FHIR is No Longer Just About Interoperability

The top tech companies are now in FHIR. Remember the statement by Microsoft, Amazon, Google, IBM, Oracle, and Salesforce at the US Government meeting in Washington DC this August? As well as that, Microsoft, Google and Philips sponsoring FHIR DevDays Amsterdam 2018 is not a coincidence. What’s going on? Is it a good thing?

When FHIR started it was all about interoperability, the ability to exchange medical data between providers, patients etc. FHIR was born within HL7, the standards body for healthcare. Interoperability has been the game for HL7 since the eighties.

When FHIR began (2011-2012), we thought it was a revolutionary way of playing the same game (interoperability). The open API would finally make data exchange in healthcare a reality, like it had done in other industries. But over the last one or two years it has become apparent that we are playing a different game now, a game called “cloud data”.

The big tech companies are not in FHIR for interoperability. They’re in it for the cloud, offering FHIR-out-of-the box services to convince care providers to move their data to the cloud. FHIR is a precondition for the cloud companies – it makes their life easier. Give us your data, in whatever format you have, we will turn it into FHIR and you will be able to run our algorithms in our cloud. Voilà!

Currently, a lot of hospitals are wary of the cloud, but they will come round when they see the benefits of AI driven diagnoses, clinical decision support, predictive medicine etc. The blessings of AI will overcome the concern for privacy, the fear for the cloud and any suspicion for the big tech companies. Those algorithms will be available in the cloud only, needless to say.

The big EHR vendors are aware of the new game and will have AI and advanced analytics in their products as well. See for instance the work by Ryan Brush from Cerner. The vendors have a head start: the install base. But will their algorithms be just as powerful?

(Apple, by the way, is another story. They use FHIR for the Health app in iOS. Their battlefield is not the cloud, it’s the phone.)

At the HL7 meeting in Baltimore last week, someone asked us: aren’t you at least a bit indignant that, after all the hard work that has been done, big tech now comes in and says thank you, we’ll take it from here?

We believe it’s a huge opportunity to have Google, Microsoft and others involved. With just the “usual suspects” in healthcare we will never solve the interoperability problem, even with FHIR. With the power of big tech we have a chance that interoperability will leap forward, in the slipstream of AI and the cloud.

Finally, how about us, the FHIR server builders of day one: HAPI/Smile CDR, Health Samurai’s Aidbox, Firely with Spark/Vonk, and others? Will we be crushed in the battle of the giants? The obvious thing to do is to partner with the vendors and the tech companies, but partnering with Google and the likes, reminds me of that joke – a mouse and elephant are crossing a bridge. The mouse says to the elephant: Don’t we make this bridge shake, eh?