Cooking with FHIR

How do they come up with the recipes?

When you work in Health IT, it’s easy to lose sight of the ultimate outcomes of all of the work we do. Measuring clinical quality, performing evidence-based medicine research, enhancing and automating laborious manual processes like Prior Authorization - these are all means to an end result that should be a drastic improvement in the quality of healthcare and patient outcomes. If we think of these outcomes and end results as delicious and complex meals and dishes that combine ingredients in the form of data and insights - then we have to ask the question - where do the recipes come from? How are these raw materials taken from their basic form and pieced together to create a meal that satisfies the needs of clinicians and patients everywhere? For the answer to that, we must look to the standards community and the methods they create to meet the healthcare use cases that exist in the world today…

Health Level Seven, or HL7 in shortened form, is an internationally recognized standards development organization that has brought together a willing coalition of experts in the field of healthcare to produce data standards and implementation guides that have propelled health IT forward and modernized the way we exchange data between healthcare entities. The newest of these standards is FHIR - the Fast Healthcare Interoperability Resources - and the momentum behind adoption of this standard has been steadily building to a crescendo since at least 2018. This momentum increased with federal regulations affecting healthcare payers and providers arriving in 2020, and since then even more regulations at the state and federal level have named FHIR as the standard of choice in exchanging patient and clinical data. 

So we have the outcome - our delicious health data dinners used to improve the lives of patients and clinicians - and now we have the raw ingredients, the FHIR data standard. All that remains are the recipes used - but where do those come from? I mentioned HL7 being a collection of healthcare experts, and those experts - most of them on a voluntary basis - meet via conference calls on a regular cadence to discuss updates to the standard, including various projects that seek to create new implementation guides for healthcare entities to meet healthcare use cases. These updates are recorded, tested, and subjected to block voting via ballot measures to produce standards that are robust enough to be implemented in the real world. A major part of this process are the Working Group Meetings that take place three times a year to coincide with the ballot cycles. These meetings bring together all of the HL7 working groups, and are open to anyone wishing to join and contribute to the standards-making process. The most recent of these meetings took place in Dallas, TX during the third week of May, where I attended and got involved in making the recipes for better healthcare outcomes.

These meetings bring together some of the finest minds in health IT and data analysis, leveraging their expertise and curiosity to discuss, dissect, and innovate in this most pivotal of industries. The meetings are conducted from Monday through Friday, descending on and taking over an entire hotel and conference center, providing forums for some to present their implementations, and for others to state their case for a recommended change to the standard. This time around, HL7 offered free educational sessions every day during almost every period of the day to anyone who wanted to learn more about various topics. I attended several of these and found them all to be highly valuable in improving my understanding of some of the areas of HL7 and FHIR that I hadn’t been overly familiar with. 

One of the pieces of these meetings and education sessions that never stops delighting me, is the emergence of new tools that help to not only implement FHIR in your organization, but also to write the standard itself. The folks from Firely had an education session around Implementation Guide (IG) authoring tools including FHIR Shorthand - a standard for quickly and easily creating Resource Profiles and other IG artifacts. Getting hands-on interaction with these tools was invaluable, and speaks to the open sharing nature of the HL7 standards community. Another session from Rob Reynolds of Smile Digital Health covered the concepts of SMART on FHIR (a launch framework for FHIR APIs and applications) and CDS Hooks (a standard used for real-time communication between EHR systems and FHIR APIs for Clinical Decision Support). Though I was already familiar with the basic concepts of these two essential pieces of the FHIR puzzle, Rob’s session taught me much more and helped to pique my curiosity around CDS Hooks and how it can be leveraged for multiple use cases in healthcare.

As with healthcare in general, the world of health data standards and FHIR itself is massive in scope and in scale, so there are always new things you can learn, new standards to digest, new use cases to dive into, and new perspectives offered by people both in the IT world and on the clinician side of things. These working group meetings offer the chance to be a part of the process, be a part of the team that creates the recipes, that taste-tests the resulting dishes and decides if they’re fit to go out into the world or not. It is an essential - perhaps the most essential part of the process whereby we modernize healthcare data to meet not only the use cases we are aware of now, but any that might come up in the future. If you’re reading this, and you are not currently involved with any of the working groups or FHIR projects that meet regularly to improve the standard, then I highly encourage you to go to, create your free account, and join the listservs of any and all working groups and project that interest you, or where you feel you can provide value. This is one case where “too many cooks” is a good thing, rather than a bad one. We all have our part to play, and even the smallest contribution can make a massive difference. Get involved and join the ever-growing community of healthcare professionals whose focus is improving the quality and delivery of healthcare to patients everywhere.

Until next time, 

Benji Graham

FHIR Evangelist