My effort for this article was to do some research on past literature concerning data integration. My findings are not really surprising but are very predictive. Let’s look at a prediction from nine years ago by a leader in health data integration, Eliot Muir, CEO of Interfaceware. Eliot penned this as a comment to an article posted in 2011 concerning HL7 and data standards in general.
Complicated standards can be pushed for a while but ultimately markets reject them. Even governments will ultimately reject complicated standards, through a democratic correction process. Although they usually waste a fair amount of other people’s money along the way.
So back to HL7. Why was it successful?
Version 2.X of HL7 solved a very big problem for many people in healthcare IT back in the 90’s. It replaced a lot of adhoc data sharing mechanisms used in the industry at the time.
It is a lie when a vendor tries to claim they are “HL7 compliant”.
The term is meaningless.
The best any vendor can ever do is provide a stream of messages with fields that map adequately to most of the data from their application. HL7 interfaces always end up being a thin wrapper around the structure of the database of the application which feeds them. The standardization comes about because there are common ways of structuring a lot of the data. The pain comes from areas where it is unclear how to structure the data.”
He goes on.
“HL7 is working on creating the final solution for healthcare interoperability – the Reference Information Model (RIM) which underlies the structure of version 3 (v3) of HL7.
I think that effort is doomed to fail for these reasons:
- There is no such thing a single optimal data model to serve all purposes. A formal data model is always going be a square peg going into a round hole. Some problems are best solved by small simple models. There are approximations which work for certain problems but are not valid for others. If there was a single solution to everything then one person would invent it and the rest of us would be out of work.
- There is substantial academic criticism of RIM that points to the semantic inconsistency within the model itself.
- It is creating complicated standards which are expensive to implement.”
So was Eliot, right? He is still the CEO of the same company doing the same stuff in 2021, HL7 data integration. HE states, “Some problems are best solved by small simple models.” Thus comes FHIR and out goes the C-CDA.
However, I want to call foul on this notion of simplicity with the FHIR standard. The data structure is no better with XML, in my opinion. One aspect of this standard is FHIR Messaging, which is not simple, as it uses web services and SOAP envelopes. I do not see this as much different than the C-CDA implementations.
Even with the REST based FHIR exchange, there is a great deal of work to not only stand up the required infrastructure and attach it to your environments. You still have to map your data to those specifications and implement new data retention and access policies for the information.
I am going to make a statement similar to Eliot in that I am betting that the disparity will continue to exist in healthcare data standards for many years to come. However, FHIR gets us closer. The world of integration has never really been a technology problem. Let us help you focus on your business … we put out the FHIRs for you!
If you are ready to leverage your data in ways you never thought of, call us to INTEGRATE NOW!
At Vorro we are positioning our clients to successfully leverage the FHIR standard and to comply with the 21st Century Cures Act. This is the future of data exchange, and we are prepared to meet this need today and tomorrow. To learn more about Vorro and our complete portfolio of solutions visit https://vorro.net/.