Friday, May 17, 2019

CDMA or GSM? V3 or FHIR? Floor wax or desert topping?

One of the issues being raised about TEFCA is related to which standards should be used for record location services.  I have to admit, this is very much a question where you can identify the sides by how much you've invested in a particular infrastructure that is already working, rather than a question of which technology we'd all like to have. It's very much like the debate around CDMA and GSM.

If you ask me where I want to be, I can tell you right now, it's on FHIR.  If you ask me what's the most cost effective solution for all involved, I'm going to tell you that the HL7 V3 transactions used by IHE are probably more cost effective and quicker to implement for all involved overall, because it's going to take time to make the switch to FHIR, and more networks are using V3 (or even V2) transactions.  And even though more cost effective for the country, it's surely going to hurt some larger exchanges that don't use it today.  CommonWell uses HL7 V2 and FHIR for patient identity queries if I can remember correctly, while Carequality, SureScripts and others use the HL7 V3 based IHE XCPD transactions ... which are actually designed to support federated record location.  As best I know, more state and regional health information exchanges support the IHE XCPD transactions than those exchanging data using V2 or FHIR.

Whatever gets chosen, it's gonna put some hurt on one group or another.  My gut instinct is that choosing FHIR is going to hurt a lot more exchanges that choosing XCPD at this time.

And this is where the debate about V3 and FHIR differs from the CDMA and GSM debate, because FHIR is closer to 4G or 5G in the whole discussion.  Some parts of FHIR, such as querying for Patient identity are generally widely available.  But complexity comes in when you get into using these transactions in a record location service, as I've described previously, and the necessary capabilities to support "record location services" in FHIR haven't been formalized by anyone ... yet.  This is where FHIR is more like 5G.

Just like 5G, this will happen eventually.  But do we really want to focus all of our attention on this, or do we want to get things up and running and give organizations the time they need to make the switch.  I think the best answer in this case is to make a very clear statement: This is where we are today (V3), and this is where we will be going in 2-3 years (FHIR), and make it stick.  And as I've said in the past, don't make it so hard for organizations to pre-adopt new standards.

Policy doesn't always work that way ... just look at what happened with ICD-10, or maybe even Claims Attachments.  But I think where we are at today is a little bit different, which is that the industry really wants to move forward, but would also like to have some room to breathe in order to move forward without stumbling along the way.  Do we really want a repeat of Meaningful Use?

We've seen how too much pressure can cause stumbles, and I think trying to use FHIR for record location services is just moving a little too fast.  I'll be happy to be proven wrong, and eat the floor wax, but frankly, right now, I just don't see it.

   Keith





2 comments:

  1. See the new work item from IHE ITI, soon to be out in Public Comment on FHIR centric Patient Identity Management. Including a classic feed, using FHIR; and a Subscription to that feed. https://healthcaresecprivacy.blogspot.com/2019/05/ihe-iti-spring-2019.html

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  2. Usually I never comment on blogs but your article is so convincing that I never stop myself to say something about it. You’re doing a great job Man, Keep it up. Dr Michael Omidi

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