Health Interoperability
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5 Key Takeaways from FHIR DevDays 2024

Ewout Kramer

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It’s hard to believe that we’ve had 10 years of HL7 FHIR DevDays. It’s always an incredible opportunity to learn from the best in the FHIR business and this year was no different. With that in mind, I wanted to share some of my key takeaways from one of the biggest DevDays yet. 

1. FHIR’s Evolution 

The maturity of FHIR tooling has taken another step forward. This year we saw some highly advanced use cases that showcased the evolution of FHIR tools and their capabilities. Sessions demonstrated everything from SQL-on-FHIR playgrounds to sophisticated Questionnaire tools. 

For instance, the Clinical Practice Guidelines (CPG) tool stood out by combining PlanDefinition and Questionnaires in novel ways. This showed how structured guidelines can be integrated into patient care workflows, making it easier for healthcare providers to deliver evidence-based care. 

Other interesting use cases were the latest mapping tool from Outburn and optimizations for hyper-scale SQL on Azure showcasing how FHIR can be scaled to support massive datasets. I was impressed with how expertly this was all done, with advancements like these paving the way for more comprehensive and dynamic use cases. 

2. Compatibility of IGs

Implementation Guides (IGs) were one of the big topics of conversation this year. In particular, the compatibility of IGs and their versioning. You could be forgiven for thinking that the migration of FHIR versions (FHIR Release 6) would take center stage. A poll during one of the sessions indicated that most attendees will likely skip R5 and move straight to R6 due to timeframes.

However, a more interesting topic that dominated conversations: how do you write profiles that depend on other profiles—and what happens if they get updated? Da Vinci’s new IG does a good job clearly indicating which profiles are compatible with which version of US Core. 

One learning from these discussions is that even native FHIR servers like ours will need to perform mapping between FHIR data transferred using different versions of IGs to maintain compatibility.

3. Tackling Cross-version Extensions

Another complex issue we tackled at DevDays 2024 was the challenge of cross-version extensions. While everyone agrees on their importance, defining them is difficult. I’ve had extensive discussions with Gino Canessa and Grahame Grieve about the problems in corner cases, and it’s clear that these issues are not an easy fix. 

I took the opportunity to present these challenges during a session at DevDays. The feedback and engagement from the audience highlighted just how crucial—and complex—this topic is. 

As we continue to work on cross-version extensions, our goal is to find solutions that balance flexibility with consistency, ensuring that these extensions can be effectively implemented without compromising the integrity of different FHIR versions. As ever, continued dialogue and collaboration within the FHIR community are essential as we try to solve these challenges. 

4. Looking Beyond Reading Data  

In FHIR’s early years, we have often focused on retrieving data, which is, by now, familiar territory. There’s still some complexity with the range of data exchange methods (pull, subscription, messaging, etc.) and how this can be managed by vendors, but it’s something the community has mostly got a handle on. 

Now the big question is how to push data and integrate new data. For example, how to enable hospitals to allow patients to send in new observations from their mobile phones. The number of options currently discussed for doing this is overwhelming, and there’s the risk that we will come up with similar, but incompatible solutions.

It would be helpful if some upcoming IGs working in this field will showcase viable solutions and pave the way for others. 

5. Celebrating Success 

There were tons of success stories and moments to celebrate during DevDays 2024. We heard some fun over-the-top home applications for the DevDays Nerds Award, with Andy Bond taking home the award for 2024.

We also saw impactful real-world applications of FHIR from Healthy Reply and Synapxe who showcased their implementation projects. A big congratulations to Synapxe for their Healthier SG project in Singapore.

The AI sessions were particularly inspiring, showcasing the potential and current advancements of AI in healthcare, with insightful and thought-provoking sessions from our keynotes Keith Figlioli and Brad Genereaux.

The early morning DevDays run and hike also saw an unexpectedly large turnout (over 50 people!), proving that the community’s commitment extends beyond the conference rooms.

Building on the Momentum of DevDays 2024 

It was another incredible DevDays full of learning, fun, and most importantly, community. Every year I’m struck by how passionate and welcoming the community is, and how many FHIR newcomers we get—over 50% of participants were attending their first DevDays! 

As we continue to build on the progress made, it’s exciting to think about the future possibilities for FHIR and the positive impact it will have on healthcare systems worldwide.

The progress showcased at FHIR DevDays 2024 is a testament to the collaborative effort and ingenuity of the FHIR community, and I look forward to seeing how these tools will continue to evolve and shape the future of health IT.

Thank you to everyone who made this year’s event truly memorable, and I look forward to continuing these important conversations until we meet again at HL7 FHIR DevDays 2025!

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