The Standard

The HL7 FHIR Connectathon Medication Track

At the HL7 FHIR Connectathon 14, held January 14 - 15, 2017 in San Antonio, I participated in the medication track. See my previous post to learn more about how I ended up in the medication track. 

HL7’s Fast Healthcare Interoperability Resources (FHIR®) standard has four key resources related to medication:

• MedicationRequest
• MedicationDispense
• MedicationAdministration
• MedicationStatement

Excitement Filled the Room

It was already 9:23 am. One could argue that on a normal Saturday morning, that's an early start time. 

But I was late. The conference room at the Hyatt Regency San Antonio on the Riverwalk was packed ... and buzzing with excitement over FHIR resources, interoperability and the like: 

I later learned the total number of participants at the HL7 FHIR Connectathon 14 was 200+  (a sharp increase from the 6 who attended the first Connectathon just a few years ago).

It seemed like 20+ round tables, packed close to each other, each with 6 to 10 participants, elbow to elbow.  Some attendees engaged in lively discussion, some furiously wrote code, and some just stared at their screens (most displaying a FHIR resource page) brows creased in concentration.

Where Do I Start? 

Why couldn’t I drag my behind out of bed a little earlier for the opening remarks so I could orient myself better?

Which table should I start from?

In this mild confusion, I walked past each table to see if I could find anyone I knew or a track I was familiar with.

HL7 on FHIR at HIMSS17 

With its world-class education, ever-expanding exhibition and exceptional networking opportunities, no other event brings the brightest minds in health and IT together like HIMSS17. More than 40,000 health and IT professionals are expected to attend to explore creative solutions to real-world challenges in Orlando, Florida at the Orange County Convention Center. 

HL7 is proud to support this annual event that helps health IT professionals find the right products and solutions for their organizations so that they can continue to transform health and lives through IT.

The Spectrum of Interoperability

In a world of polychromatic nuance, it’s interesting to see how often some individuals try to see things in black and white.  This tendency also seems to apply to healthcare data interoperability, as if any given product, organization or service can be classified as either “interoperable” or not. To me it’s absolutely clear that interoperability is a spectrum, which can only be aspired to as a matter of degree. 

Any given player may be viewed as more or less interoperable, but not wholly interoperable, because we live in such a heterogeneous world, with science and medicine continuously evolving. But no matter how you might personally think of interoperability, we can probably all agree that we still have a long, long way to go before we get there.

This is why we need events like Partners in Interoperability.  To achieve real progress, we must engage major stakeholders to stop and listen for awhile, and roll up their sleeves to make small incremental steps to move along that spectrum from the cold blue reality of the recent past to a warm, FHIR-y future based on improved interoperability. 

Partners in Interoperability October Meeting

The second Partners in Interoperability meeting was held at the Johns Hopkins Mt. Washington Conference Center in Baltimore on Oct. 18-19, an arcadian space conducive to deep thought.  As before, the meeting included a set of opening talks each day followed by breakouts focusing on the particular challenges of using FHIR among three distinct business communities:  Clinicians, Payers and Biopharma. 

Day 1

The meeting opened with a welcome from Dr. Christopher Chute, a long-time thought leader in the world of health data standards.  Dr. Chute evoked the history of the Great Baltimore Fire of 1904, which even predates the last Chicago Cubs championship, and led to the establishment of national standards for fire hose fittings.  The metaphor of a great fire being a pivotal event that burned down the old to create a new and improved place did not go unnoticed by the 60+ attendees at the event.

Next was a fast-paced set of five short insights on what FHIR means to the three represented communities, the health IT industry, and, above all, to the future of interoperability which we all aspire toward. 

The morning concluded with three lively presentations on FHIR’s promise and reality:

• Micky Tripathi gave an update on the Argonaut Project, which is close to completing its implementation guides for using the FHIR API and is already thinking about what to tackle next
• Ricky Bloomfield, MD gave an exciting visual talk on how FHIR is enabling several mobile apps to enhance patient care and interaction at Duke University’s Health System
• Sean Khozin, MD, presented on how the FDA is reinventing itself to capitalize on real world evidence from EHRs as well as multiomics big data sources – portraying several opportunity areas where FHIR can help advance the FDA’s mission.

