Health Interoperability
7 Min Read

FHIR: knocking down the walls of healthcare

Rien Wertheim

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Meeting up with Grahame Grieve

In June 2022, Firely was delighted to welcome Grahame Grieve to Amsterdam. We’d already met up with the HL7 FHIR Product Director at HIMSS in Helsinki and were delighted to host him at our offices for his week-long stay in the Netherlands.

Grahame Grieve with fellow FHIR co-creator, Firely’s Ewout Kramer

As well as getting some great insights and the chance to discuss FHIR in one-to-one meetings, we were able to arrange a well-attended meet-up in association with Founda Health, a Dutch HealthTech start-up.

21 June 2022 – the Midsummer FHIR meet-up

This was an informal event hosted by Firely and Founda at Founda’s offices in Amsterdam and a great opportunity to meet the ‘founding father of FHIR’ in person. Around 25 people did just that, with another 40 or more joining in online. They were all invited to submit their burning FHIR-related questions and share their views.

It was a lively, fast-moving, and inspiring session, as Grahame took us with him on his HL7 FHIR journey. We’ve summarized the key takeaways below.

How far have we got with FHIR?

Changing things in healthcare is a bit like turning round a tanker: it takes a long time. Ten years on, FHIR is still the new kid on the block, which means a lot of traveling, writing, and talking.

The drive to make healthcare interoperable means meeting real people in multiple countries and asking about their experiences and the obstacles they are experiencing.

Rolling out FHIR is a 15-year project. Five years to get it off the ground, five years of consolidation into a solid standard people are using, and then at least five years of further evolution. 

FHIR has a strong foothold in the USA, Germany, and the Netherlands, and is now gaining traction in the UK, Canada, South America, Japan, and India, with interest and enquiries coming in from governments and health authorities around the world.

What about the consensus model?

The model chosen to develop FHIR is based on consensus. There is a committed community of people working with and improving the standard, and HL7 puts a lot of emphasis on the FHIR working groups and connectathons that co-develop the standard.

FHIR works because it is practical, implementable, and the process is scalable. The community makes decisions, so the community believes in the decisions. This is far better than a company or a visionary individual calling all the shots. It’s persuasion-based, ground-up, democratic, and taps into the collective wisdom that’s out there.

It’s vital to keep nurturing an open community that’s responsive to all parties, and it’s great that chat.fhir.org continues to be so vibrant – with good questions, and good answers.

But we need to see the boundaries break down at the institutional level.

“Diagnostics are getting more expensive. More people are getting old. We have to get this right; we have to solve digital health.”

Grahame Grieve

How do we knock down the walls?

Care providers inevitably focus on what happens within the walls of their institution. But how can an organization be held responsible for what happens after the patient is discharged? Answer: it can’t. Imagine a patient leaves hospital, and 30 days later they’re admitted with the same condition to a second hospital, but the two can’t communicate. Who is responsible when and if things go wrong?

More interoperability means knocking down the walls of healthcare and opening up data silos: to start looking at things from the individual’s viewpoint and not from the perspective of institutions.

“When you speak to families about the healthcare they get, you quickly get into clinical hand-over issues. Healthcare systems should be able to deal with this, and they should be accountable.”

Grahame Grieve

What have been the pivotal moments for FHIR so far?

There have been three:

US vendors chose FHIR

At a meeting in the White House in 2014 some of the biggest vendors of Electronic Health Record systems in the USA were given two years to come up with a common API for patient data. It was a great moment when they came to HL7 and said, “We choose FHIR.”

The HL7 board adopted an open-source license 

FHIR started life as the ‘fresh look project’, with the taskforce briefed to ignore existing versions and ask themselves “what if we could start over again in the world of standards”. HL7 decided to follow the Creative Commons model, with an open-source license that removed legal barriers to adoption right from the start.

Apple got on board

When the computer giant issued a press release saying they were going to use FHIR as part of the iOS HealthKit framework for personal medical apps on its devices, this was nothing special from a technical perspective. But from a HealthTech point of view, it was huge. CEOs and COOs of hospitals suddenly saw that this thing was real, and wanted to be part of it.  

What’s the next big thing in FHIR?

After DevDays in 2019, Grahame, Dave deBronkart (aka ePatient Dave) and the HL7 and DevDays teams launched the Patient Empowerment Group.

When patients get access to their records, 80% of them find errors in the data. The Patient Empowerment Group is working on adjusting FHIR to enable data correction by patients and their families and advocates.  

It will be interesting to see how patients respond to their new role in improving healthcare.


Interested in hearing more about FHIR adoption in different countries? Be a ‘fly on the wall’ at our expert table-talk in Berlin: Discussing KHZG, ISiK and the 21st Century Cures Act over Dinner at DMEA 2022

To discuss your own FHIR implementation, please contact the Firely team.

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2 thoughts

  1. Chris Parker on said:

    Great article!

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