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I Just Discovered FHIR exists ... Now What?

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Maybe you are a titan in the tech world branching out into healthcare.

You realize what a mess healthcare data is.

And you stumble across FHIR.

It looks like the solution to the health data mess.

But some subtle stumbling blocks I often see when you first find FHIR:

  1. EHR FHIR is only a small subset of the entirety of FHIR.
    1. If you look at https://hl7.org/fhir/R4/ your first reaction is "Wow ... it is all there"
    2. ... but if you look at https://fhir.cerner.com/millennium/r4/ or https://fhir.epic.com/ you think ... "What, only that? You mean I can't get MAR data from MedicationAdministration as it doesn't really exist in the real world?" Yup.
    3. Reason: Most EHRs only support USCDI V1 FHIR endpoints (see https://www.healthit.gov/isa/united-states-core-data-interoperability-uscdi).
    4. Take home: It is amazing it exists, but there is a difference between appearance and reality.
  2. EHR FHIR is different depending on whether the user is a patient, a provider (doctor/nurse/etc), or a headless system account:
    1. The following is from https://fhir.cerner.com/millennium/r4/clinical/diagnostics/observation/ ... and shows how important the user is.
    2. You could build an app that lets patients can search for their own. Observations (vital signs, lab results) ... but you can't create an app that lets patient add their own vital signs (like blood pressure from a home device) to the EHR.

... more lessons learned to come in other posts 😀 [or reach out to me at kevin at patient.dev]