Before the HIMSS17 conference in Orlando, I interviewed Charles Jaffe, M.D., CEO of HL7, about developments surrounding the interoperability standard FHIR (Fast Healthcare Interoperability Resources). During HIMSS I had a chance to chat with Wayne Kubick, HL7’s chief technology officer, about his impressions of the meeting.
Kubick, who joined the standards development organization in February 2016, admitted he is a relative newbie to HIMSS meetings. This is only his second. He came to HL7 after a career in the biopharma industry, including working for the Clinical Data Interchange Standards Consortium (CDISC), a data standards organization focused on clinical research studies.
Kubick said it was obvious from walking the floor of the show that FHIR is becoming much more commonplace. “When we did the first FHIR roundtable at Harvard last year, we didn’t have a good idea of how many people were really doing things, but then this year at HIMSS, it is almost like it isn’t a big deal,” he said. Companies will say, ‘we have FHIR capabilities here, here, and here.’ “There are dozens of booths showing that, but it is less of a showcase item, and more, ‘Of course we do that.’”
On the eve of HIMSS, the Argonaut Project announced the publication of its FHIR Data and Document Query Implementation Guide. It also announced its plan for 2017 includes expanding its focus to other key use cases using the FHIR and OAuth standards.
Kubick said that one of the areas he hopes Argonaut will get into is using FHIR to write back data to an EHR, instead of just reading it out through an API as is done right now. “That just came up in a question from Russ Branzell of CHIME to Steve Poznack in an ONC presentation,” he said, “and Steve was saying ONC is quite interested in that. There is certainly a desire to go beyond the common clinical data set and establish ways to get data in, particularly patient-provided data. I expect we will see the Argonaut Project work on that, because the spec supports it.”
When I spoke to him on Tuesday, Kubick had already done three presentations. He said the types of questions are a mixture of broad topical questions from people still learning about FHIR to serious questions from implementers who askthe best way to handle authentication within an organization. “I walk those folks over to Graham Grieve,” he said with a laugh.
One conversation he has had quite a bit is about the meaning of FHIR’s status as a draft standard for trial use. “What we are seeing is that it doesn’t really stop people. There are major, large-scale implementations in place and multiple large-scale organizations doing interoperability applications,” Kubick said. “Some are still working with DSTU1 of FHIR and they are OK with it. The FHIR core team has migrations scripts to help you move up and it is not that hard. During my HIMSS talk on clinical research I said there is no reason not to start — you are just delaying yourself. And when people pushed back and said it is just a standard for trial use, my response is, ‘So is C-CDA. Are you using that?’ C-CDA has been around a little longer, but is in exactly the same state as far as standards are concerned. That is not an obstacle to using it.”
Speaking more broadly about the conference, he said there is more talk now about the potential for artificial intelligence and machine learning. He mentioned IBM CEO Ginny Rometty’s keynote. She talked about how the cloud is the way people do things now, more data is available, and AI is the next logical progression, he said. “The possibilities of having much broader access to clinical data, partly through FHIR, will make it more consistent and more usable. The industry is just starting to get a sense of what this does in terms of opening up new horizons that were impossible before. But they are still at the early stages of it.”
Kubick added that security is coming up big at the conference. He said security expert Kevin Mitnick was entertaining at the CHIME forum on Sunday. “He scared the hell out of everyone very quickly, because he said there is really almost nothing you can do to stop a breach from the professionals,” he said. “But that is not the biggest problem. The human errors by the nonprofessionals are causing the problems. We can limit the vulnerabilities of the people responsible for data. That is a good take-away. So everyone is scared about security, and they have to find a balance between greater access to data and security.
Kubick said he liked a presentation by another CHIME speaker, futurist Lowell Catlett. He summarized Catlett’s presentation this way: “Today is the best of times. There were no good old days. We have never been able to do the things we can do now. Stop whining and worrying. Let’s just get our act together and move forward,” he said. “That gets me in the right frame of mind for this conference.”
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