Monthly Archives: May 2016

Question: where did the v2 messages and events go in FHIR?


I’m relatively new to the HL7 scene having implemented a few V2 messaging solutions (A08 , A19, ORU) and the V3/CDA work on PCEHR.  I am trying to get my head around FHIR.  So far I am stumped in how I would go about for example implementing the various trigger/messages I have done in V2.  Is there any guidance?  I cant find much.  Is that because the objective of FHIR is implementers are free to do it anyway they like?  If you could send me some links that would be a good starting point that would be great


Most implementers of FHIR use the RESTful interface. In this approach, there’s no messaging events: you just post the Patient, Encounter etc resources directly to the server. The resources contain the new state of the Patient/Encounter etc, and the server (or any system subscribed to the server) infers the events as needed.

A few implementers use the messaging approach. In this case, the architecture works like v2 messaging, with triggers, and events. However, because the resources are inherently richer than the equivalent v2 segments (e.g. see, we didn’t need to define a whole set of A** messages, like in V3. Instead, there’s just “admin-notify” in the event list.

For XDS users (HIE or the PCEHR in Australia), see IHE’s Mobile Health Document Specification.


#FHIR in China

For the last few days, I’ve been in China for the China Health Information Network Conference 2016. I’d like to thank HL7 China and Professor Li (Chair, HL7 China) for inviting me – I really enjoyed the trip.


Simon Gong from Orion Health introducing me for the HL7 China technical session.

I was really keen to make this trip, because China is a really important potential stakeholder for FHIR. Not only is it a really large market, by many reports, Chinese medical practice can sometimes be quite different to western medicine, and I’ve worried that if China sits out the development stage of FHIR, and only gets involved late in the process, it might be too late for valid input to be heard.

I enjoyed my time in China immensely. I found a community struggling with the same things that challenge everyone. In fact, every time someone said to me, “What’s different about China, is that X is a problem”, I’d think to myself, yes, X is something that everyone struggles with to some degree or other. Interoperability is all about the people, and it’s the same in China just like anywhere else. But I think that what distinguishes China is the scale of the problem – China is vast, the healthcare system operates at a huge scale, modernization is happening so quickly, the economic factors that make it hard for vendors to collaborate are stronger, and the government’s ability to influence things (for good or bad) is stronger, etc.

Like many other countries, China is trying to figure out what to do about FHIR. Getting involved early in the process has it’s own costs, but gives you more influence over the final outcome, but sitting the process out avoids the cost of change and preserves your existing investment. I hope that my presence, my presentations, and my comments in discussion with Professor Li and others helped the Chinese community figure this out.

On other hand, several implementers described systems – including production systems – built using FHIR APIs – population surveillance, and clinical data repositories – just as real as anything built elsewhere. Some of these implementers I had already met, or even people who’ve contributed to FHIR (e.g. translations) – it was great to meet them in person. But others were new to me.

After my formal presentations, the HL7 China Technical Steering Committee (which is chaired by old friend JD Li), invited me to talk  with them about how to create an active FHIR community in China. They decided to plan a FHIR Connectathon for sometime in the period Oct – Nov, which we’re working on planning now. Also, by their request, I created a Chinese stream at We also talked at length about translation plans, which is a significant issue in China. We didn’t make any solid plans in that regard, but the TSC will be working on that.

Hopefully we can build on the interest and commitment that already exists, and seed an active community that can catalyse wider uptake of FHIR in China.

Finally, I’d like to thank Sean Xie from Orion Health, who translated my presentations for me – Sean did a great job, and I really appreciated his excellent work.

Update: Chinese translation of this post from Linforest (thanks) (and with improved photos including Prof Li owning the floor while questioning me!).

#FHIR and the Gartner Hype Cycle

As FHIR product director, I get plenty of comments about the hype associated with FHIR. And there is plenty of hype. Here’s the Gartner hype curve:

Where are we on that curve, people want to know? Well, my answer is that as far as I can tell, the rate of increase of hype is still increasing, so it seems as though we’re still in the initial rocket phase.

What’s the hype?

For me, hype is beyond enthusiasm – it’s when people make wildly inflated claims about what is possible, (wilfully) misunderstand the limitations of the technology, and evangelise the technology for all sorts of ill judged applications (about where block chain in healthcare is right now).

So what things do I see that I think are hype? Well there are many symptoms, but one fundamental cause: there’s an apparently widely held view that “FHIR will solve interoperability”.

It’s not going to.

FHIR is 2 things: a technology, and a culture. I’m proud of both of those things. I think both of those will make a huge contribution towards solving the problems of interoperability in healthcare. But people who think that problem will be solved anytime soon don’t understand the constraints we work under.

HL7 is an IT standardisation Organization. We have severely limited ability to standardise the practice of healthcare or medicine. We just have to accept them as they are. So we can’t provide prescriptive information models. We can’t force vendors or institutions to do things the same way. We can’t force them to share particular kinds of information at particular times. All we can do is describe a common way to do it, if people want to do it.

FHIR is good for sharing information out of an EHR – but confirming to FHIR doesn’t prove anything; there’ll have to be some policy layer above that. More generally, if you have 2 teams (departments, vendors, governments, whatever) that don’t see eye to eye, forcing them to adopt FHIR as a technology isn’t going to change anything. Getting them to adopt the FHIR culture – that will. But you cannot impose that.

So what can we do about that?

What we – the FHIR team – can do is to make sure the fundamentals are in place. Good governance, solid processes, well tested specifications, an open and inclusive engagement framework. If we can get that right – and it’s a work in process – then the trough of despair won’t be as deep as it might, and we can focus on our task: getting the standards out of the way of solving problems in people’s healthcare.

Follow up: have you read my 3 laws of interoperability?


BlockChain is the new XML

There’s an amazing amount of noise running around the healthcare about Blockchain.

Blockchain! Blockchain! Yay for Blockchain! 

Blockchain is a great solution for a set of hard problems to solve. But I’m not entirely sure which of those problems is related to healthcare. But that doesn’t seem to matter – BlockChain!

So I’m holding a contest – please make suggestions for useful ways to leverage Blockchain in healthcare. I’ll award a whole Blockchain to the person who makes the most outrageous use.