FHIR: Technology and Governance

Screen Shot 2015-03-21 at 3.47.47 PMThere has been much enthusiasm in the health IT industry regarding the health data standard that HL7 International is working on, HL7 FHIR, which is now a DSTU (draft standard for trial use). Everyone involved with health data – EHR vendors, interoperability vendors, medical app developers, “big data” proponents and hospital CIOs, to name a few – have high hopes that FHIR can be the golden ticket that leads to true health care interoperability.

Most of the enthusiasm is around the technologies being utilized in the standard including RESTful web services, JSON encoding, and granular data content called resources.

Technology-Empowered FHIR Data

RESTful web services, in particular, is a technology that has been strongly embraced by other industries and has the potential to be leveraged for engaging patients by connecting mobile technologies with their provider’s EHR system. This advancement represents a huge step toward building a patient-centered health care system.

FHIR Interest

Over the last decade, the healthcare industry has utilized SOAP-based web services to transfer documents. Most programmers today, if given their choice, would likely lean towards RESTful web services, preferably with data encoded in the JSON format. It is a better choice for mobile applications independent of whether the client device technology is iOS, Android, Windows, or even Mobile Web. Most social media sites today, such as Twitter and Facebook, publish RESTful APIs for connectivity.

This preference towards RESTful web services is based on some of the advantages that REST has over SOAP:

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Medicine in Denial: What Larry Weed Can Teach Us About Patient Empowerment

[This post is the third and final part of a commentary on “Medicine in Denial,”(2011) by Dr. Lawrence Weed and Lincoln Weed. You can read Part 1 here and Part 2 here.]

It seems that Dr. Larry Weed is commonly referred to as the father of the SOAP note and of the problem list.

Having read his book, I’d say he should also be known as the father of orderly patient-centered care, and I’d encourage all those interested in patient empowerment and personalized care to learn more about his ideas. (Digital health enthusiasts, this means you too.)

Skeptical of this paternity claim? Consider this:

“The patient must have a copy of his own record. He must be involved with organizing and recording the variables so that the course of his own data on disease and treatment will slowly reveal to him what the best care for him should be.”

“Our job is to give the patient the tools and responsibility to organize the knowledge and slowly learn to integrate it. This can be done with modern guidance tools.”

These quotes of Dr. Weed’s were published in 1975, in a book titled “Your Health Care and How to Manage It.” The introduction to this older book is conveniently included as an appendix within “Medicine in Denial.” I highlighted it this section intensely, astounded at how forward-thinking and pragmatically patient-centered Dr. Weed’s ideas were back in 1975.

Thirty-eight years ago, Dr. Weed was encouraging patients to self-track and to participate in identifying the best course of medical management for themselves. Plus he thought they should have access to their records.

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Not Everything that Counts Can Be Counted

Have you ever wished that instead of choosing a single answer on a multiple choice exam you could write an essay instead to show how you are thinking about the question? It happened to me many times, particularly on my medical board exams, where the object seemed more to guess what the question writers were thinking than to get at the depth of my knowledge. And even though each question typically had a menu of 5 possible answers, the message was binary: right vs.wrong. There was never room for anything between these two extremes. Yet this middle ground is where most of our lives take place.

This “yes/no” is a digital philosophy, where strings of 0s and 1s act as switches for the information that runs our world. These answers are easily quantifiable because they are easily counted. But what are we quantifying? What are we counting? Has the proliferation of easily quantifiable standardized testing led us to more and deeper knowledge? I think we all know the answer to that question. Yet are heading in the same direction with electronic medical data? Let me explain what I mean.

There was an interesting discussion yesterday on a listserv I am a part of about structured vs. unstructured (narrative) clinical data. I don’t often jump into these discussions (believe it or not), but this time I had to make my views heard, because I believe they are similar to the views of many clinicians.

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