To date, all signs suggest that the FHIR standard set has tremendous promise, and that FHIR adoption is growing by leaps and bounds. In fact, one well-connected developer I spoke with recently argues that FHIR will be integrated into ONC’s EHR certification standards by 2017, when MACRA demands its much ballyhooed “widespread interoperability.”
However, like any other new technology or standard, FHIR is susceptible to being over-hyped. And when the one suggesting that FHIR fandom is getting out of control is Grahame Grieve, FHIR product director, his arguments definitely deserve a listen.
In a recent blog post, Grieve notes that the Gartner hype cycle predicts that a new technology will keep generating enthusiasm until it hits the peak of inflated expectations. Only after falling into te trough of disillusionment and climbing the slope of enlightenment does it reach the plateau of productivity, the Gartner model suggests.
Now, a guy who’s driving FHIR’s development could be forgiven for sucking up the praise and excitement around the emerging standard and enjoying the moment. Instead, though, it seems that Grieve thinks people are getting ahead of themselves.
To his way of thinking, the rate of hype speech around FHIR continues to expand. As he sees it, people are “[making] wildly inflated claims about what is possible, (wilfully) misunderstanding the limitations of the technology, and evangelizing the technology for all sorts of ill judged applications.”
As Grieve sees it, the biggest cloud of smoke around FHIR is that it will “solve interoperability.” And, he flatly states, it’s not going to do that, and can’t:
FHIR is two things: a technology, and a culture. I’m proud of both of those things…But people who think that [interoperability] will be solved anytime soon don’t understand the constraints we work under…We have severely limited ability to standardise the practice of healthcare or medicine. We just have to accept them as they are. So we can’t provide prescriptive information models. We can’t force vendors or institutions to do things the same way. We can’t force them to share particular kinds of information at particular times. All we can do is describe a common way to do it, if people want to do it.
The reality is that while FHIR works as a means of sharing information out of an EHR, it can’t force different stakeholders (such as departments, vendors or governments) to cooperate successfully on sharing data, he notes. So while the FHIR culture can help get things done, the FHIR standard — like other standards efforts — is just a tool.
To be sure, FHIR seems to have legs, and efforts like the Argonaut Project — which is working to develop a first-generation FHIR-based API and Core Data Services specification — are likely to keep moving full steam ahead.
But as Grieve sees it, it’s important to keep the pace of FHIR work deliberate and keep fundamentals like solid processes and well-tested specifications in mind: “If we can get that right — and it’s a work in process — then the trough of despair won’t be as deep as it might.”