The Standard

The HL7® FHIR® at Scale Taskforce (FAST) continues to translate national interoperability policy into implementable, real-world infrastructure. This month marks several major milestones, including the opening of the FAST Consent Ballot, the official publication of FAST Identity STU 2 and FAST Security STU 2, and continued progress on FAST National Directory toward STU 2. This reinforces the growing momentum toward CMS-Aligned Networks powered by FAST. 

These advances demonstrate how standards, trust frameworks, directory infrastructure and testing at scale converge to support scalable, secure and interoperable data exchange across the healthcare ecosystem. 

FAST Consent Ballot: Advancing Scalable, Network-Ready Consent 

The FAST Consent Implementation Guide (Edition 1 – US Realm) has entered formal HL7 balloting, providing the industry with a practical, interoperable approach to consent management at scale. 

The guide is designed to support: 

• Computable and portable consent representations across organizational and network boundaries 

• Subscription-based workflows for consent updates and downstream disclosures 

• Alignment with FAST Identity, FAST Security, and FAST Directory infrastructure 

• Use cases spanning payer-to-payer exchange, provider workflows, HIEs, and consumer-mediated access 

The International Patient Summary (IPS) is a key standard for global interoperability. Its goal is to create a common foundation for patient summary exchange across borders and ensure the ability to share key information with caregivers whenever and wherever needed. Several nations and international organizations have selected the IPS as a baseline for their summaries, and recently major electronic health record (EHR) and health information technology (IT) vendors have shared their planned implementations. These include Epic, MEDITECH, CommonHealth, Google, Patient Centric Solutions, VeroSource and Verto Health. Like many successful standards, today’s progress has been years in the making.

The HL7 FHIR at Scale Taskforce (FAST) UDAP Security for Scalable Registration, Authentication and Authorization Implementation Guide (FAST Security IG) was designed to streamline and secure data exchange across different healthcare stakeholders. This blog post seeks to dispel common misconceptions about the complexity of implementing the FAST Security IG. 

April 24 Session Focuses on Importance of Testing and Connectathons for Implementation Success

In this timely overview, which allows you to prepare to participate in upcoming May, July and September Connectathons, the HL7 Da Vinci Projectwill highlight a key component of implementation: testing.

Experts and hands-on participants will outline why testing is important, the terms used in testing and how testing events, such as Connectathons, are organized and critical to implementation success. Who should be involved, the value of testing partnerships, what activities are planned, and how you can participate will also be discussed. The session concludes with an invaluable primer on testing tools and resources available for your use.

“Jumpstart Your HL7 FHIR Implementation: Testing and Connectathons Demystified,” is slated for April 24, 4 - 5:30 p.m. ET and features the following presenters:

• Jeff Brown, Healthcare Standards Advisor, Lantana Consulting Group
• Mike Gould, Associate Vice President, Interoperability Strategy, ZeOmega
• Kyle Johnsen, Software Developer, Epic

The session is moderated by Alix Goss, HL7 Da Vinci Project PMO, and Senior Consultant, Point-of-Care Partners.

2023 Accomplishments Position Industry for Year Ahead

Substantial progress has been made this year on HL7 Da Vinci Project Implementation Guides (IGs), which describe how to use HL7’s Fast Healthcare Interoperability Resources (HL7 FHIR®) standard for exchanging data to support value-based healthcare and implementations of the guides.

Sizing Up Accomplishments

At the December Da Vinci Community Roundtable, Hans Buitendijk, Da Vinci Project Steering Committee Vice Chair, reviewed progress this year and offered an outlook for 2024.

“We have a number of organizations across the spectrum that have adopted one or more of our [FHIR implementation] capabilities. … That's fantastic in the short number of years that this initiative started to look at what is necessary to make it happen,” Buitendijk said.

“We currently have about eight publishing updates that have been accomplished and quite a few ballot processes that are in flight and being planned for, and there is a good amount of commitment to making this happen. So, we really need to be proud of what we have achieved to date, and particularly in the last year.”

In the year ahead, alignment with emerging regulations, including the final CMS Interoperability Rule, will be a top priority, he pointed out.

Interoperability efforts must go beyond a general set of data to ensure adequate support for public health, research, quality measures and more, he added. “We are all going to impact the ability and the opportunity to share more data over time,” he said.

The key to advancing interoperability by leveraging FHIR, he stressed, is to involve many different parties and develop “the same language where we have a minimum set of capabilities that everybody can support, and leaving room … to grow, to explore, to define new things.”

