Sunday, February 3, 2019

Cleveland 2019 IHE connectathon: it’s all about FHIR.

The 2019 IHE connectathon drew more than 300 healthcare IT professionals to a snowy and cold
Cleveland to test interoperability between their devices using IHE defined profiles. What was new this year were the recently published profiles facilitating exchange of information using mobile communications based on the new FHIR standard, which is based on standard web protocols.
The FHIR testing emphasized querying for patient information, corresponding documents, and uploading and retrieving them. In addition, we tested the audit trails using FHIR, which is important from a security and privacy perspective.

There are still relatively few FHIR based implementations in the field due to the immaturity of the standard (most of it is still a draft), the lack of critical mass (implementing FHIR for just one application such as scheduling does not make sense), and its steep learning curve as it is sufficiently different from what healthcare IT is accustomed to. Therefore, the more that can be verified and tested in a neutral environment such as the connectathon the better it is. Speaking with the participants, they uncovered quite a few issues in their early FHIR implementations, which again is good as it is better to solve these issues beforehand than during an actual deployment.

The attendance at this year’s event seemed to be lower than previous years, which could be due to the fact that there are several local connectathons happening during the year on other continents, which draw from the same crowd, and that implementations are starting to mature (except for FHIR of course) and therefore, there is less need for debugging.

There could also be somewhat of a “standards overkill” in place if one considers the fact that for radiology alone, which is one of the 11 domains, there are 22 defined profiles and another 27 published as draft. It is hard to keep up with all of these and for vendors to deploy all of these new requirements.

As FHIR matures, which will take several years as its typical release cycle is 12-18 months, there will be a need to test these new releases between the vendors providing the medical devices and software products. There were a few new vendors present but most of them consist of the same “crowd,” which is somewhat disappointing because I believe that the real FHIR implementation breakthrough will come from outsiders such as Apple, Amazon, Microsoft and/or Google, all of which were notably absent.

In conclusion, another very successful event, giving a boost to interoperability, something we very badly need as patients, especially in the US where we are still struggling to get access to our medical records, including images, and where healthcare institutions continue to have difficulty exchanging information among themselves and other providers. In many departments and medical offices, the fax machine still is an important tool, hopefully not for long.