At a regional DFW HIMSS  CIO roundtable discussion, the topic of standards came up with regards to the impact they could or should have on healthcare IT. Pam McNutt , Sr VP & CIO at Methodist Health System, started the conversation by arguing for stronger standards when sharing data among facilities. As a proof point, she pointed to the rigor that Epic tries to maintain with providers that install their software. It is because of this rigor that Epic facilities have an easier time sharing data with each other.
Kirk Kirksey , CIO at UT Southwestern Medical Center at Dallas, then cautioned that standards can be limiting as well. He pointed to a Russian car manufacturer that had strict standards on changing parts from year to year. While this is an auto mechanics dream, it does not foster creativity or innovation and thus technology can become stagnant for the sake of standards.
So which is it? Does healthcare need stricter or looser standards?
It is often said that when you’ve seen one HL7 V2 message , you’ve seen one. This points to the variability that is allowed within the structure of an HL7 is a Standards Developing Organization accredited by the American National Standards Institute (ANSI) to author consensus-based standards representing a board view from healthcare system stakeholders. HL7 has compiled a collection of message form... V2 message. There have been efforts in healthcare to constrain this variability. For example, when sending immunization data for Meaningful Use, one must comply with the HL7 2.5.1 Implementation Guide for Immunization Messaging while using the HL7 Standard Code Set CVX vocabulary standard. This constraint of the standard provides more consistent data transfer for immunizations, but the reporting of immunizations is a simple and repeatable workflow that is the same for most parties doing this. On the other hand, can such rigor be applied to healthcare workflows that vary more widely from facility to facility?
The HL7 organization tried to deliver a more “real” standard with HL7 V3. It was supposed to be the replacement for HL7 V2 and touted more consistency and rigor. However, because the standard tried to apply this consistency across so many workflows, the standard evolved into something so complex that it was very hard for the user to navigate. And thus, really never took hold in the United States, other than the Clinical Document Architecture (CDA) HL7 CDA uses XML for encoding of the documents and breaks down the document in generic, unnamed, and non-templated sections. Documents can include discharge summaries, progress notes, history and physical reports,... documents that were mandated by Meaningful Use.
With all this in mind, HL7 FHIR  has emerged onto the scene the past couple of years. FHIR stands for Fast Healthcare Interoperable Resource. This emerging standard combines the best features of HL7 V2, HL7 V3, and CDA, while leveraging the latest web service technologies. The design of FHIR is based on RESTful web services. With REST..., while still a draft standard, has achieved high expectations for what it might be able to accomplish. Part of this hope is based on the concept of providing a certain amount of rigor through profiles for 80% of the healthcare workflows, while providing an easy way to extend the standard for other necessary workflows. This combination would give health care exactly what it needs – the rigor that Pam wants to connect with other facilities while not trapping creativity in a box as Kirk voiced concerns about.
In the United States, organizations are actively working on HL7 FHIR profiles through the HL7 Argonaut  project. These profiles will provide the rigor we need to Make America Great Again, while still leaving extensibility in the standard for innovation and creativity. HL7 An HL7 standard that is short for Fast Healthcare Interoperability Resources and pronounced “Fire”. The standard defines a set of “Resources” that represent granular clinical concepts. The resources provide flexibility for a range of healthca... is the HL7 organization’s third big attempt at a core standard. It will probably be a few more years before we know whether the third time is a charm. But, to answer the title of the blog: healthcare needs both.