FHIR Foundation Report for March 2019

Apologies again for missing the February report – I lost Feb due to travelling way too much, and March was heads down getting ready to publish a big set of Implementation Guides for ballot (or trial-use formal releases) at the end of the month. After this month’s investment, publishing IGs should be much more scalable than it was before.

Though sometimes I wonder whether that’s actually a good idea – we are at capacity (or beyond it) for the existing community to review what’s coming out at high rate now. Any chance the FHIR foundation members get, you should encourage anyone in the community to take part in ballot review. I know it’s kind of tiresome to review: the timing never matches your own commercial cycle of interest, but if you don’t invest in review, then you won’t get what you want. And if no one reviews…. Everyone says that consistency between guides is a primary concern- and it certainly is, but in the end the only way to ensure alignment is by human review. We can provide tooling, and will, but if you want to see an example of this at work, check Michele Mottini’s excellent cross-comparison of the Argonaut/US-Core spec and the International Patient Summary (mainly European lead) – his review is driving change in the future specifications to get better alignment.


HIMSS (in Orlando: just another small meeting)

Other than the usual Orlando transportation problems, many people told me that the biggest theme at HIMSS was FHIR. I think that’s a simplification; the real theme was making integration real between all the software everyone has bought. Naturally, that means FHIR - that’s not going to be a controversial statement to the FHIR Foundation ;-). I’m pleased to see the work of the community being recognised, and it’s good, I think, that the community is now starting to think about how to leverage all the investment that’s gone by better. Also thanks to HIMSS (and Hal Wolfe) for making that transition evident in the program.

Obviously a lot of the discussion was driven by the notice of proposed rule making (NPRM) that came out on the Monday of the conference. The NPRM had a strong focus on FHIR (though other standards featured, happily). The focus for the FHIR community and foundation and HL7 has to be how can the community scale further?

I was happy (I think) that no one reported any bad FHIR puns from the floor of the exhibition, though I did hear a few in presentations of one kind or other. I’m taking this as a demonstration of maturity on the part of the industry, though I still think that we have a long way to go in terms of completing the journey (more on that below).

Commiserations to the FHIR Foundation members who had their laptops stolen from a van while they were at the HIMSS FHIR dinner 

I did an interview with Mr HIStalk after HIMSS – see https://histalk2.com/2019/03/25/histalk-interviews-grahame-grieve-fhir-architect-and-interoperability-consultant/. You too – like the rest of the world – can feel free to let me know if I got any of my responses wrong.


Almost immediately after getting home from HIMSS, some of us turned around and headed to Delhi in India for the Global Digital Health Partnership Meeting. This is very much a government policy maker’s equivalent to the technical meetings we’re used to – a community to foster growth of capacity in health interoperability at that level. I was invited to this meeting courtesy of the Australian Digital Health Agency. Some 18 countries or so were in attendance, and I met with representatives from many of them.

There’s clearly a maturity process that government leaders have to go through before they’re ready to seriously engage with a standards community – from outside, it seems arcane and needlessly complex. We’ve done what we know how to do to make FHIR as less like this as possible, but it seems to be inevitable. Some countries are further down the road of this understanding than others who look at the whole standards thing and decide they can do better by doing their own thing. Empirically, it’s unlikely that they well, but it seems that most governments have to learn this the hard way (each election, for some countries)

One big message that was loud and clear from the policy makers is that the relationship between HL7 and IHE needs to be better explained (at least) to help them figure out how to choose the right standards and partners – more on that below.

The bestest fun of the whole meeting was going to a “European” restaurant at the end of the meeting because everyone was ‘so sick of curry’ (that’s heresy!) and trying out interoperability between Spotify and the 3.5mm speaker jack at the restaurant – much harder than anyone expected (I do not think Health is doing so bad after all….)



I mentioned the Gemini project – a joint project between HL7 and Gemini – back in June last year. I haven’t reported on it since – it’s slowly gathering steam, and is serving both as a general meeting place between HL7 and IHE, and specifically it is running some joint projects and preparing others.