Day 2

The second morning included recaps  from each of the breakouts, followed by one more set of plenary presentations:

• Avinash Shanbhag of ONC discussed the importance of FHIR to realize the goals of the next phase of Meaningful Use
• Titus Schleyer, PhD, of the Regenstrief Institute painted the vision that health information should flow like water, and demoed a FHIR app that allows patients to collect all their medication data from disparate health IT systems into one unified list
• The legendary Dr. Clem McDonald discussed and demonstrated an intriguing JSON-based forms generation toolset used by the National Library of Medicine that can be used, for example, with the Surgeon General’s Family Health History form.

Vote for the 2017 Top 50 in Digital Health 

Each year 50 of the leading entrepreneurs, investors, technologists, reporters, and providers dedicated to bringing technological advancements to healthcare are recognized at the Top 50 in Digital Health dinner hosted by Rock Health, Fenwick & West, Goldman Sachs, and Square 1 Bank. 

 
Many have asked the question: When are we going to realize the promises of sequencing the human genome?

Some argue the benefits are here. Others say not much has changed for healthcare consumers and patients. Some have invested in pharmcogenomic programs in the clinic, while there remain pharmacists who say the evidence still isn’t there. Patients see advertisements for cancer services that utilize genetic testing for targeted therapy, while others still claim most cancer patients don’t see any benefit.

We are in a period of both confidence and uncertainty, enough evidence and not enough evidence; let’s move forward with expanded testing and let’s only adopt a few tests, promises and warnings, a cost benefit or just increased cost.

Investments in Genomics Advances

In spite of the controversy, billions of dollars in investments are developing more products and services directed at healthcare consumers. This already includes direct-to-consumer genetic and genomic testing.

The precision medicine initiative is emerging as a high profile effort in genomic research and encourages patient-directed data ownership and sharing. It will be a major driver in building awareness and demand for genetic-based clinical services.

Tools from vendors—that range from biomarker and drug discovery to the clinical knowledge of diagnosis, risk assessment, and clinical meaning—are working toward advancing genetic-based care and realizing greatly improved outcomes.

Amidst this debate, many are committed to moving ahead to find clarity and the right path forward. In increasing numbers, people with day jobs are participating in mostly volunteer organizations to define and complete demonstration projects that prove both clinical utility to healthcare providers and significant value to patients.

Progress in Genomics

Internationally-focused organizations—like the Global Alliance for Genomics and Health (GA4GH), the Global Genomic Medicine Collaborative (G2MC), and US-based activities like the Genetic Alliance, the National Academies DIGITizE action collaborative, NIH grants like IGNITE and eMerge, and HL7 clinical genomics and Fast Healthcare Interoperability Resources (FHIR®)—are all making substantial progress. And there are many more related and critical activities I haven’t listed. Not only do we need to coordinate these activities, but we also need to bring together the diverse stakeholders in academics, research, technology, and national and global policy to see the vision move forward as well as how we’ll get there together.

 
Why FHIR for LATAM?
Latin America (LATAM) arrived on the scene late in terms of the use of earlier HL7 standards. HL7 Version 2 was created in 1985 but we (LATAM) did not begin using it until after 2000). HL7's Clinical Document Architecture (CDA®) was published in 2000 but we  began using it after 2005. HL7's Fast Healthcare Interoperability Resources (FHIR®) is being created now and we are starting to use it in LATAM. Two implementation guides have been developed in Argentina and Colombia; Chile is working on one. We can discuss the ‘we’ (as in ‘Who in LATAM’?), but the trend cannot be discussed.  Some countries in our region have yet to use any standard—there is NO installed base— why get stuck with stuff that’s 10 or 20 years old?

However, work is still in progress. While CDA Release 2 is good for document repositories, when it comes to mobile, what you can/should exchange is more discrete and granular. The choices will come down to how to use FHIR for examples such as:

• Only display allergies
• Only display the lab results for a graph.