#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?



  1. Jim McCusker says:

    The hype will start to die away when people start realizing that FHIR is based on the same flawed underlying model that the rest of HL7 standards are – observations and codes, rather than qualities and measurements. SNOMED-CT, LOINC, and ICD will continue to be the messes they have been, and FHIR will attempt to model language and discourse instead of entities, attributes, and processes.

    Medical language attempts to model reality as the observer sees it. HL7 et al. only provides a level of indirection on top of that, attempting to model reality as the observer *says* it. It reifies medical language instead of providing a structured way to model reality as the observer sees it.

    Not that I have an ax to grind. 🙂

    • Lloyd McKenzie says:

      We have to reflect data as statements of opinion rather than facts because the record may well need to host two simultaneous statements that are directly contradictory. Both statements were made. Both were believed by their author to be true. But which one is true (if either) may not be determinable by the reader. That’s the reality of the process by which data is collected.

    • Grahame Grieve says:

      I’m not sure what you mean by the differences between observations|codes and qualities|measures. I guess you’re looking for an ontological frame of reference?

  2. Michael Osborne says:

    I’m very impressed by Gunther’s reply to your 2nd Law: Complexity …you can’t make it go away.

  3. Scott Robertson says:

    A realistic post on what FHIR is, and what it isn’t. I have been in to many meeting where there are presentations on a FHIR implementations – really good work – but the speaker and audience don’t understand what FHIR is and isn’t. In particular, the concept of DSTU (soon to be STU) and that the “standard” will change. That worries me: as FHIR evolves, those that don’t understand the process may get confused. We May end up with isolated implementations using “the old FHIR” which can work with the current standard.

    • Grahame Grieve says:

      Of course that will happen – it’s always been inevitable. Now our primary task is to head for stability in the core so that there’s another choice other than fragmentation

  4. Hi Grahame – cheer up yourself and FHIR fans. Leaders don’t drop what they start, they pivot and push forward. Will FHIR solve everything? Nothing can do that. Can it make things a little better? Sure. In tech-deprived, anti-analytical healthcare, it still is a tremendous step forward.

    • Grahame Grieve says:

      Thanks. We think it’s a big step forward too. And we’re not going to stop working on it.

  5. Dan Morford says:

    “Getting them to adopt the FHIR culture – that will. But you cannot impose that.” IMHO, the most powerful and relevant observation in the post. As we work toward making FHIR the best it can be (not a panacea, but a definitive major step forward over its predecessors), it is vital to embrace the immutable fact that while the technological elements are indeed both broad and complex, such pales by comparison to the human and clinical cultural challenges that interoperability must surmount to come to tangible fruition.

  6. Jay Lyle says:

    What is this FHIR culture you speak of?

    • Grahame Grieve says:

      A culture of engagement, collaboration, and use of social media forums to work together iteratively rather than working alone and doing your own thing. Of course, it’s not unique to FHIR…

      • Jay Lyle says:

        Would there be any operational definition-like things floating around for that? That would be good. Without something concrete, “engagement and collaboration” sound unobjectionable but unhelpful. I was on an agile call last year with 150 people.

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