John, appreciate the feedback (and link back to your earlier Blog Post), completely agree; now what do you suggest? Count us in!
]]>Paul, I agree that wider industry-adoption remains the goal, and “At Scale” now figures into a lot of these conversations. You are correct one-size may not fit all; however, we want to be careful not to fractionalize the community by “segment the user base” … we are still a community by-and-large. But whole heartily agree this is a definite calling to “industry execs and govt. leaders” to recognize the power of this community and the “art of” the possible. Appreciate the support and feedback.
]]>Yes! We expect a record number of attendees in Baltimore!
]]>Cheers, Michel
]]>It’s a relief seeing that some are noticing the illusions and myths that are being created around FHIR.
The work and the tectonic shift by the HL7 warriors that brought FHIR to life is laudable to a great extent.
But sometimes I wonder if the FHIR team is getting real-world feedback from those that have to implement this currently and in the future.
Everyone seems to believe that only vendors work with interoperability. Large healthcare systems have to deal with it as well because they are unable to rely on vendors to solve all of their problems. As a matter of fact, vendors only solve a small portion of the interoperability requirements.
We already have RESTful API gateways in place which share information across the spectrum with OAuth2 authorization standards to allow access to entities or (resources). Just to name a couple of technologies.
If being standard means scrapping those efforts and only using FHIR resources and their relationships then we are going to continue down the path of using HL7 where most needed and doing our own stuff elsewhere, just like it has been done with HL7 v2.x and the CCD, I hesitate to even mention HL7 v3.0 because I’ve not yet seen an implemented data model based on the RIM.
If we are going to rely on conformance statements that say what we support and what not then we will end up with the same situation as with DICOM and IHE. In DICOM the non-standard way of using tags by many modalities makes it difficult to integrate with CAD and other similar software. IHE adopters tend to only implement a few transactions of a profile while claiming to conform to the entire profile, XDS-b being a common one.
I don’t think it’s a fault of a particular group, but I don’t think the standards are being built to what has brought us to this current hodge-podge state that we are in. We have tons of legacy systems with data models built with the concepts of the 70s; abhorrent SQL code and ETL that intertwines everything in an almost undecipherable way. Just building the resources requires to get the data out of the cryptic state into an EDW and then presenting the resources to consumer applications whether internal or external in a form that FHIR specifies.
FHIR helps solve the tip of the iceberg problem and it is ideal for new development, but does FHIR help address the underlying massive rock of the iceberg problem? This is where most of the data lives. Some tend to call this rock a “data lake”.
These are just memes from someone that has to work daily with the realities within healthcare systems data.
]]>There’s a Part II to the story in the blog post. My relative had to be transferred to the flagship hospital of the system she was admitted to in this latest encounter. That flagship hospital did not have electronic access to the records accumulated at the smaller hospital in its own system! That’s unforgivable in my opinion and points right back to the problem I mentioned earlier – current technology is not the barrier to making interoperability happen. The problem is the people who ‘own’ (I use that word loosely) and manage the data and the decisions they are making or not making to cooperate with interoperability. I think vendors have culpability as Mr. Hudson notes. My understanding is that some of the big players “don’t agree with the standards.” Isn’t like like GM saying they don’t agree with seat belts? And some providers share in the culpability – they consider the data “theirs” and are loath to share it because, I suppose, it represents a certain kind of intellectual capital? It leads me to wonder, sadly and somewhat frighteningly, that if there isn’t a clear business benefit to sharing information, is it not a priority? Is this about money and stock value instead of patient safety and quality of care?
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