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FHIR on Fire: A New Standard to Make Patient Data More Mobile

Posted on Jul 09, 2019 by Dave deBronkart

    FHIR-1Every ten years or so there’s a first moment when you hear about something new. It might not make sense at first as something important, but later it becomes so normal that it’s hard to imagine life without it. I think one of those moments is arriving for health data, with a new data standard called FHIR (pronounced FIRE).

     (Happily, they officially welcome FHIR puns, even bad ones! The most famous use of FHIR is called SMART on FHIR, developed by a really smart guy, so have at it with your own “on FHIR” jokes.)

     It’s officially called the HL7 FHIR standard, a software standard created (not surprisingly!) by the HL7 standards organization. It’s been in development for about six years, and currently has a limited range of uses. Its original purpose is to help health data workers move data between computer systems, but now, in the era of apps and smartphones, it appears it will also help us all get easy access to our own health data, as individuals and families.

     And that, we hope, will open the door for a generation of new apps to keep track of family health, including both the data from the doctor’s office and data from our apps and our gadgets like Fitbits, WiFi bathroom scales, etc., etc., etc. We hope.

     And oh yeahthere’s a new government regulation in the works, due out soon, that will require future U.S. health data systems to include FHIR, to improve healthcare’s ability to move a patient’s data around, for better and more coordinated care.

     Like every new technology, the first news of FHIR doesn’t mean it’s ready for prime time yet. But similar memories can trigger intriguing thoughts. Let’s think back ...

    Time for a time trip:

    • Back in the Stone Age (1994) we started hearing about HTTP, HTML, and “web browsers.” At first the natural reaction was “Who needs that?? What problem does that solve??”
    • Then this thing called email came along, with its “SMTP” protocol. I well remember people again saying “Who needs that??”
    • And way before that, one day my father said he’d heard about some new thing called “cellular technology” that would let you carry phones around in your pocket. (“Who needs that???”, said everyone I knew, including me!)

    In all three cases, today we know “Who needs that??” was the wrong question, because our minds were set on what we were doing then, not on what we might do. In each case the new technology made something new possible, which turned out to be useful (or at least fun):

    • The web started out quirky, but it enabled getting at information from anywhere, which really did have enormous practical advantages … beyond what we’d imagined.
    • Email turned out to be useful for instantly sending things, which we had never imagined we would need.
    • Cell phones became indispensable.

    And of course when you mix all three, you get smartphones. For those of us raised on phones that were attached to walls, it’s a hoot to think what you can use one for today.


    I don’t want to overhype it, because it’ll take time, but do keep an eye out for it. And start thinking ahead about what you would do with it if you could easily get - and send - your health data.

    “Like QuickBooks for health data”

    Some people are sayingcorrectly, I thinkthat the FHIR standard will let programmers create apps you can use, “like QuickBooks or Mint, for health data.” Those financial apps are useful!

    Way back in the days before the internet, to get a handle on your financial picture you had to open paper envelopes every month and do arithmetic with your brain and a pencil. (I know, right???) Or use a calculator, or maybe a spreadsheet if you were really technical. Today you can use software like QuickBooks for businesses, or Quicken or Mint for people … they’ll go get the data for you, so you just open the app and there it is, for you to browse through, create pre-packaged reports (“How much did I spend on restaurants? On gas?”), or custom reports to stay on top of whatever you want. And there are fancier apps for more specialized needs, all using the same basic “data pipelines” to collect your information … but each app can display it in different ways, and you can adjust them with settings.

    Imagine that for your health data.

    That’s exactly the vision for a future enabled by the FHIR standardnot just moving your data from doctor to doctor or hospital to hospital, but also letting you choose apps to view the whole picture yourself, and whatever parts are important at the moment. What would you want, for your family’s needs or your own?

    To me the clear picture starting to emerge is one where some years from now it will be NORMAL to have all your  health data in one place, just as Quicken and Mint do with your money info.  Health data is enormously more complex but the bottom line is the same: we'll finally be able to check up on things (for ourselves, our kids, our elders) quickly and easily, and when questions or trouble arise, share the data with whatever providers we want.

    And that will usher in an era of unprecedented consumer power.

    Dave deBronkart

    Dave deBronkart

    Dave deBronkart, known online a "e-Patient Dave," is a high tech marketing veteran who in 2007 survived a near fatal kidney cancer by being actively engaged in his care. He's gone on to become an international keynote speaker on health related topics, widely respected by the health system: he's a co-founder of the Society for Participatory Medicine, the National Library of Medicine is capturing his blog in its History of Medicine, his TED Talk has over a half million views, and he was the Mayo Clinic's 2015 Visiting Professor in internal medicine.

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