1. HL7® FHIR® Applications Roundtable
Keynote
Grahame Grieve
Washington 27-Sept 2018
HL7® FHIR® Applications Roundtable

2. HL7 Organizational Strategy
Enhance the public image and achieve recognition by stakeholders as the leading SDO for worldwide health data interoperability standards
Secure long-term sustainable revenue to realize the vision and improve customer experiences (internal and external)
Establish FHIR as the primary standard for global health data interoperability
Enhance and maintain quality of and accessibility to HL7 standards in current use

3. Establish FHIR as the primary standard
Increase understanding of FHIR usage and value of usage worldwide (Immediate)
Achieve symbiotic link of brand and financial benefit between HL7 and FHIR. (Immediate)
Demonstrate the value of FHIR in enabling interoperability (Midterm)
Ensure resources are most effectively focused to enhance FHIR (Midterm)

4. Big features in R4 Normative Core
Significant investment in Implementation Guide publishing
Bulk Data API
Support for multiple versions
Extensive new areas

5. FHIR R4 Normative! Some parts of R4 balloted as normative
Definition Infrastructure, Data types, XML and JSON formats, RESTful API
CodeSystem, ValueSet, ConceptMap, StructureDefinition
Patient
Observation
The rest of R4 will still be Standard for Trial Use (STU)
Normative = no breaking changes (? Meaning)

6. R4 Normative Ballot Report
Round #2 Closed 2 days ago
Infrastructure: Passed
Conformance & Terminology: Not passed
Reconciliation expected be possible
May need a special recirculation ballot
Patient: Passed
Observation: Passed
We still expect to publish normative FHIR R4 at end of December

7. Inter-Version Support
Paying more attention to supporting multiple versions
Ongoing Connection Stream
Defines the media type parameter “fhir-version” e.g.
Accept: application/fhir+json; fhir-version=3.0
Define the $versions operation
Add a page about supporting multiple versions

8. Bulk Data Support
Expand FHIR to support extraction of large amounts of data
HTTP API for long running requests
Format suitable for large amounts of data
Semantics to request a large amount of data
Implementation Guide maintained by the Smart Group
+ Primitive operations as draft in the specification
Technicals:
Backend services authentication
Asynchronous Request pattern
Format: ND-Json vs Avro/Parquet/Protobuf/

9. New Content in the specification
Public Health Case Reporting and Reportability Responses
Occupational Data for Health
Laboratory Test Catalog
BiologicallyDerivedProduct ( blood transfusion, and hematopoietic cell transplant material.)
Medical Device Nomenclature/Vocabulary Service
Insurance Plans
Improvements to Subscription
Medication Registration Process?

10. R5 Plans We’ve been on 18 month cycle Normative Content:
R5 expected August 2020
Will review plans late 2019 (market survey)
Normative Content:
Patient summary information (= US CDI)
More of conformance infrastructure / terminology service
Continue to flesh out domain functionality
Adapt publishing/conformance to support v2 / CDA
As yet, no agreed plans (January meeting)

11. Gartner Technology Adoption Curve

12. Where is FHIR on the Hype Cycle?
Wes Rishel’s criteria for the slope of enlightenment:
One or more well-defined, application-specific market segments
Full adoption by a small portion of the market
Predictability in assessing project risk and timing, based on experience with the technology
Reasonable labor pool of experienced developers
Conformance testing
The development body of knowledge in market
Having been through the “trough of disillusionment”

13. Where is FHIR on the Hype Cycle?
Where are the click-bait postings on problems with FHIR?
Where are the failures of early startup vendors?
I’ve heard is some grumbling among sidecar-app vendors:
they thought using FHIR would make it easy to sell.
problems getting big company CIOs to take their calls
Focus not moved from technology to selling and delivery.
“So, as much as I would like to be at Gartner positioning FHIR on the slope I would almost surely still place it pre-trough”

14. FHIR Use around the world
Projects in many countries (all continents)
Some in production
Lots in pre-production
National EHRs adopting FHIR
Speed variable based on project life cycles & shape
Many using XDS + CDA – what’s the migration pathway?

16. FHIR Status in Australia
National Clinical Terminology Service ( other countries)
Provider Directory Project (supporting secure messaging)
Document access to national health record for mobile apps
Lots of internal use in vendors (Telstra)
Some classic interop in GP space
Appointments / decision support
Not in common use in institutions yet

17. FHIR Certification FHIR Proficiency Certificate being introduced now
Basic Test for knowing the specification (R3)
Can sit and pass at WGMs or any time/any where
FHIR Professional Certification coming
Hard – requires deep knowledge of the specification
Prerequisites: practical experience, creating resources
Introduction in 2018

18. FHIR & Disruptive Change
Primary uses of FHIR:
Patient access to Data
Application eco-system around health record systems
Data Analytics
Specific purpose repositories
Enabling Decision Support

20. Empowering Patients Making data accessible to Patients
Making Data from patients accessible to system
Allowing patient to control data sharing
Creating a single common patient record
Services not Data are empowering

21. Coordinated Care Common Frustration of Patients:
Scheduling/Communication problems
Conflicting care plans / payment options
Conflicting system definitions of success
Must be resolved by the patient
FHIR enables Services for
distributed care plan
virtual clinical review
Virtual Institutions
Integrated Home Care (medication management)

22. FHIR & Disruption FHIR disrupts healthcare (& healthcare it):
Significantly reducing the cost of data exchange
Making it easy and natural to use the web
Encouraging the development of open community
Building a solid base to scale computation about healthcare
At the same time as wider web / open community transforms are happening.

23. Getting involved FHIR is an idea: Part of a web of open communities
Open source community knowledge is treasure we can build on
Open community is the best way to develop common infrastructure
Part of a web of open communities
Localised FHIR communities (e.g. country/language)
Domain specialties, other open communities
Get involved!
FHIR Open Community:
Spanish language:
Create your own community