Given the feedback from the GDHP meeting, we’ll be putting more work into Gemini to make it more prominent and get better coordination between IHE and HL7 (though I think that more than just joint technical projects will be required).

FHIR Accelerator

HL7 Announced the FHIR accelerator project at HIMSS. This is a formal partnership mode between HL7 and other organizations that are not formal Standards Development Organizations where by HL7 will work with implementers to facilitate FHIR acceleration and adoption activities. HL7 provides formal standards process / community backing to projects that need the organizational capabilities HL7 can bring.

We’re still working out the details of the FHIR Accelerator project(s), but FHIR community members can be sure that we will support any organization that wants to follow the standard FHIR community process, whether they are FHIR accelerator or now. We’re working on bringing more formal expectations and documentation around how this works, including working with this through Gemini.

Da Vinci

The Da Vinci project is a US based project covering Payers and Providers (and their vendors) with HL7 support that helps both payers and providers to positively impact clinical, quality, cost and care management outcomes. The Da Vinci project is looking at various workflow issues that make healthcare outcomes – both in terms of efficiency of provision and in terms of patient health – less than optimal that may be amenable to improvement through interoperability, and specifying new interface APIS to solve those.

Da Vinci is very active and is starting to produce lots of Implementation guides for different identified problems in the healthcare process.

Personal Healthcare Interfaces

One of the areas that Da Vinci is starting to work on is bring the patient and their carer into the process. They have proposed creating an implementation guide for patient focused software to report on things like supply delivery, device usage, etc.

This is interesting because you could easily imagine a whole different set of organizations wanting to say something about how FHIR should be used in patient accessible software running on a hand-held device, all with a different focus. And so the developers of that softward might find themselves implementing lots of different IGs – is that the right outcome? Or should we try and impose some management process such that there’s only one, or a few, patient Implementation Guides? Were not sure which is better – there’s pros and cons with all approaches. Comment is welcome (here).

Data Transfer Project

Mark Zuckerberg (Facebook CEO) wrote an op-ed in a number of prominent US papers today where as one of his initiatives he mentioned the “Data Transfer project”. For details, see https://datatransferproject.dev/dtp-overview.pdf. It looks like a very early version of FHIR to me – clearly there is a lot of water to go under the bridge before it’s something real that can actually be implemented.

I hope that when it gets to the Health Vertical, the project will come talk to FHIR. If you’re at one of the DTP member companies, can you keep tabs on the project? Thanks… (cause it could be really big, or really not)

Future of FHIR Foundation

The HL7 Board has informed the FHIR Foundation Board that the existence of the FHIR foundation creates corporate issues for HL7, and proposed that the FHIR Foundation close down. It proposes that the important activities of the FHIR Foundation be moved within HL7 under a newly created implementation branch.

The FHIR Foundation board is discussing this request, and how to respond. I realise that I’ve falled badly behind posting board minutes I undertake to catch up on this in the next few days, and then I’ll provide a more complete report to the FHIR members. I’ll be looking for comments from FHIR Foundation members about how to proceed. (I realise that the FHIR foundation hasn’t been as successful as we’d like, and this is one reason why, but we value the contribution you’ve all made, and we want to know what you think)

Kennedy Space Centre

I travelled to HIMSS this time with family – they checked out the Orlando theme parks. But I did go to Kennedy Space Center with them – and that’s an awesome place to visit. The photo is of the Saturn 5 moon rocket a junction between 2 of the phases of the rocket. It’s basically physical interoperability (and if you want to see how fragile the junctions are, check this video at about 1:20).

The comparison between the Saturn 5 program safety record and the reports into the Challenger and Columbia disasters was interesting and informative. The Saturn 5 program was driven by the fear that the Russians would win, where the Shuttle program has lost the management edge that created, and managers had got complacent. I feel that this speaks to us in FHIR – we could easily lose our edge, and start making decisions for program convenience than because they’re needed.

Hold on to your fear. And what to be afraid of:

All of us will be patients one day