FHIR Foundation Monthly Report - Feb/Mar 2018

Note: Combined report for Feb/Mar because of combination of HIMSS and FHIR ballot preparation at the end of February.


The main event during this period was HIMSS in Las Vegas. Over the past few years FHIR has transitioned from a coming idea that everyone was talking about to something that many institutions have in production and are now figuring out how to make the best use of. The strengths of FHIR are very different to those of v2 and CDA, so organizations have to start thinking differently about what they're trying to do. FHIR was evident in a number of presentations, particularly Eric Shmidt's keynote, and the government briefing given by Seema Verma & Jared Kushner. This year, HIMSS themselves organized a developer education stream with a strong FHIR focus, which seemed very successful. The highlight for me was a CIO/vendor forum convened by Aneesh Chopra and supported by the FHIR foundation, discussing future directions for the Argonaut project. One announcement at this forum was about the VA Lighthouse project - see below.


When I present about FHIR, I always say that FHIR is 2 things: a community, and a technical specification. And that the community is the more important thing - the amazing group of people that are the community, the priorities we have, the way we work. Events like HIMSS are proving strong recruitment grounds for extending the community. The FHIR Foundation is a key part of the community, but it's only coming together slowly. For our current members, thanks for your patience as we build our vision. I know not every one has a clear idea of what the FHIR Foundation is for. One thing - see this twitter exchange with Arian Malec: https://twitter.com/amalec/status/980258593155964929 My experience is that a typical consortium costs minimum US$500k. It's *hard* to get those $$ together - and I think an underlying problem for why health is so hard to wrangle. One of our core missions is to be a ready made consortium, so you just have to focus on the problem, not raising money. I've had some offline communications that there's still not really a value proposition for being a FHIR foundation member - yes, I agree. We *will* get there (competes with all the other things we do). Suggestions are always welcome. I've had several discussions with HL7 affiliates about the right way for the FHIR Foundation and HL7 affiliates to interact - I'm interested in comments, either here or directly.

VA Lighthouse: The Pledge & Patient Empowerment

The VA unveiled their lighthouse pledge:
We, the VA Open API Pledge signatories, will voluntarily collaborate with VA to map health data to industry standards (including the current and forthcoming versions of the Argonaut Project specifications of FHIR API over the next 18 months. We will allow access to FHIR as mutually agreed via a standards acceleration collaborative that will be made freely available for anyone to use or share. We will provide API access to developers for Veteran-designated mobile and web-based apps, clinician-designated applications for those who serve them, and choice care act partners responsible for coordinating their care via “bulk” access. We intend to make the “common clinical data set” available but will work on an initial roster of additional FHIR resources - including scheduling, questionnaire, clinical notes, and patient encounters.
This represents a logical progression of focus from vendors towards providers - moving further into the implementation life cycle. Vendors can't sign the pledge, but do need to support their provider customers if they take the pledge. This seems likely to be a significant development in the biggest and most internationally exposed Health IT market in the world. There's similar activities happening in other countries:
  • MedMij in the Netherlands
  • HL7 Australia is kicking off it's own Argonaut clone project (just starting)
There's lots of stuff happening now that I don't know about, or that I don't track when they're officially announced. If you know of a similar national program... let me know. This is part of a general groundswell of interest in empowering patients by providing access to data - though not that it's access to services, not data, that actually empowers people. But data comes before services. If you're interested in working to improve patient access and services (and I know that many FHIR foundation members are deeply involved with projects that do just that), consider joining SPM - we're discussing working with SPM around the VA pledge on the consumer side. Also, HIMSS is looking at a patient stream and we're talking to Matthew Holt (Health 2.0 -> HIMSS) and ePatient Dave around what that might look like. If you're interested in this, join us at https://chat.fhir.org/#narrow/stream/patient.20empowerment


HL7 has a formal collaboration with IHE (and has for years) and HL7 and IHE have collaborated variably well for a long time. There's some boundary issues between the organizations, and these move around, which can be challenging at times. With regard to FHIR, there's been some loose collaboration around FHIR - IHE has published FHIR profiles, but not using FHIR tooling to do so, and HL7 has tested out IHE profiles as part of the FHIR connectathons. But we could do better than that. There's new energy around collaboration between HL7 and IHE on FHIR profiles. It's too early to announce any specifics, but if you're interested in this subject, get in contact with Jürgen Brandstätter (J.Brandstaetter@codewerk.at) on the IHE side, or Wayne Kubick (wkubick@hl7.org) on the HL7 side.

