technology to create layers of standardized software that led to the creation of software tools for creating innovative applications in a variety of industries. The FHIR builds on these layers and tools to create a standardized software layer for the healthcare industry.

While HL7 FHIR is an international standard, this blog will focus on the FHIR Interoperability Ecosystem in the United States. The industry and government organizations involved in designing and testing these data standards in the United States are shown in the diagram above. All these organizations had representatives at the FHIR Connectathon last week 

Industry Standards Organizations: HL7 collaborates with IHE, IEEE, NEMA (DICOM), and OMG on the creation of the base healthcare standards. FHIR is the most recent standard from HL7 but HL7 continues to also evolve and support both the HL7 V2 standard and the CDA standard that is used extensively in real-world systems. The most recent release of the FHIR base standard is documented online.

US Government Agencies: The Office of the National Coordinator (ONC)  and the Centers for Medicare and Medicaid Services (CMS) are the two primary government agencies that set interoperability rules in the United States. They have recently issued interoperability rules that require EHR vendors to support client application access to a subset of the data defined in the base FHIR standard using the standard FHIR API. The standards referenced by these rules were developed and tested over the last few years by HL7 Working Groups and FHIR Accelerator Projects in a series of three FHIR Connectathons each year.

FHIR Accelerator Projects: Seven FHIR Accelerator Projects have been launched by industry software vendors to collaborate on the design of data standards in a specific area of the healthcare industry. For example,  the Argonaut Project was launched in 2014 by EHR vendors to collaborate on the creation and testing of FHIR Implementation Guides that define and test how their products will support access to patient data. The Argonaut Project Implementation Guides were the basis for the ONC and CMS interoperability rules. The Da Vince Project was launched in 2018 by providers and payers to collaborate on the creation and testing of FHIR Implementation Guides for sharing information about patient health and patient insurance benefits. The Da Vinci Implementation Guides will be the source for ONC and CMS interoperability rules related to sharing patient health and patient benefit information.

FHIR Taskforces: The FHIR at Scale Taskforce (FAST) was launched in 2020 to identify FHIR scalability gaps and define solutions to address current barriers and identify needed infrastructure for scalable FHIR solutions. The FAST task force is investigating scaling problems that are not covered by the FHIR Accelerator projects including barriers such as patient identity, security, patient and provider directories, and testing and certification that may prevent the scaling of the solutions from FHIR Accelerators.

The future for you as a patient, a healthcare provider, or a vendor of healthcare software is going to be impacted by FHIR. Contact me if you want more information about what that impact will be on you or if you would like to join us in an HL7 Working Group, a FHIR Accelerator, or a FHIR Taskforce. 

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