Blog – FHIR Version 1.0

Check out this blog discussing FHIR. While the initial post seeks to simplify the intent of FHIR to a practical application (essentially a summary document), if you read the author’s own comments on their post, they are already starting to realize the real value of FHIR.

FHIR creates the platform, and the summary document is an application of the platform.

Open mHealth vs. HL7 FHIR

OK, so check this out. I signed up to the mailing list for Open mHealth, an initiative that promotes the use of designs and technologies that I believe in, like REST APIs and JSON. They have started to post some documentation and specs, and have even have published some early implementation code. They have some discussion going on in a Google Group.

But what I am trying to figure out is how this relates to HL7’s FHIR. They seem to be using the same tools with similar missions.

It will be interesting to see which one gets traction:

  • the open initiative (seemingly) driven by the user community (doctors and people working in hospitals), or;
  • the standard from the well-established and accepted healthcare standards body

It reminds me of MINT (open community) and DICOM Working Group 27‘s (standards body) output (but in this case it was many of the same people involved in both).

In general, the open community moves faster, drives rapid innovation, and gets lots of attention, but the established healthcare IT vendor community often waits for the responsible standards body committee to provide a formal, consensus-driven specification (with design controls and governance around it to prevent unexpected changes), before implementing the API. Also, initiatives like IHE will typically only reference final standards in their integration profiles.

Plug-ins vs. APIs

Without endorsing the product represented (I have not looked at it at), I think this blog post is covering some important points (and is well written, so do have a look).

Some thoughts, though…

Pet peeve of mine: The smartphone app metaphor is a bit overused in enterprise software that manages personal healthcare information. When a physician is making a life-altering decision about my (or my loved ones’) care, I would hope that they are relying on something with a bit more vigilance around it than something that they downloaded along with a Kanye West tune. I want something that is “battled tested” and properly integrated in the enterprise (see ITIL Change and Configuration Management) before being used clinically in the hands of healthcare providers. Call me paranoid.

Look, I get it. Users like downloading and using “apps”. But, the expression of desire for “apps” is properly translated in a desire for more flexibility and responsiveness from their healthcare IT vendor(s)–people like the personal experience of the control that downloading apps provides them and speed of innovation (with a decent platform, apps can be developed with massive parallelism–think Army of Nerds) , but if Angry Birds makes a mistake, no one dies (well, a bird, I suppose–never played the game so I am only guessing).

I may get some flame mail from respected friends for this one: open source applications are also not the (complete) answer. Sure, its fun to be able to change and extend source code (and to become a hero by fixing bugs yourself instead of waiting for a fix from your vendor), but for every “coder” I have met only a small percentage that really understand the full scope of work of professional software development required to produce an application to the quality we need in healthcare. Don’t get me wrong: I love hackers. They break through barriers and solve problems with practical methods. But, their output typically needs a lot more work to make something that is production ready. Great power, great responsibility, and all that.

The reality is: we don’t need a bunch of user-downloadable apps or developer-modifiable source code. We need APIs. Good ones. REST-based Web service APIs. Documented, well-designed and tested. Supported. Unbreakable, secure ones.

When done right, APIs are contracts. Promises. They aren’t some side-door or limited set of functions added as an afterthought. They become the language by which applications speak to each other, even internal parts of an application.

Healthcare standards like DICOM and HL7 standards include APIs, just ones based on older technologies and protocols. The information model is still pretty solid, I would argue, so we don’t need completely new “words”, just some different ways to communicate.

Oh, and products with great APIs are generally higher quality because it is much easier to write automated tests to beat the crap out of them before unleashing them on to the world.

More on this topic later.

The Future of Image Sharing

I have been keeping tabs on some of the work in standards groups; most notably HL7’s FHIR and DICOM WG-27’s DICOMweb™ APIs: WADO-RS, QIDO-RS and STOW-RS. I think the ‘awakening’ to REST based Web APIs and the willingness to accept the use of data in new forms (e.g. metadata in JSON vs. traditional DICOM C-FIND RSP), marks a watershed moment in the healthcare IT industry. I spent some time looking at a project focused on image sharing and tried to see what impact these changes might have on how it manages data. Check it out.