After a decade on FHIR, where are we at?

This week saw international standards body HL7 celebrate the 10th anniversary of the adoption of the FHIR specification, which has since become one of most widely used standards in the world for healthcare interoperability. Created by Victorian Grahame Grieve and now adopted by any global health software company worth its salt, FHIR is widely touted as nothing short of a revolution in health IT.

We remember doing some of the first reporting on FHIR back in the early days, when we were alerted to the concept by former chair of HL7 Australia Klaus Veil. Klaus told us back in 2012 that FHIR was “the latest trending interoperability technology that has taken the eHealth world by storm”, and he was right. The promise was that it would be faster, easier and far more comprehensible than standards like HL7 v3, which got so bogged down in its own complexity that it was pretty much dropped.

FHIR, on the other hand, is so good that even the clueless amongst us – this reporter in particular – can grasp its value. We sat in on an HL7 New Zealand webinar this week on how medication management software developer Medi-Map has implemented FHIR, and we actually understood it. (Well, most of it.) We also reported this week on the first local implementation of Cerner’s FHIR service, with Melbourne’s Austin Health putting up its hand to pilot the capability in a real-life setting in a big, complex hospital.

Austin Health is also planning to leverage Microsoft’s FHIR capabilities and has some pretty big plans for what it can achieve with the new capability down the track. It is starting slowly, but the plan is that the other Cerner sites in Australia – which include quite a number of large public health services in Melbourne as well as most of NSW and the whole of Queensland – will be looking closely at what it is up to. After years of bad press, Cerner is kicking quite a few goals recently, and the notoriously secretive company is also increasingly open to scrutiny. This is a good thing.

Victoria is also in the news as it continues to grapple with the extended COVID-19 outbreak. Victorian health services like to do their own thing under the state’s decentralised system, and all are hard at work rolling out different ways to manage the pandemic. We’ve recently looked at Gippsland’s approach using the LifeguardMobile platform, as well as Ballarat Health Services’ BHS at Home model, which uses Smart Health Solutions’ Patient Watch module.

We were pretty impressed this week with the approach taken by the Loddon Mallee Health Network, which is using existing technology from Data Capture Experts and repurposing it for COVID-19 home monitoring. While telehealth has taken the prize for the most widely embraced technology during this pandemic, we think remote monitoring will be up there with it as a modality that will become business as usual.

Changes have been afoot elsewhere in political circles, with New Zealand getting a new opposition leader and Australia set to lose its health minister as he retires at the next election. Last week in our poll we asked if you thought Greg Hunt was a good health minister. The majority did – 58 per cent to 42 per cent – but there were some interesting comments in the negative.

This week we ask:

Has FHIR lived up to its promise of revolutionising interoperability?

If yes, why? If no, what is the problem?

Vote here or leave your comments below.


+1 # Kate McDonald 2021-12-17 10:42
Has FHIR lived up to its promise of revolutionising interoperabilit y? 40 per cent of respondents said yes, but 60 per cent said no. We also asked your thoughts on why.

- Taken time, but getting there.

- FHIR is gaining international support which will influence the major international vendors operating in Australia. The Draft National Healthcare Interoperabilit y Plan out for consultation has included use of FHIR in several proposed actions to drive interoperabilit y in Australia.

- no way to organise secure messaging profits

- FHIR promotion is largely in the hands of excited technocrats and the use cases are not promoted in English. We should run 3 registries and a comprehensive referral model pilot with current industry players

- No GP related services using it.

- Vendors too slow to implement

- We are yet to come across a single health service in Australia that uses FHIR.

- Slow adoption in healthcare traditionally known for its slowness

- It has opened the way for flexibility between legacy systems and new options for data exchange

- FHIR is a technical solution. It does nothing to address the bigger problem of exchanging meaningful clinical information. More data is not the answer, better curated information is.

- It’s just another tool. It offers nothing more. It’s just as hard and just as “non standard” as the other 20 odd “standards” are. We just have yet another standard we pretend to

- Because its easy to enhance

- It’s improved the situation but healthcare electronic communication is still way complicated to attract the universal standards adoption needed. e.g. communication between Primary Care, Specialists and Acute Care.

- We use for all of our integration internally

- FHIR is based on simple, commonly used IT approaches that make it easy to understand and implement.

- Previous attempts at progressing beyond HL7 V2.x, e.g. CDA and V3 took complex custom approaches that invariably led to "White Elephant" standards and systems...

- So today we find that HL7 2.x and FHIR are "it" in healthcare systems interoperabilit y!

- A little bit of FHIR (formerly known as RFH) history:

- not yet - it certainly has the potential - but things change slowly in Health IT

- It's open, free and interactive, and has developers onboard, as well as many clinicians, who can see how to translate their old validation of clinical concepts.... Who knows how a clinician could have understood how to modify an off-the shelf HL7 v3 specification?

- We have started a project off the back of a FHIR repository and it shows a lot of promise, big step up from standard HL7 which is problematic for images in the non radiology space

- Too few people are using it and there is no real trigger event to make interoperabilit y happen

- XML Schemas are still too complex.

- Can't connect

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