He also pointed out: “We must continuously raise the bar for what we can exchange and determine what is relevant across many different stakeholders that we should all do in the same way … because the data that we have covered so far is still only a part of the variety of data exchanges that are relevant and can benefit from improvements."

Register Now for January Virtual FHIR Connectathon and Gain Perspective from a New Participant: the Value-Based Performance Reporting Use Case Co-Lead

Those interested in gaining a better understanding of how the HL7 Fast Healthcare Interoperability Resource (FHIR®) standard works – and helping to develop specification refinements – should consider attending the upcoming connectathon, which will be held online January 16-18, 2024.

“Connectathons can be an effective way for organizations to initiate or advance their FHIR capabilities,’ Viet Nguyen, MD, HL7 Da Vinci Project Technical Director and HL7 Chief Implementation Officer, says.

Nguyen notes that the numerous tracks within the connectathon event allows organizations to pick and choose which tracks they want to emphasize based on their regulatory or strategic needs.

First-time HL7 FHIR Connectathon participant Teresa Younkin, HL7 Value-Based Performance Reporting (VBPR) Project Co-Lead and Senior Consultant at Point-of-Care Partners, attended the September 2023 event. She says, “The value of the connectathons is to actually get to see the systems work and move from the theoretical to the concrete.”

According to Younkin, connectathons are an opportunity to bridge the gap between the technical and the business. It goes beyond just exchanging bits and bytes; instead, you can see in real time how the data could be ingested and utilized in an organization. Many reference implementations have simple interfaces to make computer code human readable. Having the ability to physically see how this data exchange impacts workflows opens cross functional dialogs, addressing communication gaps that traditionally exist between technical teams and business teams.

Da Vinci is creating the foundation to solve large scale industry problems.

The HL7 January FHIR Connectathon  was a success, with all examples from the implementation guides (IGs) tested, including over 20 test cases.

The HL7 Da Vinci Project, through its efforts that include Connectathons, “continues to focus on solving real-world data exchange challenges between payers and providers,” said Vanessa Candelora, Da Vinci’s project manager and senior consultant with Point-of-Care Partners, at the Jan. 26 Da Vinci Community Roundtable. “Da Vinci is creating the foundation to solve large scale industry problems, including, risk and quality data sharing and workflow; unlocking data or freeing data needed for patient costs; and reducing provider burden.”

Candelora called HL7 Connectathons, “a fundamentally human-powered endeavor,” praising Da Vinci as “a really great community,” with a multi-stakeholder membership that includes providers, payers, vendors, industry partners and EHRs. “We continue to grow and learn from each other in this party of the willing.”

Candelora added that founders of Da Vinci are pleased with the amount of work the group has accomplished in such a short time. “They really couldn't have envisioned the impact and the progress that this project has made,” she said.

In July 2021, the Centers for Medicare & Medicaid Services (CMS) hosted its second HL7® FHIR® Connectathon, welcoming over 800 participants from Federal agencies, payer organizations, and the health IT industry to a three-day event with more than 70 presentations focusing on education, implementation guide testing, and community-building around Fast Healthcare Interoperability Resources (FHIR)-based application programming interfaces (APIs).

Just over one month ago, I leaped into  HL7 FHIR through involvement of the Da Vinci Project. Having worked in the healthcare technology industry for more than 10 years aligned with implementers of payer-provider workflows, data reporting and analytics, it was compelling to see how the proverbial “sausage is made” in the standards world. I made my debut by attending the HL7 FHIR Patient Access API Implementation event in August and I have since attended the September HL7 Connectathon.

Here are three key takeaways from my first month in the FHIR community.

The Room Where it Happens: Developing a Standard Doesn’t Transpire Behind Closed Doors By the Elite.

As an implementer reading a standards’ implementation guide (IG), it’s inevitable to reach a point of confusion where you say to yourself, “Clearly the writer of this didn’t consider my business need.” HL7 has a robust process that prioritizes adoption and reaching consensus among the public community before stamping approval on a standard. The continuous improvement method includes one or more balloting cycles (where the public community essentially critiques the IG and provides detailed feedback) as well as multiple connectathons (at which IGs are tested against by the community), providing ample opportunity for feedback from the community to evolve the IG. The HL7 Da Vinci Project, as well as other FHIR accelerators, have reference implementation prototypes, documented examples, sample test scripts and weekly calls open to the public, encouraging participation throughout the development lifecycle.