Ballot Preparation

We're a week away from opening what is potentially the most significant ballot in the life cycle of the FHIR specification: the first normative ballot. Preparation is well in hand - the committees and editors have been working really hard for months on this. We're balloting the main FHIR specification, 6 implementation guides, and publishing 3 final copies of implementation guides... busy season. There's been a rash of minor changes to the normative candidate resources as the committees finalised issues prior to normative ballot. Mostly,these were alignment things for consistency between the resources. They generally didn't reflect real functional requirements changes. But we do expect a big ballot. On this subject: ballot sign up closes midnight April 5th (US time). If you're an HL7 voting member, you can sign up for free by going to the Ballot Desktop (Non-members can pay to be part of the ballot pool). While anyone can submit change proposals to the FHIR spec, it's the ballot process that drives the standardization process. Those who are in the ballot pool will have the final say on whether any FHIR content goes normative and if so, what. Comments submitted by balloters are therefore also treated with higher priority. And once the ballot opens, requests for substantive change to candidate normative content will have a higher bar to cross if they haven't come through the balloting process. So if you haven't signed up, definitely think about it. Note that if you don't sign up for normative ballot this time, you can't vote on the second normative ballot that may happen in September to confirm substantive changes

Cologne Connectathon Planning

Planning for the May Connectathon in Cologne is going slowly: clearly,we're going to have a much reduced turnout. We have every expectation that we'll have a massive connectathon in Baltimore in September as a result - but we would like to have as vibrant a connectathon in Cologne as we can. In particular, this is an opportunity to address European specific issues - such as GPDR, for which there is a specific thread. It's supposed to be too late for connectathon track proposals: but there's just a few days if any foundation members want to suggest European focused/relevant activities.

Educational Material

At HIMSS, there was quite a bit of interest in integrating access to educational material with an EHR. Something like this:
  • given a particular view in the EHR, suggest relevant educational material
    • (for the patient or for the care provider)
  • views of interest:
    • viewing a patient record
    • making a referral / diagnostic request
    • viewing a diagnostic request / referral
  • relevant educational material
    • provide external link
    • send it to (patient|contact|provider intray)
    • record use of the relevant documentation in the EHR
Talking to known interested parties, there seems to be enough interest for an HL7 project, possibly producing a FHIR implementation guide (join between PC and CDS for HL7 folks). if you're interested - contact me directly, and I'll hook you in.


Conversion between FHIR and CCDA remains a topic of great interest to US implementers. HL7 is working towards a project that will result in tools to convert from CCDA to FHIR and vice versa, though we expect that there will always be limitations and caveats around that.


There's a great deal of interest (and hype) around block chain at the moment, including in healthcare. The general perspective of the FHIR team is that most of the people looking to use blockchain for non-money related uses don't really understand the problems in healthcare. But in case the problem is that the FHIR team doesn't understand blockchain, a number of us met with some block chain experts in the day before HIMSS started. My report on that meeting is here: http://www.healthintersections.com.au/?p=2778. We're still talking about a blockchain stream at the Cologne or Baltimore Connectathons, looking at the audit trail aspect.


I was invited to a meeting of the Australian Physiotherapists Association to talk about FHIR. We haven't really have any interactions with this part of the healthcare domain, but perhaps we should? - they have some specific interests that are highly relevant for FHIR.

Upcoming Events

See also http://fhir.org/calendar (reminder: please let grahame@hl7.org or wkubick@fhir.org of FHIR related events)