My View - International health information standards

VIEW - Peter Jordan, digital health applications architect and standards implementer

Peter Jordan attend the recent HL7 International Work Group Meeting in Madrid in May and the FHIR DevDays Conference in Amsterdam in June. 

The HL7® FHIR® standard was at the forefront of these recent events, after all it is now being used in nearly 100 countries, but it is only part of a complex landscape involving many organisations and jurisdictions. 

This was the first HL7 International meeting outside of the USA since the pandemic and attracted a truly global audience with an emphasis on HL7 standards development whereas the focus of DevDays – although similarly international in terms of participation - was principally dedicated to the evolution and implementation of HL7 FHIR.  Both events were full of positive energy and underpinned by worldwide challenges in improving healthcare outcomes via interoperability standards. 

Growing co-operation

It was hugely encouraging to see the growing co-operation between the various international standards development organisations (SDOs). This was evident in the positive outcomes from the joint 2-day openEHR & HL7: Converge or Collide symposium that preceded DevDays. These included agreement on creating and publishing openEHR Archetypes for domain/clinical analysis as part of HL7's development process which, it is suggested, might lead HISO to consider the (re)endorsement of openEHR for clinical information modelling within New Zealand 

Both events were attended by representatives of the Terminology Standards Organisations – notably SNOMED International and Regenstreif (LOINC®) – who presented work on the new LOINC Ontology and NUVA (Unified Nomenclature of Vaccines) extensions for SNOMED CT®. The collaborations are highly significant for New Zealand in providing a more consistent, manageable and implementable approach for the use of clinical terminology in our digital healthcare systems and, of course, by Generative AI. 

The International Patient Summary probably provides the best example of multiple SDO involvement and significant progress was made towards publishing version 2 of the related FHIR IPS Implementation Guide. There were also deep discussions about aligning national base and core FHIR implementation guides with IPS to facilitate a truly international framework for patient summaries, including local IPS derivations such as the New Zealand Patient Summary. 

A new release 

The principal goal of HL7 International at present is to ballot, refine and publish Release 6 (R6) of the HL7 FHIR Specification. This will contain ‘normative’ and stable resources only with the remainder moved out to separate Implementation Guides, along with HL7 Approved ‘Additional Resources’.  

This should provide both a definitive answer to those doubting FHIR’s maturity level and a means of extending the scope of FHIR without requiring regular version updates. There are potentially significant challenges for implementers in moving from existing versions to R6; however, these are being addressed, in plain sight, by the FHIR Core Team and common tooling community. 

The role of AI  

There were numerous presentations and discussions about AI and, notably, the role that it might play in standards development and implementation with a view to providing clear and trustworthy outcomes.  

Many products are already incorporating AI into their FHIR-based solutions, such as generating FHIR resources and completing FHIR questionnaires using voice recognition. However, the general feeling is that we have not yet scratched the surface of its full potential, but we should be aware that, ultimately, AI is a tool (although, potentially, a game-changing one) and its effectiveness depends on how it is used. 

A changing world 

The current geo-political landscape also generated a good deal of discussion. Although, thankfully, New Zealand is a long way removed from many of these issues, there is relevance in concerns such aas the location of cloud-based data and services, including AI-based solutions. How comfortable are we with the potential for overseas governments to access Kiwi data that is stored on their territory?  

Overseas regulatory regimes also impact local suppliers who operate in those markets as well as providing exemplars for the potential effectiveness of applying similar methods here to support the conformant, consistent and equitable use of information standards.  

The European Health Data Space is a health specific ecosystem comprised of rules, common standards and practices, infrastructures and a governance framework that, among its aims, is to empower individuals through increased digital access to and control of their electronic personal health data, at national level and EU-wide. A ‘space’ worth watching. 

Collaboration is key 

Both globally and locally, collaboration remains the key to driving exponential improvements in digital health and, consequently, healthcare outcomes.  

In my view, there is also no effective substitute for in-person participation at international meetings where everyone is together in one place and time zone, dedicated to achieving consensus-based solutions based on common goals and experiences.  

Our healthcare systems all share the same supply and demand related challenges: New Zealand must learn from the experiences of others, particularly regarding the percentage of overall healthcare spending that should be allocated to digital health. In this respect we are neither unique nor alone! 

 

Disclaimer: The opinions expressed in this article are purely personal and do not represent the views of my clients, HL7 New Zealand, HL7 International or generative AI. All related travelling and accommodation expenses were self-funded. 

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